The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is India’s largest health insurance scheme, providing free medical treatment up to ₹5 lakh per year for poor and vulnerable families. It covers hospital expenses for major illnesses and surgeries.
Recently, the scheme has been approved for implementation in Delhi, and eligible people will soon be able to apply for the Ayushman Card. However, before using this card for treatment, it is important to know which medical expenses are not covered under this scheme.
While Ayushman Bharat covers most hospitalization costs, there are some exclusions. Here is a complete list of treatments that are not included in the scheme.
No Coverage for OPD Consultations and Routine Checkups
One of the biggest limitations of the Ayushman Card is that it does not cover OPD (Outpatient Department) expenses. This means that if you visit a private hospital for a general consultation, you will have to pay the doctor’s fees yourself.
Only treatments that require hospitalization are covered under this scheme. If your illness can be treated without hospital admission, you will not get any financial support from Ayushman Bharat.
Diagnostic Tests Without Hospitalization Not Covered
Medical tests such as blood tests, X-rays, CT scans, and MRI scans are covered under Ayushman Bharat only if they are part of a hospitalization process.
If you go to a diagnostic center just for a health checkup, you will have to pay from your own pocket. Even if a doctor prescribes tests before admission or after discharge, they are included. But if you are admitted only for tests, then the scheme does not cover those costs.
No Coverage for Vitamins and Health Supplements
Ayushman Bharat does not cover expenses for general health supplements, tonics, or vitamins unless they are medically necessary.
If a doctor prescribes these supplements as part of a treatment plan, and they are essential for recovery, then they may be covered. Otherwise, you will need to buy them yourself.
Dental Treatments Not Covered
Dental care is not included in the Ayushman Bharat scheme unless it is related to a major medical condition or an accident.
Here are some common dental treatments that are not covered under Ayushman Bharat:
- Routine tooth extraction
- Root Canal Treatment (RCT)
- Cavity fillings
- Gum disease treatments
- Dental prosthetics (crowns, dentures)
- Teeth whitening or cosmetic dental procedures
However, if a dental surgery is needed due to an accident, tumor, or serious infection, then the cost may be covered under the scheme.
IVF and Infertility Treatments Not Covered
If a couple is facing difficulty in conceiving, Ayushman Bharat does not cover expenses related to In-Vitro Fertilization (IVF) or any Assisted Reproductive Techniques (ART).
Couples seeking fertility treatments will have to bear the entire cost themselves, as these procedures are not considered essential medical treatments under the scheme.
Cosmetic and Weight Loss Surgeries Not Covered
Ayushman Bharat does not cover cosmetic surgeries performed for improving appearance. These include:
- Anti-aging surgeries
- Liposuction (fat removal surgery)
- Botox or wrinkle treatment
- Tattoo removal
- Neck lift or face-lift surgeries
- Breast implants or reduction surgeries
However, if a reconstructive surgery is medically necessary after an accident, burns, or disease, then it may be covered.
Vaccinations and Immunizations Not Covered
Routine vaccinations like flu shots, hepatitis vaccines, or childhood immunizations are not covered under Ayushman Bharat.
Vaccines are available at government health centers for free, but if you get them from private hospitals, you will have to pay for them yourself.
Circumcision for Children Below 2 Years Not Covered
If a baby needs circumcision for religious or personal reasons, the cost is not covered under Ayushman Bharat.
However, if circumcision is necessary due to a medical condition, then it may be included in the scheme.
Surgeries for Lifestyle and Personal Choice Not Covered
There are some surgeries that people undergo for personal or lifestyle reasons, which are not included in the Ayushman Bharat scheme. These include:
- Hair transplant
- Laser eye surgery (LASIK)
- Nose reshaping (Rhinoplasty)
- Gender change surgery
- Breast enhancement or reduction
- Ear or nose correction surgery
If these surgeries are performed due to medical emergencies, then they may be covered.
When Will Ayushman Bharat Be Implemented in Delhi?
Although the BJP government has approved Ayushman Bharat for Delhi, the scheme is not yet operational in the capital. Officials have stated that new documents are required, and the process was delayed due to Holi celebrations.
It is expected that the scheme will be officially launched on April 10, and after that, people can start applying for the Ayushman Card in Delhi.
Check the Full Exclusion List of Ayushman Bharat
For a detailed list of all treatments not covered under this scheme, you can check the PMJAY Exclusion Policy on the official website.
Before using your Ayushman Card, it is important to understand what is covered and what is not, so you can plan your medical expenses accordingly.
