Ayushman Card Treatment Limit: Know This Before You Go for Treatment

Ayushman Card Treatment Limit: Know This Before You Go for Treatment – Max Bill, Conditions & Approval Process Newspoint | 10/06/2025 03:39:13

If you're planning to get medical treatment using the Ayushman Bharat Health Card, it’s important to first understand the treatment cost limits and guidelines. While the treatment coverage limit under the scheme is ₹5 lakh in most states, it is ₹10 lakh in Delhi. However, that doesn't mean you can avail free treatment up to that amount without restrictions.

🏥 Over 1,900 Treatments Covered Under Ayushman Bharat Scheme

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) offers cashless treatment for over 1,900 procedures. The National Health Authority (NHA) has created a Health Benefit Package 2.2, which defines:

What treatments are covered
What aren’t included
Fixed rates for each procedure

This ensures transparency and prevents misuse.

📋 Every Procedure Has a Predefined Rate

The NHA has released a comprehensive rate list, which includes treatment packages starting from ₹1,000 up to ₹2.25 lakh. These rates are pre-approved, making the treatment process smoother. You can:

Check the rate list at the hospital
Or view it online under the Ayushman Package List

❗ What If Your Treatment Isn’t Listed?

If the treatment you need isn't in the predefined package list, it is categorized as an "Unspecified Procedure". In such cases:

You are eligible for cashless treatment up to ₹1 lakh
Only applicable for surgical treatments
Approval is required for treatment beyond this limit

🛑 Conditions Apply for Treatment Above ₹1 Lakh

If your treatment exceeds ₹1 lakh under the Unspecified Procedure category:

A request must be submitted by the hospital (EHCP/NHCP).

This request is first reviewed by the State Health Authority (SHA).

Then, it is forwarded to the National Health Authority (NHA).

Approval is given only in critical or urgent situations.

This entire process takes a maximum of 48 hours.

✅ Key Points to Remember

Delhi residents can avail up to ₹10 lakh under the Ayushman Card
Treatment is not entirely free without conditions
Only listed procedures are covered by default
For unlisted treatments, a cap of ₹1 lakh applies (with conditions)
Pre-approval is mandatory for treatment above ₹1 lakh

🔍 Common Queries

Q1. Is Ayushman Card valid in Delhi hospitals?

Yes, and Delhi offers a higher coverage limit of ₹10 lakh.

Q2. What is the treatment cost limit without prior approval?
Up to ₹1 lakh, only for surgical procedures.

Q3. Can approval be taken for treatment over ₹1 lakh?
Yes, with pre-approval from SHA and NHA within 48 hours.

Q4. Are all diseases covered under Ayushman Bharat?
No. Only those listed in the Health Benefit Package 2.2 are covered.

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