The Ayushman Bharat Yojana has emerged as a relief scheme for poor families. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is considered one of the largest health schemes in the country. The scheme's primary objective is to protect economically weaker families from the financial burden of expensive medical treatment. Under this initiative, eligible families are provided with cashless medical treatment up to ₹5 lakh per year. This scheme is especially helpful in cases of serious illnesses and hospitalization. The scheme can be availed at both government hospitals and private hospitals affiliated with the scheme. However, despite the scheme's vast scope, it has certain limitations; let's understand what these limitations include.

OPD and Routine Diagnostic Tests
Many people think that once they have an Ayushman Card, every visit to a doctor is completely free; however, this is not true. The scheme prioritizes only treatments that require hospitalization. If a person goes for a consultation only and is not admitted to a hospital, the OPD expenses associated with that visit are not covered. Similarly, the cost of diagnostic tests alone is also not covered under the scheme; however, if the doctor has stated that certain tests are necessary during the patient's treatment while hospitalized, the situation may be different. Because of this, patients often have to pay some out-of-pocket expenses upon reaching the hospital.

Vitamins, tonics, and regular medicines are not covered
The primary objective of the Ayushman Yojana is to provide financial assistance for critical illnesses and essential medical treatment. Therefore, the cost of vitamins, tonics, and supplements, which are primarily used to treat general weakness, fatigue, or improve overall health, is not covered under the scheme. However, if a doctor deems it necessary to prescribe these medicines during the treatment of a serious illness or injury, the situation may be different. According to experts, the scheme is primarily designed to cover the cost of life-saving treatment and specialized medical treatments provided in hospitals; therefore, routine medications used daily are not covered under the scheme.

Benefits like routine dental treatment and IVF
The scheme does not cover the cost of routine dental cleaning, cavity filling, or general dental check-ups. Dental treatment is covered only in cases of serious accidents, jaw injuries, or serious illnesses like tumors or cysts. Furthermore, IVF and other assisted reproductive technology treatments are not included in the scheme. Procedures like cosmetic surgery, tattoo removal, weight loss surgery, and neck lifts are also not included in the list of free treatments. The government believes that the main focus of the scheme should be on essential and necessary healthcare services; therefore, cosmetic or elective procedures are not included.

Who can get the Ayushman Card?
This scheme is specifically designed for the economically weaker sections of society. Therefore, not everyone is eligible for this scheme. Government employees, income tax paying citizens, ESIC beneficiaries, and those working in the organized sector whose provident fund money is deducted are generally not included in this scheme. According to experts, before starting medical treatment, it is very important to understand in detail which expenses are covered under this scheme and which are not. Doing so helps avoid future financial stress and confusion. As the scope of health schemes is expanding, 'correct information' is being considered the biggest security.

PC: Navarastra