Government of Bihar | बिहार सरकार
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Service Coverage

Inclusions Exclusions
1393 treatment packages Out-patient care
Family deductible bucket of INR 5,00,000 Individual diagnostics (for evaluation)
Secondary & Tertiary care IP services + day care procedures Drug rehabilitation programs
Pre-existing conditions Cosmetic related
New born care Assisted reproduction
Provision to cover ‘unspecified surgical conditions’, on pre-authorization up to a limit of INR 1,00,000 Organ Transplant

Hospital Pricing under PM-JAY

  • Under the scheme hospitals are paid based on the package rate
  • Package rate includes all the cost associated with the treatment including
    • Medicines, Diagnostics, Consultations
    • Implants, Pre-hospitalisation and Post hospitalisation cost
  • Hospitals are not allowed to charge anything else other than the package rates from the hospitals
  • These rates have been prepared by the Government and same rates are paid to public or private hospitals

Medical Packages add-ons

End to end coverage for entire episode of care
  • Medical examination, treatment, and consultation
  • Pre-hospitalization (3 days)
  • Medicine and medical consumables
  • ICU services
  • Diagnostic and laboratory investigations
  • Medical implant services (where necessary)
  • Accommodation benefits, Food services
  • Complications arising during treatment
  • Post-hospitalization medicines (up to max.15 days)

Medical Packages add-ons

  • Special investigation packages on pre-auth capped at 5000 per family per annum linked as an add-on to medical packages:
    • High end radiological diagnostic (CT, MRI, imaging including nuclear imaging)
    • High end histopathology (biopsy) and advanced serology investigations
  • Blood or Blood components transfusion on pre-authorization
  • Neo-natal medical packages have maximum ceiling limits on package amounts and pre-authorization requirement after certain days