Under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), I have been advised hospitalization for fistula treatment. Will I be eligible for a separate single room during treatment?

Under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), I have been advised hospitalization for fistula treatment. Will I be eligible for a separate single room during treatment?

I have been advised hospitalization for fistula. Will I be eligible for a separate single room under Ayushman?”Under the Ayushman Bharat - Pradhan Mantri Jan ArogyaYojana (AB-PMJAY), also known as Ayushman Bharat, hospitalization for conditions like fistula (such as anal fistula surgery, which falls under general surgery or related packages) is covered on a cashless basis at empanelled public and private hospitals, up to ₹5 lakh per family per year (for eligible beneficiaries).

However, regarding a separate single room (private/single occupancy room):

The scheme includes accommodation benefits as part of the fixed package rates, but it typically covers general ward (shared/multi-bed) or standard/semi-private rooms, depending on the hospital type and the specific treatment package.

Private or deluxe single rooms are not automatically covered under the standard entitlements. Hospitals are required to follow government-fixed rates for room categories (e.g., general ward around ₹1,800/day, higher for HDU/ICU), and the package rate includes bed charges accordingly.

If you opt for a separate single/private room (beyond what's included in the package), you may have to pay the extra/differential cost out-of-pocket. The scheme's purpose is to provide essential, quality care without luxury add-ons being fully covered.

In many empanelled private hospitals, semi-private or standard rooms may be provided as per the package norms, but exclusive single rooms often involve additional charges. In government hospitals, it's usually general wards or shared facilities (though some states encourage preferential treatment for beneficiaries).

Fistula treatment (e.g., fistula-in-ano surgery) is generally covered under general surgery packages, including hospitalization, surgery, medicines, and related costs.

For your specific case:

Eligibility for the scheme itself depends on whether you hold a valid Ayushman card (based on SECC-2011 criteria or state expansions).

Room allocation depends on hospital policy, availability, medical need (e.g., if isolation is required), and the package.

It's best to check directly with the empanelled hospital where you're advised for admission (ask the Arogyamitra or beneficiary help desk there) or contact the Ayushman Bharat helpline (14555 or 1800-111-565) for clarification on your package and room entitlements. You can also verify on the official portal (pmjay.gov.in) by entering your details.

This ensures you get accurate, location-specific info (e.g., Delhi hospitals may have slight variations in implementation). Wishing you a smooth recovery!