Every week, patients walk into Global Eye Hospital holding an Ayushman Bharat card and the same question: “Doctor, kinni treatment is scheme de under free hai?” It’s a fair question — and a confusing one, because Punjab actually runs two overlapping government health-cover systems, and the answer changes depending on which eye problem you have. This guide breaks down, in plain terms, what Ayushman Bharat and Punjab’s state scheme cover in ophthalmology, what they don’t, and what a private hospital like ours can still do for cardholders when a procedure falls outside the scheme.
Quick summary: Cataract, glaucoma, corneal, squint and retina surgeries are covered under the government schemes at empanelled hospitals. LASIK and other pure vision-correction laser procedures (SMILE, SILK, CLEAR, Contoura) are not — not because Punjab has a special restriction, but because the central Health Benefit Package classifies them as elective across all of India. Private health insurance is a separate route, and it can cover refractive surgery, but only above a specific threshold set by the insurance regulator.
Two Schemes, One Card: How Ayushman Bharat Works in Punjab
Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the Central Government’s cashless hospitalisation scheme, built around a master list of pre-priced treatment “packages” set by the National Health Authority (NHA). Historically it covered only families identified in the 2011 Socio-Economic Caste Census, offering ₹5 lakh of family-floater cover a year at empanelled government and private hospitals.
Punjab layered its own scheme on top of this from 2019 — the Sarbat Sehat Bima Yojana (SSBY) — to bring in groups PM-JAY left out: Smart Ration Card families, J-form farmers, small traders, construction workers and journalists. In January 2026, the state folded SSBY into a single, universal programme called the Mukh Mantri Sehat Yojana (MMSY), run by the State Health Agency, Punjab (SHA Punjab). MMSY:
- Covers every bona fide Punjab resident, with no income ceiling, category restriction or age limit.
- Provides ₹10 lakh of cashless cover per family per year, on a floater basis (Central PM-JAY families get their first ₹5 lakh nationally portable, topped up by the state).
- Operates through the same unified health card for both the central and state components, at government hospitals and roughly 800–900 empanelled private hospitals across Punjab and Chandigarh.
- Follows the same national package list the NHA uses for PM-JAY, plus additional state-specific packages Punjab has added on top.
That last point matters for this article: it’s why what’s covered for an eye patient in Patiala is, package-for-package, almost identical to what’s covered in Delhi or Nagpur — Punjab hasn’t written its own separate rulebook for ophthalmology. The differences are in eligibility and funding, not in which surgeries qualify.
What Eye Treatment Is Actually Covered
Ophthalmology is one of PM-JAY/MMSY’s higher-volume specialties nationally, and cataract surgery in particular is consistently the single most-used package under the entire scheme. The procedures classified as medically necessary — and therefore covered at Government Empanelled hospitals — include:
- Cataract surgery (phacoemulsification or SICS with intraocular lens implantation) — by far the most common claim
- Glaucoma surgery, including trabeculectomy and related pressure-lowering procedures
- Pterygium excision
- Dacryocystorhinostomy (DCR) for blocked tear ducts
- Squint (strabismus) correction surgery
- Corneal transplant (keratoplasty), for corneal scarring or disease
- Vitreoretinal surgery, including surgery for retinal detachment and related conditions
So, to directly answer the question we’re asked most often: Standard cataract is covered in government-empaneled hospitals, and so is retina surgery — the scheme is not retina-only. The government’s underlying logic for what qualifies is consistent across every specialty: a condition is covered when it threatens vision or function and surgery is the medically necessary route, regardless of which part of the eye is involved.
Package amounts are fixed and all-inclusive — surgery, IOL (up to the standard lens allowance), bed, medication and the standard pre- and post-operative window are bundled into one rate that the hospital cannot bill above. If a family chooses a premium IOL or a technology upgrade beyond what the package allows, that difference is payable separately — this is standard across every empanelled hospital in India, not a Global Eye Hospital-specific charge.
Free Cataract Surgery with standard lenses:
Beyond the Ayushman Scheme: Free Cataract Camps at Global Eye Hospital, right after the “what we do for cardholders” part, plus a matching FAQ entry. It covers:
We at the Global eye Hopsital Patiala regularlay organized Free/heavily subsidised eye camps run alongside government programs, NGOs and our CSR partners. We cover
- Zero-cost surgery for deserving disabled and economically vulnerable patients, independent of whether they hold an Ayushman/MMSY card
- Surgery + post-op care + eyewear + medicines all free for qualifying beneficiaries
- Framed as a parallel route, not a replacement for the scheme-based coverage already covered in the article
Where the Coverage Stops: LASIK and Refractive Surgery
This is the part that surprises most patients: Ayushman Bharat and MMSY do not cover LASIK, SMILE, SILK, CLEAR, Contoura or any other laser vision-correction procedure, in Punjab or anywhere else in India.
The reasoning is consistent across the scheme’s rules: refractive errors like myopia, hyperopia and astigmatism are considered correctable by glasses or contact lenses, which makes laser correction an elective, lifestyle procedure in the scheme’s eyes rather than a vision-threatening one — even though the actual surgery and its outcomes are exactly as advanced. This isn’t a Punjab-specific restriction, and it isn’t something Global Eye Hospital or any other empanelled hospital can override locally — it’s set centrally in the NHA’s Health Benefit Package that both PM-JAY and MMSY draw from.
One narrow exception exists: if a refractive error is the result of an injury, trauma, or a complication of an earlier eye surgery — rather than a naturally occurring prescription — it can sometimes be assessed differently. This is decided case by case with supporting medical records, not something a patient can assume applies to them.
Does Private Insurance Cover LASIK? The 7.5-Diopter Rule
Separate from any government scheme, patients with private health insurance have a real, regulator-backed path to coverage that most people don’t know about. The Insurance Regulatory and Development Authority of India (IRDAI) standardised health insurance exclusions in 2019, and “Exclusion 15” specifically addresses refractive error correction: insurers may exclude LASIK-type treatment only when the refractive error is below 7.5 dioptres. Above that threshold, the surgery is treated as medically necessary and insurers are expected to cover it, subject to the individual policy’s waiting period (commonly around 24 months) and standard documentation.
Coverage under this rule can also apply regardless of the 7.5D threshold when the refractive error followed an eye injury, developed after another surgery, or where a physical condition makes glasses or contact lenses genuinely unworkable.
In short: government scheme cardholders should not expect LASIK coverage under Ayushman Bharat or MMSY, but a patient with private Mediclaim and a high enough prescription may have a legitimate insurance claim worth checking before assuming the full cost is out of pocket.
What Global Eye Hospital Does for Ayushman/MMSY Cardholders
Being an NABH-accredited hospital in Patiala, we work with cardholders in both directions — for the procedures the scheme covers, and for the ones it doesn’t:
- For covered procedures (glaucoma, DCR, squint, corneal, retina): our team handles the pre-authorization paperwork with SHA Punjab directly, so the patient isn’t left chasing approvals between departments.
- Documentation support: we help first-time cardholders who haven’t yet linked their Aadhaar-based health card, or whose MMSY registration needs updating after the SSBY-to-MMSY transition.
- EMI provisions: for any surgery, component not covered by the package — a premium IOL upgrade during cataract surgery, or an elective procedure like LASIK/SMILE/CLEAR that falls outside the scheme entirely — we offer structured EMI options so cost isn’t a barrier to timely treatment.
- Private insurance verification: for patients considering refractive surgery, our team can check whether their existing Mediclaim policy is likely to qualify under the IRDAI threshold before they commit to a treatment plan.
We’d rather a patient know exactly what’s covered, what isn’t, and what their options are for the gap — before the day of surgery, not after.
Frequently Asked Questions for Ayushman and Eye surgeries in Punjab
Yes. Cataract surgery with a standard IOL is a defined, cashless package at Government hospitals/empanelled hospitals for eligible MMSY/PM-JAY cardholders. Premium IOLsor Lens upgrades — such as a premium or multifocal lens beyond the standard allowance — are charged separately.
Both. Vitreoretinal surgery, including treatment for retinal detachment, is on the covered package list alongside cataract, glaucoma, corneal and squint procedures.
Both. Vitreoretinal surgery, including treatment for retinal detachment, is on the covered package list alongside cataract, glaucoma, corneal and squint procedures.
Eligibility is assessed case by case by the hospital and the sponsoring government programme, NGO or CSR partner, generally based on disability status and economic need. It isn’t tied to holding (or not holding) an Ayushman/MMSY card — a patient can qualify for a free camp even if they’re already covered under the scheme, and vice versa.
For qualifying beneficiaries, the camp covers the full episode of care — the cataract surgery itself, the intraocular lens, post-operative check-ups, prescribed eyewear and medicines — not just the surgical fee.
No.LASIK and similar refractive procedures are classified as elective across India’s Health Benefit Package and are excluded from both PM-JAY and MMSY, regardless of which empanelled hospital you visit.
No — Punjab’s MMSY uses the same central package list as PM-JAY, so the exclusion applies the same way. The only exceptions are refractive errors caused by injury or a prior surgery, assessed case by case.
Possibly. Under IRDAI’s standardised exclusion rules, insurers may decline refractive surgery cover only if the error is below 7.5 dioptres. Above that, or where injury/post-surgical causes apply, it can be a valid claim — check your specific policy wording and waiting period.
Yes. We offer EMI plans for any procedure or upgrade outside scheme coverage, and our team will check your private insurance eligibility before you decide on treatment.
In some cases,yes .However, cashless treatment is available at any empanelled private hospital, including NABH-accredited hospitals like Global Eye Hospital, Patiala
IMPORTANT
Scheme rules, coverage amounts, and empanelment lists are set and periodically revised by the National Health Authority and the State Health Agency, Punjab, and can change. Patients are advised to confirm current eligibility and package details with SHA Punjab or our hospital’s insurance desk before planning treatment.
For an Ayushman Bharat / MMSY eligibility /Free Eye camps check or a consultation, visit Global Eye Hospital, S.S.T Nagar, Rajpura Road, Patiala, or call +91 99886 61075