Sri Vijaya Puram, Sept. 4: For islanders who have to leave the Andaman and Nicobar Islands for specialised medical treatment, the cost of reaching a mainland hospital can often become an additional burden on top of the illness itself. Air tickets, ship fares, local transport and loss of income during treatment can quickly add up.
Now, revised guidelines under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) seek to ease some of that financial burden by laying down clear provisions for patient referrals, travel reimbursement and compensation for loss of wages.
Issued with the approval of the competent authority and concurrence of the Finance Department of the Andaman and Nicobar Administration, the new guidelines will come into force from August 1, 2026. They supersede the earlier guidelines issued in June 2023.
For eligible island beneficiaries, the rules essentially answer a question that matters greatly when a serious illness requires mainland treatment: How much of the cost of getting there and staying there for treatment can be supported by the scheme?
Who is covered?
The guidelines cover SECC, Vay Vandana Scheme (VVS), ASHA, Anganwadi Workers (AWW), Anganwadi Helpers (AWH), Building and Other Construction Workers (BoCW) and Non-SECC beneficiaries under AB-PMJAY.
The scheme provides eligible beneficiaries with cashless treatment of up to ₹5 lakh per family per year at empanelled hospitals on the mainland.
The guidelines also provide for reimbursement of eligible travel expenses and compensation for loss of wages when the patient is officially referred for treatment.
The earlier Andaman & Nicobar Islands Scheme for Health Insurance (ANISHI) was discontinued from June 30, 2020, and merged with AB-PMJAY. Under the merged arrangement, former ANISHI beneficiaries are treated as Non-SECC beneficiaries.
First rule: You need an official referral
For a patient to claim travel reimbursement and wage-loss compensation, the journey cannot simply be a personal decision to seek treatment outside the islands.
The patient must first be referred by the concerned specialist at G.B. Pant Hospital, Sri Vijaya Puram, with the referral endorsed by the Head of the respective department.
The specialist will recommend how the patient should travel — by ship, by air in a sitting position or by air as a stretcher case.
The referral case sheet must then be approved by the Medical Superintendent of G.B. Pant Hospital and the Director of Health Services.
Once approved, the Director of Health Services will issue the official referral letter that the patient will carry to an empanelled AB-PMJAY hospital on the mainland.
In simple terms, getting the referral before travelling is crucial if the patient wants to claim travel and wage-loss benefits later.
What happens if you go to the mainland on your own?
This is one of the most important clarifications in the new guidelines.
If an AB-PMJAY beneficiary happens to fall ill while visiting the mainland, or independently travels to the mainland for treatment without being referred by the Directorate of Health Services, the person can still receive cashless treatment at an empanelled hospital under AB-PMJAY.
But there is a catch.
The cost of travel and compensation for loss of wages will not be reimbursed in such cases.
So, while AB-PMJAY treatment remains available, the additional travel-related benefits are linked to the official referral process.
Up to ₹40,000 for regular travel
For patients officially referred by ship or by air in a sitting position, the Administration has fixed a reimbursement ceiling of ₹40,000 for the patient and one attendant for the onward and return journey.
The amount payable will be ₹40,000 or the actual eligible ship/air fare, whichever is lower.
If travelling by air, the patient must travel in economy class.
The guidelines also specify that air tickets should normally be purchased through government-approved authorised agents, Balmer Lawrie & Company Limited, Ashok Travels and Tours or IRCTC.
However, in unavoidable circumstances, if a ticket has been booked through an unauthorised agent or website, the CEO, State Health Agency can grant relaxation.
Stretcher patients get a different benefit
For critically ill patients who cannot travel in a sitting position, the rules are considerably different.
Where a patient is referred as a stretcher case by air, the State Health Agency will arrange the patient’s ticket and that of one attendant for the onward journey.
If the treating doctor on the mainland determines that the patient must return by air as a stretcher case, the State Health Agency will similarly arrange the return journey.
Most importantly, there is no ₹40,000 cap for stretcher cases.
This is significant because stretcher travel by air can be substantially more expensive than a normal economy-class ticket.
If a stretcher patient has to purchase the ticket independently due to unavoidable circumstances, reimbursement may also be permitted after submission of the required documents and approval by the CEO, State Health Agency.
Airport-to-hospital travel also covered
The journey does not end when the patient lands on the mainland.
Recognising the cost of travelling from an airport or harbour to the hospital, the guidelines allow an additional reimbursement of up to ₹3,000, or the actual ambulance/cab cost, whichever is lower.
But patients will have to produce bills or vouchers for the expense.
This means that a patient travelling from the islands should carefully preserve every ticket, boarding pass, hospital document and local transport receipt.
Losing wages? You can claim compensation too
For many island families, medical treatment on the mainland comes with another hidden cost – loss of income.
The revised guidelines provide compensation of ₹1,000 per day for eligible wage loss.
For an inpatient, the compensation is calculated from the date of admission to the date of discharge, subject to a maximum of 20 days.
That means a patient could receive up to ₹20,000 towards wage-loss compensation if the eligible treatment period extends to 20 days.
A discharge document showing the admission and discharge dates must be submitted.
The benefit also extends to patients treated on an outpatient basis. In such cases, the eligible period is calculated from the first outpatient visit to the last visit for consultation, investigation or treatment, again subject to a maximum of 20 days for treatment of a particular illness.
The wage-loss benefit is available to both SECC/VVS/ASHA/AWW/AWH/BoCW beneficiaries and Non-SECC beneficiaries.
One important calculation to remember
For patients travelling by ship or by air in a sitting position, the combined reimbursement towards transport and wage-loss compensation is capped at ₹40,000, or the actual eligible amount, whichever is lower.
However, this ceiling does not apply to patients referred by air as stretcher cases.
So, for a regular referral, the ₹40,000 limit is not simply a travel allowance, it covers the applicable transport reimbursement and wage-loss compensation together.
Don’t miss the 60-day deadline
After returning to Sri Vijaya Puram, beneficiaries have 60 days from the date of their return journey to submit their claim.
The claim must be submitted to the AB-PMJAY Nodal Cell along with the required documents, including:
- Original ship or air tickets and boarding passes of the patient and attendant;
- Referral letter issued by the Director of Health Services;
- Bank passbook details;
- Aadhaar copies of the patient and attendant;
- AB-PMJAY e-Card;
- Discharge summary or OPD slip; and
- Ambulance/cab receipts, wherever applicable.
For minors, the bank account of either parent or a legal guardian can be used if the child does not have a bank account.
What this means for an island family
The revised rules do not eliminate every expense associated with mainland treatment. But they provide a clearer mechanism through which eligible beneficiaries can receive financial support for the journey, local transportation and loss of income.
For an island family facing the uncertainty of a serious illness, knowing before travelling what is covered, what documents are required and what limits apply can make a significant difference.
The biggest takeaway is simple: if mainland treatment is medically required, get the official referral first, keep every travel and hospital document, and submit the claim within 60 days of returning to Sri Vijaya Puram.
The revised AB-PMJAY guidelines are therefore not merely an administrative update. For patients who have no choice but to cross the sea for specialised healthcare, it could mean one less financial worry at a time when the focus should be on getting well.
