About the PMJAY Referral System in Sikkim
The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is a vital healthcare initiative in Sikkim, designed to provide comprehensive medical protection to its citizens amidst the state's challenging Himalayan geography. The scheme offers a robust cashless health cover of up to ₹5 lakh per family per year, ensuring that vulnerable families can access quality secondary and tertiary care without financial hardship.
This detailed 2025 guide provides the official list of all PMJAY empanelled hospitals in Sikkim and explains the state's structured referral system. Beneficiaries across all districts—East Sikkim (Gangtok), West Sikkim, South Sikkim, and North Sikkim—can avail benefits at local hospitals, the state's premier medical institution, and even super-speciality hospitals outside the state.
Healthcare in Sikkim: The PMJAY Referral Pathway
Healthcare delivery in Sikkim under PMJAY follows a structured referral system to ensure patients receive the most appropriate level of care:
- Level 1: Primary and District-Level Care: Initial consultation and treatment for most common ailments are provided at the local Primary Health Centres (PHCs) and District Hospitals. These facilities are the first point of contact for beneficiaries.
- Level 2: State-Level Tertiary Care: For serious conditions requiring advanced diagnostics or specialist care, patients are referred to the state's main tertiary care hospital, the new Sir Thutob Namgyal Memorial (STNM) Hospital in Sochakgang, Gangtok. This modern, multi-speciality hospital is the central hub for PMJAY in Sikkim.
- Level 3: Out-of-State Super-Speciality Care: If a patient requires highly specialized treatment (like complex organ transplants or advanced neurosurgery) that is not available within Sikkim, they are officially referred to empanelled super-speciality hospitals in nearby cities like Siliguri and Kolkata.
How to Find a Network Hospital in Sikkim
As a beneficiary, your treatment journey will be guided by medical professionals through the referral system. To see the list of available hospitals:
- Visit the official PMJAY Hospital Search Portal.
- In the 'State' dropdown menu, select 'Sikkim'.
- Choose your 'District' from the list to see the local and district-level hospitals.
- For out-of-state options, you would search under the respective state (e.g., West Bengal).
At each empanelled hospital, a dedicated "Ayushman Mitra" helpdesk is available to assist you with the cashless treatment process.
Eligibility Criteria and Core Benefits
Who is Eligible in Sikkim?
Eligibility for Ayushman Bharat PMJAY in Sikkim is targeted towards the most vulnerable sections of society:
- Families identified from the Socio-Economic Caste Census (SECC) 2011 database.
- Other categories as specified by the state government, including certain BPL card holders.
You can confirm your eligibility status on the PMJAY Beneficiary Portal or at your local health center.
The Key Benefits of PMJAY in Sikkim
- ₹5 Lakh Cashless Cover: Each beneficiary family receives a health cover of ₹5 lakh per year on a family floater basis.
- Access to Out-of-State Super-Speciality Care: The scheme's referral system ensures that if treatment isn't available in Sikkim, you get access to top hospitals in other states, completely cashless.
- Comprehensive Coverage: The scheme covers all costs associated with hospitalization, including diagnostics, medicines, doctor fees, and room charges.
- Pre-existing Diseases Covered: All pre-existing conditions are covered from day one of enrollment without any waiting period.
Frequently Asked Questions (FAQs)
1. What is the main referral hospital for Ayushman Bharat in Sikkim?
The main state-level tertiary care and referral hospital for the PMJAY scheme in Sikkim is the new Sir Thutob Namgyal Memorial (STNM) Hospital located in Sochakgang, Gangtok. Most major procedures available within the state are performed here.
2. What happens if the treatment I need is not available in Sikkim?
A key feature of the scheme's implementation in Sikkim is the strong out-of-state referral system. If a specialist or a specific super-speciality treatment is not available at STNM Hospital, you will be officially referred to a larger, empanelled hospital in a city like Siliguri or Kolkata. The treatment there will also be cashless under PMJAY.
3. Is the new STNM Hospital in Gangtok covered under PMJAY?
Yes, the new STNM Multi-Speciality Hospital is fully empanelled and serves as the backbone of the PMJAY scheme in Sikkim, providing a wide range of advanced medical and surgical treatments.
4. How does the referral system work?
You must first visit your local PHC or District Hospital. If they are unable to treat your condition, they will provide an official referral to a higher center, which is typically STNM Hospital. If doctors at STNM determine that the required treatment is not available in-house, they will process the official referral for you to travel to an empanelled hospital outside the state.
5. Do I need to pay any fee to get an Ayushman Card in Sikkim?
No, the Ayushman Bharat PMJAY scheme is completely free for all eligible beneficiaries. There are no premiums, registration fees, or charges for card generation or for any covered treatment at a network hospital.