I belong to a BPL family but my name is not in the PM-JAY beneficiary list. Can RTI help me understand why and what to do?

Yes. PM-JAY eligibility is primarily determined by the Socio-Economic and Caste Census (SECC) 2011 data, which identified deprived rural and occupational urban households. The scheme covers approximately 50 crore beneficiaries. If your family meets the deprivation criteria but is not in the list, RTI can establish: (1) whether your family's name appears in the SECC 2011 database as a deprived household; (2) whether the State Health Agency has received and processed an application from your family for PM-JAY inclusion; (3) the specific deprivation category (D1 to D7 for rural, occupational category for urban) that your family should qualify under and whether it is recorded. If you are excluded despite meeting SECC criteria, approach the State Health Agency with the RTI response and file a grievance on the PM-JAY portal (pmjay.gov.in → Grievance). State governments also have the discretion to add additional beneficiary categories — check if your state has expanded coverage.

A hospital denied me cashless PM-JAY treatment saying the procedure is not covered. How can RTI verify if this is correct?

RTI to the National Health Authority or State Health Agency can provide: (1) the current list of Health Benefit Packages (HBPs) under PM-JAY — the complete list of procedures, surgeries, and treatments covered, with their package codes and rates; (2) whether the specific procedure you needed (e.g., knee replacement, dialysis, cardiac stent, maternity surgery) is in the HBP list and the package rate applicable; (3) whether [Hospital Name] is empanelled for this specific package/category. PM-JAY covers over 1,900 procedures across 27 specialties. If the hospital's claim that the procedure is not covered is incorrect — i.e., the procedure is in the HBP list — you can file a complaint with the State Health Agency and the hospital's de-empanelment can be initiated for wrongful denial. The RTI response giving the exact package list and rates is the evidence.

My PM-JAY claim was submitted after hospitalization but has not been reimbursed for months. Who should I RTI — the hospital, NHA, or the state?

Under PM-JAY, claims are processed by the State Health Agency (SHA) or the Trust/Insurance Company managing the scheme in your state. The hospital submits the claim; the SHA or its designated insurer processes it. File RTI with the State Health Agency (through your state's RTI portal) asking for the claim status and the reason for any delay or rejection. If you do not know which body manages PM-JAY in your state — some states use an insurance model (the SHA contracts a general insurance company), others use a trust model (SHA directly pays) — ask the State Health Agency both for the claim status and for which entity is responsible for claim processing in your state. For policy-level information about the NHA's guidelines on claim timelines, file with NHA through rtionline.gov.in.

Is PM-JAY available in all states and what is the difference between PM-JAY and state health schemes like Chief Minister's health insurance?

PM-JAY is a Central Government scheme covering approximately 50 crore beneficiaries nationally. Most states participate in PM-JAY, but some states (including Delhi as of 2024) have not adopted PM-JAY and instead run their own state health scheme (e.g., Delhi's Mukhyamantri Arogya Yojana). States that participate may integrate their own state scheme with PM-JAY under an AB-PMJAY umbrella — expanding coverage above the Central scheme's ₹5 lakh per family per year limit. For Delhi residents: PM-JAY is not currently operational; the Delhi government runs a separate scheme. Check your state's Health Department for which scheme applies. RTI to NHA can confirm whether your state is part of PM-JAY and the scheme's coverage in your state.

What if NHA or the State Health Agency does not respond to my RTI within 30 days?

If you filed with NHA (Central Government body) through rtionline.gov.in: File a First Appeal with the FAA at NHA within 30 days of the date of decision or expiry of the 30-day response period, whichever is applicable. If the FAA is unsatisfactory, file a Second Appeal with the Central Information Commission (CIC) within 90 days. If you filed with the State Health Agency (state government body) through your state's RTI portal: Second appeal goes to your State Information Commission. NHA is under the Ministry of Health and Family Welfare — a Central body. State Health Agencies are state bodies.

Home/Guides/How to File RTI for Ayushman Bharat PM-JAY — Card Delay, Hospital Empanelment and Claim Rejection

Central Government

How to File RTI for Ayushman Bharat PM-JAY — Card Delay, Hospital Empanelment and Claim Rejection

Step-by-step guide to file an RTI with the National Health Authority (NHA) or State Health Agency for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) — covering Ayushman card issuance delays, beneficiary eligibility disputes, cashless treatment denial at empanelled hospitals, claim rejection basis, and hospital de-empanelment. Includes a ready-to-use sample RTI draft.

Updated 24 May 2026

Quick Facts

MinistryMinistry of Health and Family Welfare

Address RTI ToCPIO, National Health Authority, New Delhi / PIO of the State Health Agency (relevant state)

Application Fee₹10 under RTI (Regulation of Fee and Cost) Rules, 2005. Free for BPL cardholders.

Response Time30 days from receipt (Section 7(1), RTI Act 2005). 48 hours if the matter involves life or liberty.

File Online Athttps://rtionline.gov.in

All information on this page is based on the Right to Information Act, 2005 (Act No. 22 of 2005) and the RTI (Regulation of Fee and Cost) Rules, 2005. First Appeal: Section 19(1). Second Appeal to CIC/SIC: Section 19(3).

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the world's largest government-funded health insurance scheme, providing cashless health coverage of up to ₹5 lakh per family per year to approximately 50 crore beneficiaries from economically vulnerable households. It is administered by the National Health Authority (NHA) under the Ministry of Health and Family Welfare at the Central level, and by State Health Agencies (SHAs) at the state level.

Both NHA and State Health Agencies are public authorities under Section 2(h) of the RTI Act, 2005.

PM-JAY at a Glance

Feature	Detail
Coverage	₹5 lakh per family per year for secondary and tertiary hospitalisation
Beneficiaries	~50 crore persons from ~12 crore families (SECC 2011 database)
Treatment	Over 1,900 Health Benefit Packages (HBPs) across 27 medical specialties
Hospitals	Empanelled government and private hospitals across India
Mode	Cashless at empanelled hospitals; post-hospitalisation reimbursement in some cases

PM-JAY Structure: Central vs. State Level

National Health Authority (NHA) — Central policy, guidelines, IT platform, oversight
        ↓
State Health Agency (SHA) — State-level implementation, hospital empanelment, claims
        ↓
Empanelled Hospital — Provides cashless treatment, files claim with SHA
        ↓
Insurance Company / Trust — Processes claim (model varies by state)

For individual beneficiary issues (card, eligibility, claims), the State Health Agency is usually more directly relevant. For policy questions and HBP lists, NHA is the authority.

Common PM-JAY Problems RTI Can Address

Problem	RTI to File With	Portal
Name not in PM-JAY beneficiary list	SHA / NHA	State RTI portal / rtionline.gov.in
Ayushman card not generated	SHA	State RTI portal
Hospital denied cashless treatment	SHA (empanelment and HBP list)	State RTI portal
Claim not reimbursed	SHA / State Insurance Trust	State RTI portal
Hospital de-empanelled without notice	NHA / SHA	rtionline.gov.in / State RTI portal
Scheme not available in your state	NHA	rtionline.gov.in

Where to File

For NHA (policy information, HBP lists, national data): file on rtionline.gov.in → Ministry of Health and Family Welfare → National Health Authority.

For State Health Agency (individual card, eligibility, claim issues): file through your state's RTI portal with the State Health Agency or Department of Health. Second appeal for SHA matters goes to the State Information Commission.

Note on Delhi: PM-JAY is currently not operational in Delhi; the Delhi government runs the Mukhyamantri Arogya Yojana — file with Delhi Health Department through rti.delhi.gov.in.

What Specific Information Can You Ask For?

Eligibility and card:

Whether household of Name, Aadhaar last 4 digits is in the PM-JAY beneficiary database — Family ID and card status
If excluded — the specific SECC deprivation criterion not met, and whether an application for inclusion was received

Empanelment: 3. Current list of empanelled hospitals under PM-JAY in District, State — names, addresses, and treatment categories 4. Whether Hospital Name is empanelled and for which HBP packages; if de-empanelled, the reason and date

Claims: 5. Status of PM-JAY Claim ID XXX — approved, rejected, or pending; if rejected, the specific reason and guideline provision 6. Claim processing timeline prescribed under PM-JAY guidelines — and whether this claim has exceeded it

HBP coverage: 7. Whether procedure Name/Code is covered under the current PM-JAY Health Benefit Package list — package code, rate, and specialties covered

Appeals

First Appeal (Section 19(1)): File with the FAA at NHA or SHA within 30 days of the date of decision or expiry of the 30-day response period, whichever is applicable.

Second Appeal (Section 19(3)): For NHA (Central body) — file with the CIC within 90 days. For State Health Agency — file with your State Information Commission.

Sample RTI Application Draft

To,
The Central Public Information Officer (CPIO),
National Health Authority (NHA),
9th Floor, Tower-l, Jeevan Bharati Building,
Connaught Place, New Delhi – 110001
[OR: PIO, State Health Agency ([State Name]), [State Capital Address]]

Subject: Application under the Right to Information Act, 2005 — PM-JAY Beneficiary Status, Card Issuance and Claim Rejection

Sir/Madam,

I, [Your Full Name], residing at [Your Full Address], submit this application under Section 6 of the Right to Information Act, 2005, to seek the following information:

PM-JAY / beneficiary details:
  Name of Beneficiary: [Full Name]
  Aadhaar Number (last 4 digits): [XXXX]
  PM-JAY Beneficiary ID / PMJAY ID (if available): [ID No.]
  State: [State Name]
  District: [Name]
  Nature of Issue: [e.g., Ayushman card not issued / eligibility rejected / cashless treatment denied / claim not reimbursed]

Information sought:

1. Whether the household of [Name], Aadhaar [last 4 digits], residing at [Address] is listed as an eligible beneficiary under PM-JAY in the Socio-Economic and Caste Census (SECC) / PM-JAY beneficiary database — and if yes, the PM-JAY Family ID and current card status (issued / pending / not generated).

2. If the household is not listed as a beneficiary — the specific eligibility criterion under the PM-JAY Scheme Guidelines on which the household is excluded, and whether the household was included in the SECC 2011 database.

3. The current list of empanelled hospitals under PM-JAY in [District Name], [State], including their names, addresses, and the categories of treatment available at each empanelled hospital.

4. Whether [Hospital Name], [City] is currently empanelled under PM-JAY — if yes, the categories of treatment covered; if not, the reason for de-empanelment or the date on which it was removed from the empanelled list.

5. The status of the PM-JAY claim bearing Claim ID / Transaction No. [XXX] submitted by / for [Beneficiary Name] in [Month/Year] for treatment at [Hospital Name] — whether the claim was approved, rejected, or is pending. If rejected, the specific reason and the provision of the PM-JAY guidelines under which rejection was made.

6. The total number of PM-JAY claims filed and reimbursed in [District Name], [State] in the last financial year — and the percentage of claims rejected, with the top three reasons for rejection.

I am enclosing the application fee of Rs. 10 [via online payment; Reference No.: [Payment Ref]].

I request the above information within 30 days as required under Section 7(1) of the RTI Act, 2005.

Yours sincerely,

[Your Full Name]
[Your Complete Address]
Phone: [Your 10-digit Mobile Number]
Email: [[email protected]]
Date: [DD/MM/YYYY]

Replace all text in [square brackets] with your actual details before filing. Do not include the brackets in your submission.

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