**Executive Summary:**
This document provides a response to questions raised in the Lok Sabha regarding the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY) in Maharashtra. It details the number of beneficiaries, card issuance status, grievance redressal mechanisms, hospital empanelment, awareness initiatives, fraud monitoring, and actions taken to improve the scheme's implementation. Key data includes over 3.17 crore Ayushman cards generated and 1,698 hospitals empanelled as of July 2025.
**Key Points / Main Content:**
* **ABPMJAY Overview:**
* Provides health coverage of Rs. 5 lakhs per eligible beneficiary family per year for secondary and tertiary care hospitalization.
* Aims to cover 12 crore families, representing the bottom 40% of India's population.
* **Beneficiary Status in Maharashtra:**
* More than 3.17 crore Ayushman cards have been generated.
* Beneficiary data from the Food and Civil Supplies Department, Maharashtra, was updated in the BIS portal on 09.07.2025.
* eKYC performance reports of Field Level Workers (FLWs) are shared regularly with District Health Officers and Civil Surgeons.
* **Grievance Redressal:**
* Hospitals cannot deny treatment to eligible beneficiaries.
* A three-tier grievance redressal system exists at District, State, and National levels.
* Nodal officers and Grievance Redressal Committees are present at each level.
* Beneficiaries can file grievances via web portal (CGRMS), call centers (14555), email, or letter.
* **Hospital Empanelment:**
* 1,698 hospitals are empanelled in Maharashtra, including 1,176 private hospitals.
* 355 talukas in Maharashtra have at least 1 hospital empanelled.
* **Awareness and Outreach:**
* Comprehensive media strategy to raise awareness, especially in rural and backward areas.
* Utilizes traditional media, frontline workers (ASHAs, AWWs, VLEs), and IEC activities.
* **Fraud Monitoring:**
* National Health Authority's (NHA) IT platform includes anti-fraud features for real-time monitoring.
* States and Union Territories have access to real-time dashboard monitoring.
**Impact Analysis:**
* **ABPMJAY Beneficiaries:**
* *Impact:* Access to healthcare services and financial protection for secondary and tertiary care hospitalization.
* *Action Required:* Utilize available grievance redressal mechanisms if facing denial of treatment or other issues.
* **State Health Authority (SHA):**
* *Impact:* Responsible for coordinating with NIC Delhi for data updates and monitoring eKYC performance.
* *Action Required:* Maintain continuous coordination with NIC Delhi and share eKYC performance reports with relevant officials.
* **Empanelled Hospitals:**
* *Impact:* Obligated to provide treatment to eligible beneficiaries.
* *Action Required:* Adhere to empanelment terms, avoid denying treatment, and participate in the grievance redressal process.
* **District Health Officers and Civil Surgeons:**
* *Impact:* Responsible for monitoring progress and ensuring active participation of Field Level Workers (FLWs).
* *Action Required:* Monitor eKYC performance reports of FLWs and take necessary actions to improve performance.
* **Frontline Workers (ASHAs, AWWs, VLEs):**
* *Impact:* Play a crucial role in creating mass awareness at the grassroots level.
* *Action Required:* Actively participate in IEC activities and raise awareness about the scheme in their respective areas.
Key Entities Referenced
Maharashtra: A state in India where the ABPMJAY scheme is being implemented and analyzed in this document.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A flagship scheme of the Government of India providing health coverage of Rs. 5 lakhs per eligible beneficiary family per year for secondary and tertiary care hospitalization.
Ministry of Health and Family Welfare: The government ministry responsible for the ABPMJAY scheme.
State Health Authority (SHA): The state-level agency responsible for implementing and coordinating the ABPMJAY scheme in Maharashtra.
National Health Authority (NHA): The apex body responsible for the implementation of ABPMJAY at the national level.
Food and Civil Supplies Department, Maharashtra: The department in Maharashtra responsible for providing beneficiary data for ABPMJAY.
Centralized Grievance Redressal Management System (CGRMS): A web-based portal for beneficiaries to file grievances related to ABPMJAY.
District Health Officers: Official at district level involved in monitoring progress of ABPMJAY implementation.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 961
TOBE ANSWERED ON25TH JULY,2025
AB-PMJAYBENEFICIARIES IN MAHARASHTRA
961. SHRIMOHITE PATILDHAIRYASHEELRAJSINH:
SHRIBHASKAR MURLIDHAR BHAGARE:
SHRINILESH DNYANDEVLANKE:
SHRISANJAYDINAPATIL:
DR. AMOLRAMSING KOLHE:
SMT. SUPRIYASULE:
SHRIBAJRANG MANOHAR SONWANE:
PROF. VARSHAEKNATHGAIKWAD:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) the total number of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)
beneficiariesinthe Stateof Maharashtra till date;
(b) whether all eligible households have been issued Ayushman cards and if not, the reasons for
the delayandthe steps taken toexpeditethe process;
(c) whether the Government is aware of any issues in Maharashtra related to denial of treatment,
rejectionof Ayushman cardsby hospitals or delayinclaim settlement underPM-JAY;
(d) if so, the number of such complaints received during the last two years and the action taken
thereon;
(e)the numberof private and Government hospitals empanelledunderPM-JAYinthe said State;
(f) whether the Government has identified gaps in PM-JAY implementation in rural, tribal and
backwarddistricts of Maharashtra;
(g) if so, the steps taken/proposed to be taken by the Government to improve awareness,
infrastructure andavailability of empanelledhospitals insuch areas;
(h) whether any hospitals have been blacklisted for non-compliance, fraud or refusal to treat
patientsunderthe scheme andif so, the detailsthereof; and(i) whether the Government is planning to strengthen grievance redressal and fraud
monitoring mechanisms in the said State under the PM-JAY framework and if so, the status
of implementation of such systems?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) and (b): Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a
flagship scheme of the Government of India that provides health coverage of Rs. 5 lakhs per
eligible beneficiary family per yearfor secondary andtertiary care hospitalization to 12crore
families, coveringthe bottom 40% of India’spopulation.
As on date, more than 3.17 crore Ayushman cards have been generated for beneficiaries in
the State of Maharashtra. In this regard, continuous coordination is maintained with State
Health Authority (SHA). The most recent beneficiary data received from the Food and Civil
Supplies Department, Maharashtra, is shared with NIC Delhi and successfully ingested into
the BIS portal on 09.07.2025. Following this update, the beneficiary database is refreshed for
further use. e-KYC performance reports of Field Level Workers (FLWs) is shared with
District Health Officers and Civil Surgeons on regular basis, to monitor progress and ensure
activeparticipation onregularbasis.
(c) and(d): As per the terms andconditions of empanelment, hospitals cannotdeny treatment
to eligible beneficiaries of the scheme. In case of denial of treatment by the empaneled
hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance
redressal system at District, State and National level has been created to resolve the issues
faced by beneficiaries in utilizing healthcare services. At each level, there is a dedicated
nodal officer andGrievance Redressal Committeestoaddress the grievances.
Beneficiaries can file their grievances using different mediums including web-based portal
Centralized Grievance Redressal Management System (CGRMS), Central & State call
centers (14555), email, letter to State Health Agencies (SHAs) etc. Based on the nature of
grievance, necessary action including providing of support to the beneficiaries in availing
treatmentunderthe scheme, istaken.
(e): As on date, a total of 1,698 hospitals have been empanelled under the scheme across the
state of Maharashtra, out of which 1,176are private hospitals.
(f) and (g): AB-PMJAY has a comprehensive media and outreach strategy to spread
awareness and empower beneficiaries for their rights and entitlements more prominently in
rural and backward areas. This includes advertisement over traditional media platforms
including newspapers, community radio, street plays, digital displays, radio campaigns, mass
messaging, and telecast of beneficiary testimonials via Doordarshan etc. In addition to this,State Health Agencies have also engaged the wide network of frontline workers i.e.,ASHAs,
AWWs and VLEs (Village Level Entrepreneurs) who are pivotal in creating mass awareness
at the grassroot level.
Further, the government has issued directions to the states to undertake extensive IEC
activities to raise the awareness about the scheme. Additionally, 355 talukas in Maharashtra
have at least 1hospital empanelledunderthe scheme.
(h): Sameas(c)and(d) above.
(i): National Health Authority’s (NHA) IT platform, includes built-in anti-fraud features.
These tools enable real-time monitoring and detection of fraudulent activities, thereby
enhancing transparency and accountability. NHA provides all States and Union Territories
with accesstorobust real time dashboard monitoring.
*****