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GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1048
TOBE ANSWERED ON24TH JULY,2026
AB-PMJAYCLAIM-SETTLEMENTTIMELINES
1048. SHRICAPTAINBRIJESH CHOWTA:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) the number and value of claims submitted by empanelled hospitals under Ayushman
Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in Karnataka during the last three
years, includingDakshina Kannada district;
(b) the detailsof claims settled, rejectedandpendingalongwith the average settlement time;
(c) the principal reasons for delays or claim rejections and the number and nature of
grievancesreceived; and
(d) the measures proposed by the Government to ensure timely settlement of claims and
uninterruptedbeneficiary treatment?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (d): During the period of last three years (FY2023-24 to FY2025-26), a total of 99.85
lakh claims amounting to Rs 5763.40 crore have been submitted by empanelled hospitals
under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in the state of
Karnataka, which includes a total of 3.18 lakh claims amounting to Rs. 407.53 crore in
Dakshina Kannada district. During the same period, a total of 92.42 lakh claims have been
settled.
Under the scheme, settlement of claims is a regular process and claims are settled by
respective State Health Agency as per claim adjudication guidelines issued by National
Health Authority. Further, for timely settlement of claims, the permissible turnaround time is
within 15daysof claimsubmission forintra-state hospitals(hospitals locatedwithinthe State)
and within 30 days of claim submission in case of portability claims (hospitals located
outside the State).
Under AB-PMJAY, a robust grievance redressal mechanism has been established to address
beneficiary grievances in a timely and transparent manner. Beneficiaries can register their
grievances through the Centralized Grievance Redressal Management System, a 24×7 toll-
free helpline number 14555, Ayushman app or the Ayushman Sarathi (WhatsApp Chatbot).
Grievances are monitored andresolved through a structured mechanism at the National,State
and District levels to ensure effective redressal and improved beneficiary experience under
the scheme.
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