Parliament Question: AB-PMJAY coverage and hospital empanelment

GOVERNMENTOFINDIA MINISTRYOFHEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH ANDFAMILYWELFARE RAJYASABHA UNSTARREDQUESTION NO. 2040 TOBE ANSWERED ON10TH MARCH, 2026 AB-PMJAYCOVERAGE AND HOSPITALEMPANELMENT 2040. SHRISAJJAD AHMAD KICHLOO: Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate: (a) the present status of Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (ABPMJAY) in J&K, including district-wise data on cards issued, eligible but excluded families, empaneledGovernment andprivate hospitals andclaims filed,settled andpendingalongwith amountsreleasedtohospitals; (b) the reason for issues of Aadhaar/SECC errors, delayed card generation, frequent claims rejections, low package rates, denial of cashless treatment and prolonged reimbursement delaystohospitals; and (c) whether the Ministry would outline a time bound plan to empanel all eligible private hospitals andensure timelypayments anduniversal coverage? ANSWER THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND FAMILYWELFARE (SHRIPRATAPRAOJADHAV) (a) to (c): As on 28.02.2026, a total of 87.91 lakh Ayushman cards have been created in Jammu and Kashmir under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB- PMJAY). The district-wise details of number of Ayushman cards created in Jammu and Kashmircanbeaccessed athttps://dashboard.nha.gov.in/public/card. The details of number of public and private hospitals empanelled underthe scheme inthe UT canbeaccessed athttps://hem.nha.gov.in/search As on 28.02.2026, the number of claims submitted, paid and rejected under the scheme, in Jammu andKashmirare asunder: Numberinlakh Claimssubmitted Claimspaid Claimsrejected 19.45 16.21 1.29Under the scheme, claims submitted by empanelled hospitals are scrutinized based on the clinical documents, investigation reports, and other supporting records, in accordance with the prescribed standard treatment guidelines. Under AB-PMJAY, settlement of claims is a regular and continuous process and claims are settled by respective State Health Agencies as per claim adjudication guidelines issued by National Health Authority. As per these guidelines, the permissible turnaround time for settlement of claims to hospitals is within 15 days of claims submission for the intra-state hospitals (hospitals located within State) and within 30 days in case of portability claims (hospitals locatedoutside State). As per the empanelment guidelines under AB-PMJAY, the empanelled hospitals cannot deny treatment to eligible beneficiaries of the scheme. In case of denial of treatment by an empanelled hospital, beneficiaries can register their grievances through the Centralized Grievance Redressal Management System (CGRMS) or through a 24*7 toll-free helpline number 14555. 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 are designated nodal officers and Grievance Redressal Committeestoaddress the grievances. Aadhaar-based e-KYC is mandatory during enrolment aswell as for availing treatment under the scheme. In case of any error in demographic details of beneficiary, re-do e-KYC functionality has been enabled in Ayushman App and the web portal. Through this process, beneficiaries can correct their demographic details on the Ayushman card in accordance with the detailsavailable intheirAadhaar. In order to improve the participation of hospitals, a hospital-specific toll-free helpline 14413 has been set-up to address the concerns of hospitals on a real-time basis including concerns relatedtoempanelment. *****