**Executive Summary**
This document is the answer provided by the Minister of State in the Ministry of Health and Family Welfare to an unstarred question in Lok Sabha regarding discrepancies in reimbursement of claims in AB-PMJAY. The question was raised on February 6th, 2026, and addresses concerns about delays, pending payments, and hospital withdrawals from the scheme. The answer outlines the claim settlement process and reports on the number of empanelled hospitals.
**Key Points / Main Content**
* **Claim Settlement Process:**
* Claims are settled by State Health Agencies according to National Health Authority guidelines.
* Turnaround time for claim settlement:
* Within 15 days for intra-state hospitals.
* Within 30 days for portability claims (hospitals located outside the state).
* **Hospital Empanelment:**
* Empanelment of private hospitals under AB-PMJAY is voluntary.
* As of December 31, 2025, 33,270 hospitals are empanelled, including 15,733 private hospitals.
* **Hospital Empanelment Growth:**
* The document provides a table showing the progressive increase in empanelled private hospitals from 2020-21 to 2025-26.
* **Review and Capacity Building:**
* Regular review meetings are conducted to monitor the progress of claims processing.
* Capacity-building activities are organized for claim settlement.
**Impact Analysis**
**Stakeholder: Private Hospitals**
* **Impact:** Affected by claim settlement timelines and voluntary empanelment status under AB-PMJAY. They could be impacted by payment delays or administrative burdens.
* **Action Required:** Adhere to claim submission guidelines, participate in capacity building activities and remain informed of the claim settlement process.
**Stakeholder: State Health Agencies**
* **Impact:** Responsible for the settlement of claims as per NHA guidelines.
* **Action Required:** Ensure adherence to the claim adjudication guidelines issued by the National Health Authority and maintain the defined turnaround times for claim settlement.
**Stakeholder: Government/Ministry of Health and Family Welfare**
* **Impact:** Oversees the AB-PMJAY scheme and ensures effective claim management and hospital empanelment.
* **Action Required:** Continue monitoring claim settlement progress through regular review meetings and organize capacity building activities. Address any systemic issues causing delays or discrepancies in reimbursements.
Key Entities Referenced
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A health insurance scheme that provides financial protection to eligible beneficiaries for secondary and tertiary care hospitalization.
Ministry of Health and Family Welfare: The government ministry responsible for health policy in India.
National Health Authority: The apex body responsible for the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1210
TOBE ANSWERED ON 06TH FEBRUARY,2026
DISCREPANCIES IN REIMBURSEMENTOFCLAIMS IN AB-PMJAY
†1210.SHRIBHUMARE SANDIPANRAOASARAM:
DR. SHIVAJI BANDAPPAKALGE:
SHRINILESH DNYANDEVLANKE:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) whether the Government is aware of the delays and discrepancies in reimbursement of
claims to the private hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya
Yojana (AB-PMJAY)invariousStatesof the country;
(b) if so, the details thereof, State-wise and hospital-wise along with the total amount of
pending claims of Government and private empanelled hospitals under AB-PMJAY of
Ahilyanaga (Ahmednagar)district includingMaharashtra;
(c) whether the Government is aware of the fact that private hospitals are gradually
withdrawing from AB-PMJAYdue topendingpayments;
(d) if so, the steps takenby the Government toexpeditesettlement of pendingpayments; and
(e)the detailsof the amount payable andalreadypaidtothe private hospitals inthisregard?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) and (b): Under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY),
settlement of claims is a regular and uninterrupted process and claims are settled by
respective State Health Agencies as per claim adjudication guidelines issued by National
Health Authority. The turnaround time for settlement of claim to hospitals is within 15 days
of claims submission for the intra-state hospitals (hospitals located within State) and within
30daysincase of portabilityclaims (hospitals locatedoutside State)
(c) to (e): Under AB-PMJAY, empanelment of private hospitals is entirely voluntary. As on
31.12.2025, more than 33,270 hospitals, including 15,733 private hospitals, are empanelledunderthescheme.Theprogressiveincreaseinthenumberofempanelledprivatehospitalsisas
indicatedbelow:
FinancialYear Number of empanelledprivate hospitals
2020-21 5,981
2021-22 7,512
2022-23 9,103
2023-24 12,018
2024-25 14,496
2025-26 (As on 31.12.2025) 15,733
Further, regular review meetings are held to take stock of the progress with regard to the
claims. Besides, capacity buildingactivitiesare also organised for settlement of claims.
*****