**Executive Summary**
The document is a response to an unstarred question in Lok Sabha regarding the effective implementation of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It outlines measures taken by the Government, including establishing a digital ecosystem, outreach strategies, and grievance redressal mechanisms. The document references data as of October 31, 2025, and provides helpline numbers for beneficiaries and hospitals.
**Key Points / Main Content**
* **Digital Ecosystem:**
* Established an end-to-end digital ecosystem for transparency and real-time monitoring.
* Implemented revamped Beneficiary Identification System (BIS 2.0) for self-verification.
* Launched Ayushman Mobile Application for on-the-go beneficiary verification.
* Transaction Management System (TMS 2.0) ensures efficient claims settlement.
* User Management Portal provides a unified login system.
* Improved Hospital Engagement Module (HEM2.0) for hospital onboarding.
* AI/ML-based analytics used to monitor transactions.
* National Anti-Fraud Unit (NAFU) coordinates with State Anti-Fraud Units (SAFU).
* Comprehensive dashboard monitors real-time performance.
* **Beneficiary Data (Gujarat):**
* Over 42.31 crore Ayushman cards created as of October 31, 2025.
* Approximately 51.82 lakh claims settled in Gujarat as of October 31, 2025.
* **Outreach and Awareness:**
* Comprehensive media and outreach strategy targeting rural and underserved areas.
* Utilizes traditional media (newspapers, radio) and digital platforms.
* Engages frontline workers (ASHA, AWW, VLE).
* Beneficiary helpline: 1800-110-770.
* 24x7 call center: 14555.
* Focus on raising awareness for senior citizens aged 70 and above.
* **Grievance Redressal:**
* Three-tier grievance redressal system at District, State, and National levels.
* Dedicated nodal officers and Grievance Redressal Committees.
* Grievances can be filed via web-based portal (CGRMS) or helpline (14555).
* **Hospital Empanelment:**
* Hospital empanelment is a continuous process.
* Over 32,403 hospitals empanelled, including 15,378 private hospitals.
* Hospital-specific call center (14413) addresses hospital concerns.
**Impact Analysis**
**Beneficiaries**
* **Impact:** Easier access to healthcare services through streamlined processes and improved identification and verification methods. Can address grievances through multiple channels.
* **Action Required:** Utilize the provided helpline numbers and grievance redressal mechanisms if facing issues. Stay informed about the scheme through outreach programs.
**Hospitals**
* **Impact:** Streamlined onboarding process and efficient claims settlement through digital platforms. Dedicated support through the hospital-specific call center.
* **Action Required:** Utilize the Hospital Engagement Module (HEM2.0) for onboarding. Contact the hospital-specific call center (14413) for concerns related to empanelment.
**State Health Agencies**
* **Impact:** Responsible for implementing outreach strategies and engaging frontline workers to raise awareness about AB-PMJAY.
* **Action Required:** Undertake extensive Information, Education and Communication activities.
Key Entities Referenced
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A health insurance scheme aimed at providing financial protection to eligible families for secondary and tertiary care hospitalization.
Ministry of Health and Family Welfare: The central ministry responsible for health policy and programs in India.
National Health Authority (NHA): The apex body responsible for the implementation of AB-PMJAY.
Gujarat: Indian state where a specific number of claims have been settled under AB-PMJAY.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 2156
TOBE ANSWERED ON12TH DECEMBER, 2025
EFFECTIVE IMPLEMENTATION OFAB-PMJAY
2156. SHRIRAJESH NARANBHAI CHUDASAMA:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) the measures taken by the Government to ensure the effective implementation of the
Ayushman Bharat PradhanMantri Jan Arogya Yojana (AB-PMJAY)across the country;
(b) the number of beneficiaries enrolled in the scheme since its inception along with the total
numberof claimssettled till date within the Stateof Gujarat;
(c) the steps taken by the Government to address any challenges faced by beneficiaries in
accessing healthcare services especiallyinrural andunderserved areasof the country;
(d) whether there is any plan to expand the list of empanelled hospitals and healthcare
services across the countryunderthe AB-PMJAY; and
(e)if so, the detailsthereof?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a): Under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a robust
end-to-end digital ecosystem has been established to ensure transparency and real-time
monitoring across all States/UTs. Several key initiatives have been implemented like
revamped Beneficiary Identification System (BIS 2.0) which allows self-verification thereby
eliminating unnecessary intermediaries. Ayushman Mobile Application enables on-the-go
beneficiary verification and card creation using face-auth technology. The Transaction
Management System (TMS 2.0) ensures efficient claims settlement for hospitals. The User
Management Portal provides a unified login system for seamless access to PMJAY
applications. An improved version of the Hospital Engagement Module (HEM2.0) has been
launchedfor smooth onboardingof hospitals.AI/ML-based analytics is used to proactively monitor all transactions. National Anti-Fraud
Unit (NAFU) established at National Health Authority (NHA) works in close coordination
with the StateAnti-Fraud Units (SAFU)toinvestigate andtake action on cases of fraud.
Acomprehensive dashboard isdesigned tomonitor the real time performance of AB-PMJAY.
The dashboard is used to objectively evaluate the scheme's performance in terms of metrics
such as the number of cards issued, hospital admissions, hospital empanellment, and claim
settlement.
(b): As on31.10.2025,more than42.31crore Ayushman cardswere createdunderthe scheme
andapproximately51.82lakh claimswere settled inGujarat.
(c): There is a comprehensive media and outreach strategy to spread awareness about AB-
PMJAY especially in rural and underserved areas. This includes advertisement over
traditional media platforms including newspapers, community radio, street plays, digital
displays, radio campaigns, mass messaging, telecast of beneficiary testimonials etc. In
addition to this, State Health Agencies have also engaged a wide network of frontline
workers i.e., ASHA (Accredited Social Health Activist), AWW (Anganwadi Workers) and
VLE (Village LevelEntrepreneurs) who have playedpivotalroles increatingmass awareness
at the grassroot level. In addition to this, the beneficiaries may give a missed call to helpline
number1800-110-770 or callat 24x7callcentre (14555) for any assistance/queries.
Further, National Health Authority has issued directions to the states to undertake extensive
Information, Education and Communication activities to raise the awareness about the
expansion of AB-PMJAYfor all senior citizensof the age 70 yearsandabove.
UnderAB-PMJAY,athree-tiergrievanceredressalsystematDistrict,State,andNationallevel
has been established to resolve the issues faced by beneficiaries. At each level, there is a
dedicatednodalofficerandGrievanceRedressalCommitteestoaddressthegrievances.
Beneficiaries can file their grievances using different mediums including web-based portal
CentralizedGrievanceRedressalManagementSystem(CGRMS),orthe24*7helplinenumber
(14555). Based on the nature of grievance, necessary action includingproviding of support to
thebeneficiariesinavailingtreatmentunderthescheme,istaken.
(d) and (e): Hospital empanelment is a continuous process and is done as per the criteria
providedundertheempanelmentguidelinesunderPMJAY.Currentlyover32,403hospitalsare
empanelledundertheschemeoutofwhich15,378areprivatehospitals.Inordertoimprovethe
participationof hospitals,a hospital-specific callcenter(14413) hasbeenset-uptoaddressthe
concernsofhospitalsonareal-timebasisincludingconcernsrelatedtoempanelment.
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