**Executive Summary**
This document presents the Minister of Health and Family Welfare's response to a Lok Sabha starred question regarding the issuance of Ayushman Cards under the PM-JAY scheme. The response provides data on the number of families issued Ayushman Cards and the number of empanelled hospitals in Bihar, Uttar Pradesh, Madhya Pradesh, and Andhra Pradesh as of January 2026. It also details the claim settlement process, anti-fraud measures, and scheme expansion plans.
**Key Points / Main Content**
* **Ayushman Card Issuance (as of January 2026):**
* Bihar: 1.16 crore families
* Uttar Pradesh: 1.26 crore families
* Madhya Pradesh: 0.89 crore families
* Andhra Pradesh: 0.59 crore families
* **Empanelled Hospitals (as of January 31, 2026):**
* Bihar: 430 Public Hospitals, 723 Private Hospitals
* Uttar Pradesh: 2926 Public Hospitals, 3413 Private Hospitals
* Madhya Pradesh: 1113 Public Hospitals, 823 Private Hospitals
* Andhra Pradesh: 1416 Public Hospitals, 1053 Private Hospitals
* **Claim Settlement Process:**
* Claims are settled by respective State Health Agencies (SHA) based on claim adjudication guidelines issued by National Health Authority (NHA).
* Permissible turnaround time for settlement of claims:
* 15 days for intra-state hospitals (within State)
* 30 days for portability claims (outside State)
* **Anti-Fraud Measures:**
* AB-PMJAY operates with a zero-tolerance approach towards fraud.
* National Anti-Fraud Unit (NAFU) at NHA uses AI/ML-based automated triggers to flag unusual claim patterns.
* Regular capacity-building workshops and field-level training sessions are conducted to strengthen the anti-fraud framework.
* **Scheme Coverage:**
* Health coverage of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization.
* Covers 12 crore families, constituting the bottom 40% of India's population.
* Expanded in March 2024 to include approximately 37 lakh families of Accredited Social Health Activists, Anganwadi Workers, and Anganwadi Helpers.
* Expanded in October 2024 to cover 6 crore senior citizens of age 70 years and above belonging to 4.5 crore families.
**Impact Analysis**
**Stakeholder: Beneficiary Families**
* **Impact:**
* Increased access to healthcare services through Ayushman Cards.
* Financial protection against healthcare expenditures up to Rs. 5 lakhs per family per year.
* **Action Required:**
* Ensure Ayushman Cards are utilized at empanelled hospitals for eligible treatments.
**Stakeholder: Empanelled Hospitals (Public and Private)**
* **Impact:**
* Opportunity to provide healthcare services to a wider patient base.
* Reimbursement of claims through the AB-PMJAY scheme.
* **Action Required:**
* Adhere to claim adjudication guidelines issued by NHA.
* Ensure timely submission of claims for reimbursement.
**Stakeholder: State Health Agencies (SHAs)**
* **Impact:**
* Responsibility for settling claims according to NHA guidelines.
* Oversight of the AB-PMJAY implementation at the state level.
* **Action Required:**
* Ensure timely and accurate settlement of claims.
* Monitor the performance of empanelled hospitals.
**Stakeholder: National Health Authority (NHA)**
* **Impact:**
* Oversight of the AB-PMJAY scheme nationally.
* Development and implementation of claim adjudication guidelines.
* **Action Required:**
* Monitor the performance of AB-PMJAY.
* Implement anti-fraud measures through the National Anti-Fraud Unit (NAFU).
Key Entities Referenced
AB-PMJAY: Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana, a health insurance scheme providing coverage for secondary and tertiary care hospitalization.
National Health Authority (NHA): The apex body responsible for implementing and managing the AB-PMJAY scheme.
Bihar: One of the states mentioned where Ayushman Cards have been issued under the PM-JAY scheme.
Uttar Pradesh: One of the states mentioned where Ayushman Cards have been issued under the PM-JAY scheme.
Madhya Pradesh: One of the states mentioned where Ayushman Cards have been issued under the PM-JAY scheme.
GOVERNMENT OF INDIA
MINISTRY OFHEALTH AND FAMILYWELFARE
DEPARTMENT OF HEALTH AND FAMILYWELFARE
LOK SABHA
STARRED QUESTION NO. 117
TO BE ANSWERED ON THE 6THFEBRUARY, 2026
ISSUANCE OF AYUSHMAN CARDS UNDER PM-JAY
*117. SMT. SHAMBHAVI:
DR. LATAWANKHEDE:
Will the MINISTER OF HEALTH AND FAMILY WELFARE be pleased to
state:
(a) the total number of families that have been issued Ayushman Cards under the
PM-JAY scheme in the States of Bihar, Uttar Pradesh, Madhya Pradesh and Andhra
Pradesh as of January 2026;
(b) the number of hospitals, both public and private, empanelled under the scheme in
the said States;
(c) the details of the claim settlement ratio and the average time taken for the
reimbursement of claims to the hospitals in the said States;
(d) the measures taken by the Government to check the fraudulent practices and ensure
genuine treatment of beneficiaries in these States; and
(e) the details of the Government's plan to expand the coverage of the scheme to the
left-out eligible families in these States?
ANSWER
THE MINISTER OFHEALTH AND FAMILYWELFARE
(SHRI JAGAT PRAKASH NADDA)
(a) to (e) AStatement is laid on the Table of the House.STATEMENT REFERRED TO IN REPLYTO LOK SABHA
STARRED QUESTION NO. 117* FOR 6TH FEBRUARY, 2026
(a) to (e) The details of number of families that have been issued Ayushman Cards under
Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in the States of
Bihar, Uttar Pradesh, Madhya Pradesh and Andhra Pradesh as of January 2026 are as
under:
State Number of families (in crore)
Bihar 1.16
Uttar Pradesh 1.26
Madhya Pradesh 0.89
Andhra Pradesh 0.59
The details of number of hospitals empanelled, both public and private, in the States of
Bihar, Uttar Pradesh, Madhya Pradesh and Andhra Pradesh under AB-PMJAY as on
31.01.2026 are as under:
State Public hospitals Private hospitals
empanelled empanelled
Bihar 430 723
Uttar Pradesh 2926 3413
Madhya Pradesh 1113 823
Andhra Pradesh 1416 1053
Under AB-PMJAY, settlement of claims is a regular and uninterrupted process and claims
are settled by respective State Health Agencies (SHA) as per claim adjudication
guidelines issued by National Health Authority (NHA). As per the guideline, the
permissible 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
30 days in case of portability claims (hospitals located outside State).
AB-PMJAYis governed on a zero-tolerance approach towards fraud. National Anti-Fraud
Unit (NAFU) established at NHA, uses AI/ML-based automated triggers to flagunusual claim patterns such as duplicate entries, inflated procedures, or misuse of patient
identity, etc. A comprehensive dashboard is designed to monitor the real time
performance of AB-PMJAY. Regular capacity-building workshops and field-level
training sessions are conducted to strengthen the overall anti-fraud framework.
AB-PMJAY provides health coverage of Rs. 5 lakhs per family per year for secondary
and tertiary care hospitalization to 12 crore families constituting bottom 40% of India’s
population. In March 2024, approximately 37 lakh families of Accredited Social Health
Activists, Anganwadi Workers and Anganwadi Helpers were included under the scheme.
In October 2024, the scheme was further expanded to cover 6 crore senior citizens of age
70 years and above belonging to 4.5 crore families irrespective of their socio-economic
status. Many States/UTs implementing AB-PMJAYhave further expanded the beneficiary
base under their own state’s scheme.
*****