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GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 5614
TOBE ANSWERED ON27TH MARCH, 2026
OPERATIONALGAPSIN AYUSHMAN BHARAT- PMJAY
5614. SHRICAPTAINBRIJESH CHOWTA:
SHRIRAJIV PRATAPRUDY:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) whether the Government is aware of the issues of low package rates under Ayushman
Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) discouraging private hospital
empanellment,resulting indenialof treatmentincertain cases, if so, the detailsthereof;
(b) whether there is any proposal to increase emergency treatment codes and address the
exclusion of specialities such as Neurology and mandatory referral requirements that are
causing hardship topatients, if so, the detailsthereof alongwith the corrective steps proposed
tobe takenby the Government inthisregard;
(c) whether any actions has been taken by the Government to resolve issues such as face
authentication failures, OTP problems, conversion from BPL to APL ration cards, non-
linkage with Kutumb ID affecting beneficiaryaccess, if so, the details thereof;
(d) whether the Government is aware of the inadequate availability of specialist doctors in
district hospitals, and the denial of referrals for cancer, other critical treatments under the
scheme and if so, the remedial measures proposed to be taken by the Government in this
regard; and
(e) whether any steps are being taken by the Government to revise package rates, expand
emergency coverage, streamline verification systems and strengthen grievance redressal
mechanisms toensure uninterrupted treatment toall beneficiaries underthe scheme,if so, the
detailsthereof?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a)to(e): Sincethe launch of the AyushmanBharat - PradhanMantri Jan Arogya Yojana(AB
-PMJAY) scheme in September 2018, the health benefit packages have been revised from
time to time. Initially, the scheme included 1391 packages, but the latest Health Benefit
Package 2022, now comprises 1,961 packages across 27 specialties including procedures
relatedtoNeurosurgery.Further, the latest Health Benefit Package 2022 provides comprehensive bundled packages
covering the entire treatment cycle. This includes pre-hospitalization expenses for up to 3
days (covering diagnostics, premedication and consultation), complete hospitalization
including medical, surgical treatment, anesthesia and implants (where applicable), and post-
hospitalization care up to 15 days including drug expenses and follow-up care, thereby
ensuring cashless, standardizedandquality treatmentunderAB-PMJAY.
The referral mechanism is not mandatory under AB-PMJAY, however, some states follow a
referral system based on their respective state-specific guidelines as flexibility in
implementation isavailabletothe states underthe scheme.
Under AB-PMJAY, Aadhaar-based authentication is mandatory for creation of Ayushman
cards and availing treatment. The authentication can be carried out through multiple modes,
including Aadhaar OTP, face authentication, fingerprint scan and iris scan. In case of face
authenticationfailure, the operator/beneficiarymayuse another mode of authentication.
Further, National Health Authority, in coordination with State Health Agencies, continuously
addresses operational concerns related to beneficiary identification and verification to ensure
seamless services underthe scheme.
Under the scheme, a Centralized Grievance Redressal Management System (CGRMS) has
been established, along with a 24×7 toll-free helpline (14555), to facilitate grievance
redressal. Beneficiaries can register their grievances through the CGRMS portal or toll-free
helpline number. Under AB-PMJAY, such grievances are monitored through a three-tier
grievance redressal mechanism at the District, State, and National level. At each level,
designated nodal officers and Grievance Redressal Committees are in place to examine and
resolve the grievances.
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