The policy addresses pending payment cases under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) as of February 6th, 2026. It confirms that the settlement of claims is a regular and uninterrupted process handled by respective State Health Agencies, following claim adjudication guidelines issued by the National Health Authority. The turnaround time for claim settlement is within 15 days for intra-state hospitals and 30 days for portability claims. Funding for AB-PMJAY is demand-driven, with the National Health Authority releasing funds to States/UTs based on actual demand.
Key Entities Referenced
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A health scheme under which pending payment cases are being discussed.
Ministry of Health and Family Welfare: The primary government body responsible for addressing the questions raised in the Lok Sabha.
National Health Authority: The authority that issues claim adjudication guidelines and releases funds for AB-PMJAY scheme implementation.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH ANDFAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1177
TOBE ANSWERED ON 06TH FEBRUARY,2026
PENDING PAYMENTCASES UNDER AB-PMJAY
1177. SMT.RACHNABANERJEE:
Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate:
(a) the total number of pending payment cases under the Ayushman Bharat Pradhan Mantri
Jan Arogya Yojana (AB-PMJAY),asof 1January 2026,State/UT-wise;
(b) the totalamount of funds pendingin the countryfor payment underthe scheme,State/UT-
wise;
(c)whether there are anypendency issues for paymentof such claims; and
(d) if so, the reasons thereof alongwith the number of claims pending since three, six months
andone yearandabove,category-wise?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND
FAMILYWELFARE
(SHRIPRATAPRAOJADHAV)
(a) to (d): 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
30 days in case of portability claims (hospitals located outside State). Further, the funding of
AB-PMJAY is entirely demand driven. National Health Authority releases funds for scheme
implementation tothe States/ UTsonthe basis of the actualdemandreceivedfrom them.
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