Quick Reply: If a hospital has refused you cashless treatment, go straight to the denial guides — refusal by an empanelled hospital is itself actionable. PM-JAY gives ₹5 lakh of cover a year per family; the card proves it, and the complaint routes below enforce it.
Direct answer. Three things get confused and are worth separating. PM-JAY is the health cover — ₹5 lakh per family per year for listed secondary and tertiary hospitalisation. The Ayushman card is how you prove entitlement to it. ABHA is a digital health ID and is not health cover at all. Most problems readers bring here are refusals at the hospital counter, which the guides below treat as a records-and-escalation problem.
PM-JAY, run by the National Health Authority, covers listed hospital packages up to ₹5 lakh per family per year, with no cap on family size or age within eligible families. Since late 2024 a second door has been open: Ayushman Vay Vandana gives every senior citizen aged 70 and above the same ₹5 lakh cover on an individual basis, regardless of income — so a family that does not qualify otherwise may still have a covered parent. Two practical facts settle most counter arguments: an empanelled hospital cannot demand money from you for a covered package, and treatment under the scheme cannot be refused for want of a “village verification” the hospital itself can run online. Your status can be checked with a mobile number at beneficiary.nha.gov.in, at a CSC, or through the Ayushman app.
An empanelled hospital refusing cashless treatment is not the end of the matter, and the paperwork trail is what decides it. Keep the admission slip, the pre-authorisation request number, the refusal in writing if you can get it, and the discharge summary. The ladder runs hospital Ayushman Mitra desk → district health authority / state health agency → the National Health Authority's grievance channel — and each guide below walks it with the exact records to carry.
It covers the listed packages — the treatment costs the package rate includes. Consumables and non-covered items are the usual fight; the pre-authorisation record shows exactly what was approved, which is why you keep it.
Yes, the scheme is portable across empanelled hospitals nationally. Your eligibility travels with your Aadhaar-linked verification at the counter.
No. The app, the beneficiary portal, a CSC or the hospital's Ayushman Mitra desk all do the same job — any one of them can verify your eligibility and issue the card.
If a department has the record you need and will not hand it over — a claim file, a treatment authorisation, an empanelment record — an RTI application is the route that forces the question. Start with the RTI application format, and if the reply does not come or does not answer, the first appeal is the next step. Worked denial examples are in The RTI Playbook.