Pradhan Mantri Jan Arogya Yojana (PMJAY) is administered by the National Health Authority (NHA) at the centre and State Health Agencies (SHAs) at the state level. Empanelled hospitals must accept eligible beneficiaries cashless for the listed package, refusal is contractually and legally disallowed. An RTI under Section 6 of the RTI Act 2005 to NHA, the SHA and the District Implementing Unit normally produces the empanelment status, pre-auth trail, denial endorsement and grievance file within 30 days.
Use this guide if (a) an empanelled hospital denied cashless treatment despite a valid PMJAY card; (b) the hospital downgraded the package or asked you to pay; © pre-authorisation was rejected without reasons; (d) the SHA's grievance cell is not responding; (e) you want the SECC eligibility entry that links your name to PMJAY; (f) you want to know whether the hospital is even on the empanelled list.
The CIC has held in Anand Saxena v NHA (CIC, 2021) and similar cases that pre-authorisation logs, package code mapping and empanelment records are disclosable to the patient.
To, The Public Information Officer, [National Health Authority / State Health Agency / District Implementing Unit] [Full address] Subject: RTI under Section 6 regarding denial of cashless treatment under PMJAY at [Hospital name and code], dated [DD/MM/YYYY] Sir / Madam, I, [Full name / patient relationship], a citizen of India and a PMJAY beneficiary holding card / family ID [number], request the following under the RTI Act 2005. Fee of Rs. 10 paid online / by IPO. In respect of the visit / admission of patient [Name] at [Hospital name and code] on [DD/MM/YYYY]: 1. Whether the hospital is on the PMJAY empanelment list as on that date, with effective date of empanelment. 2. Package code(s) corresponding to the diagnosis / procedure noted on the OPD or IPD record. 3. Pre-authorisation log: requests filed, reasons for rejection or downgrade, and SHA approver's noting. 4. Denial endorsement on the OPD card / admission slip and the reason recorded in writing. 5. Whether any payment was demanded; if so, the receipt number. 6. SECC eligibility entry linking my name to PMJAY for the present family ID. 7. Standard Operating Procedure for cashless treatment under PMJAY at empanelled hospitals. 8. Status of any grievance filed by me against the hospital, including ticket number, present custodian and reasons recorded. 9. Penalty action, if any, taken against the hospital under the Tripartite Agreement. [If applicable: This is a life-and-liberty matter under the proviso to Section 7(1); reply is sought within 48 hours.] I invoke Section 10 (severability). I undertake to pay further fee under Section 7(3). Yours faithfully, [Signature, name, date]
No. The Tripartite Agreement and PMJAY Operational Guidelines require acceptance for the listed package. Refusal is grounds for action by SHA, including suspension and recovery of penalty.
Ask via RTI for the additional-beneficiary route notified by your state, and for the grievance file. Many states permit Antyodaya, BOCW and other identity proofs.
No directly, but a parallel writ under Article 21, backed by the RTI denial endorsement, has worked in many High Courts.
Yes, it is a registered society under DA&FW, financed entirely by the central government, with a designated CPIO.
The pre-auth trail, package code, denial endorsement, treatment records and bills. With death certificate and relationship proof.
Generally no, unless substantially financed. But under PMJAY, their conduct is regulated through SHA, which is the public authority.
Yes. NHA publishes it on pmjay.gov.in; if outdated, RTI to NHA / SHA gives the live list.
Last reviewed: 9 May 2026.