Your father is admitted, you carried the Ayushman card, and the hospital desk says the treatment is “not covered” or asks for cash. You can fight this. First call the PM-JAY helpline 14555, then lodge a grievance on the CGRMS portal, and escalate to the State Health Agency if needed.
Quick answer: If an empanelled hospital denies cashless care or demands money, call 14555 right away. Lodge a written grievance on the CGRMS portal at cgrms.nha.gov.in. If it is not fixed in 15 days it escalates to the District and State Grievance Committees. Use RTI to get the written reason for any rejection.
Short on time? Read the step-by-step section and use the sample RTI letter below.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, called PM-JAY, is a government health scheme. It gives eligible families cashless cover of up to ₹5 lakh per family per year for secondary and tertiary hospital care at empanelled hospitals. It was launched on 23 September 2018 and is run by the National Health Authority.
PM-JAY is a centrally sponsored scheme, not an Act of Parliament. There is no “PMJAY Act”. It runs on the scheme guidelines and grievance rules issued by the National Health Authority (NHA), which is an attached office of the Ministry of Health and Family Welfare set up by government notification.
Treatment under PM-JAY is meant to be cashless and paperless at empanelled hospitals. An empanelled hospital should not ask a beneficiary for money for a covered package. If it does, that is a violation you can report.
In 2024 the scheme was widened. The Ayushman Vay Vandana Card was launched on 29 October 2024 to give ₹5 lakh annual cover to all senior citizens aged 70 and above, with no income test.
The NHA runs a three-tier grievance system. Committees sit at District, State and National levels, chaired by the District Magistrate, the State Health Agency CEO and the NHA CEO. Each level has a Grievance Nodal Officer.
Because the NHA and the State Health Agencies are public authorities, the Right to Information Act 2005 applies to them. You can file an RTI under Section 6 to get the written reason for a rejection or a hospital's empanelment status. See the full RTI Act 2005.
Real-life example: Sunita Devi from Patna district took her husband to an empanelled private hospital with their Ayushman card. The desk said his heart procedure was “not in the package” and asked for ₹40,000. She called 14555 from the ward and got a complaint number, then lodged a grievance on CGRMS with the card details and the hospital name. When nothing moved in two weeks, she filed an RTI to the Bihar State Health Agency asking for the recorded reason and the hospital's empanelment status. The written reply showed the procedure was in fact covered. The cashless treatment was approved and her deposit was refunded.
To, The Public Information Officer (CPIO), State Health Agency / National Health Authority, [full office address] Subject: Request for information under the RTI Act 2005 - PM-JAY claim rejection Sir/Madam, Under Section 6(1) of the Right to Information Act 2005, I request the following information regarding my Ayushman Bharat PM-JAY case. My card number: ____________ Hospital name and address: ____________ Date of admission / denial: ____________ 1. The recorded reason for rejecting cashless treatment / the claim in my case, with copies of the relevant file notings. 2. Whether the above hospital is currently empanelled under PM-JAY, and the date and validity of its empanelment. 3. Whether the procedure / package in my case is covered under PM-JAY, with the package code and rate. 4. Action taken on my grievance number ________ filed on CGRMS, with current status and the responsible officer. If any part is held by another authority, please transfer it under Section 6(3) and inform me. I request the reply within the time fixed under Section 7(1). I am eligible for a fee waiver if I am below the poverty line and enclose proof; otherwise I enclose the ₹10 application fee. If the reply is not received in time, I reserve my right of first appeal under Section 19(1). Place: Date: Signature: Name and full address:
If the office gives no reply or an evasive one, you can move a first appeal. Build it with the First Appeal Builder. To draft a fresh RTI fast, try the AI RTI Drafter. If typing is hard, use AwaazRTI voice tool.
No. PM-JAY is a centrally sponsored scheme run by the National Health Authority, not an Act of Parliament. It works on scheme guidelines and grievance rules. The Act you can quote against the NHA or a State Health Agency is the RTI Act 2005, because both are public authorities.
No, not for a covered package. PM-JAY is meant to be cashless and paperless at empanelled hospitals. If a hospital demands money for a covered treatment, call 14555 at once and lodge a CGRMS grievance. Keep every receipt so you can claim a refund.
The national toll-free helpline is 14555. The number 1800-111-565 is also used by the National Call Centre and is linked to the grievance portal. Call before you pay so the refusal is recorded.
On the Central Grievance Redressal Management System (CGRMS) portal at cgrms.nha.gov.in. Register with your card number, the hospital name and what happened. Save the grievance ID. You can also use the central CPGRAMS portal at pgportal.gov.in.
The committee should decide within 30 days. If your grievance is not resolved within 15 days, it is referred up to the District Grievance Redressal Committee, then the State and National committees chaired by the State Health Agency CEO and the NHA CEO.
Yes. Eligible families get up to ₹5 lakh per family per year. Since the Ayushman Vay Vandana Card launched on 29 October 2024, all senior citizens aged 70 and above also get ₹5 lakh annual cover, with no income test.
File an RTI under Section 6 of the RTI Act 2005 to the State Health Agency or NHA. Ask for the recorded reason for the rejection, the hospital's empanelment status, and whether your package is covered. A written reply often forces a stuck or wrong rejection to be corrected.
Keep all bills and receipts. Lodge the grievance on CGRMS and note that you were made to pay for a covered package. Ask, by RTI if needed, whether the package was covered. If it was, push for a refund through the grievance committee.