1. Visit beneficiary.nha.gov.in → Login → enter Mobile Number → OTP.
2. Search by Aadhaar OR Name + Father's Name + State OR Ration Card Number.
3. If eligible, your family's details show with Rs. 5 lakh coverage indicator.
4. Click Download e-Card — PDF with Aadhaar-OTP-protected card.
5. For hospital admission: present e-card or PMJAY ID to the Pradhan Mantri Aarogya Mitra at the empanelled hospital. Cashless treatment via TPA.
6. For claim status post-discharge: ask hospital for the claim ID. State Health Agency (SHA) tracks claims; typical settlement 30-90 days.
7. If not in eligibility list, check State Health Agency for additional state-only schemes (Mukhyamantri Jan Arogya, etc.).

What we hear from RTI Wiki users: Geeta, a 38-year-old domestic worker in Mumbai, took her father (heart attack) to a PMJAY-empanelled hospital. Hospital claimed her father wasn't eligible despite SECC inclusion. Discharge bill: Rs. 1.4 lakh. She filed an RTI to State Health Agency Maharashtra under §6 asking (a) father's eligibility status, (b) hospital empanelment criteria, © why pre-auth was rejected, (d) appeal mechanism. Reply in 24 days confirmed eligibility and revealed hospital had wrongly classified the case as “non-emergency”. Reimbursement of Rs. 1.2 lakh processed in 35 days.

• Not in SECC 2011 — primary eligibility base. Some states added post-SECC categories (e.g., Maharashtra added construction workers). Check state-specific.
• Aadhaar-mobile mismatch — family verification fails. Fix: link Aadhaar with mobile via UIDAI.
• Hospital not empanelled for that procedure — check hospitals.pmjay.gov.in for procedure-wise list.
• Pre-authorisation rejected — hospital didn't submit pre-auth on time, or TPA rejected. Fix: appeal via SHA.
• Treatment not in PMJAY package list — only listed procedures covered (1,800+ packages). Check at hospitals.pmjay.gov.in.
• Annual cap reached — Rs. 5 lakh/family/year used up. Reset on April 1.
• Migration / cross-state — PMJAY allows portability (treatment in any state with home-state card), but some hospitals don't recognise portability. RTI for SHA portability policy.

• ABHA ID (Ayushman Bharat Health Account) is a separate health-record ID — different from PMJAY. Get free at abha.abdm.gov.in.
• Pradhan Mantri Aarogya Mitra (PMAM) at every empanelled hospital — they verify eligibility + pre-auth on the spot. Always go to PMAM first.
• Reimbursement (post-payment) claims are possible if you paid first — file with SHA within 30 days of discharge with all bills + hospital empanelment proof.
• State top-ups — Maharashtra, Punjab, MP add their own state schemes layered on PMJAY (e.g., Maharashtra MJPJAY adds Rs. 1.5 L extra). Check state-specific.
• Senior Citizens (70+) — universal coverage announced 2024; no SECC requirement. Apply at beneficiary.nha.gov.in.

PMJAY: 14555 (24/7 toll-free) · State Health Agencies have own helplines · WhatsApp: 9223141414 · webmaster@nha.gov.in

The official SLA on this service is published. If your status is stuck beyond it, you have a statutory right under §6 RTI Act 2005 to demand information from the public authority. Reply mandatory in 30 days.

File an RTI to: State Health Authority (SHA) + National Health Authority (NHA)

Ask these 5 questions:

1. eligibility (SECC-linked)
2. hospital pre-auth records
3. claim status
4. denial reasons
5. projected release

→ Use our free AI RTI Drafter to generate a complete §6(1) application in 60 seconds. The Drafter pre-fills your name, address, fee statement, and the 5 questions above.

→ Or speak it in हिन्दी / English / 9 other Indian languages via AwaazRTI.

→ For deeper case-law on this scenario: Read the full RTI guide for ayushman bharat claim.

• Q: How to check if I'm eligible without going online? — Call 14555 with your Aadhaar number — they'll check and confirm.
• Q: Is treatment fully cashless? — Yes for empanelled hospitals on listed packages. Some non-package items (specific imports, super-luxury room) may have co-pay.
• Q: What if my hospital demands payment? — Refuse + insist on PMAM contact. If they still insist, file complaint with SHA + RTI for hospital empanelment terms.
• Q: Is dental and OPD covered? — OPD generally NOT covered. Dental only for accident-related, not routine. Mental health limited.
• Q: Senior citizens 70+ — what to do? — Universal coverage announced 2024. Apply at beneficiary.nha.gov.in with Aadhaar; no SECC requirement.

To check status: use the official portal listed above with your reference number. SLA is published; if stuck beyond it, file a free RTI.

• If status is normal → wait the published SLA, then download/use your document
• If status is delayed → click 🪄 AI RTI Drafter now; complete §6 application in 60 seconds
• If status is rejected → demand reasons under §4(1)(d) RTI Act; appeal/represent
• For state-specific guidance → see state-by-state guide

• 🪄 AI RTI Drafter — type problem, get §6 application
• 🎤 AwaazRTI — voice-to-RTI in 11 Indian languages
• 🔮 Outcome Predictor — score your draft's win-likelihood
• ⚖️ First Appeal Generator — §19(1) draft on Day 31
• 📬 PIO Reply Checker — analyse evasive replies
• 📅 Timeline Calculator — track 30-day window
• 💰 Fee Calculator — state-wise fees
• 🔍 RTI Research — AI Q&A from this site

• Master guide: Full RTI for ayushman bharat claim
• State-by-state: Pick your state
• Citizen RTI playbook: All 100+ scenarios
• The RTI Act 2005: Complete guide
• All status-check guides: All 25 status-check pages

• RTI Act 2005 §§6, 7, 19
• Official portal (linked in Quick Facts)
• Statute referenced in Quick Facts

Last reviewed: 25 April 2026.