The Pradhan Mantri Jan Arogya Yojana (PMJAY), launched in September 2018 by the National Health Authority (NHA) under the Ayushman Bharat Mission, is the world's largest publicly funded health assurance scheme. As of early 2026, 35+ crore Ayushman Bharat cards have been issued and over 8.7 crore hospital admissions authorised. About 27,000 empanelled hospitals (roughly 45% public, 55% private) deliver care across 1,949 treatment packages under the revised Health Benefit Package 2.2 (HBP 2.2, 2024 revision).

The cover is ₹5 lakh per family per year, on a family-floater basis, with no cap on family size and no upper age limit. It is fully cashless and paperless at the point of care — a beneficiary simply walks in with the Ayushman card (or Aadhaar / ration card / SECC reference for verification) and the hospital raises a pre-authorisation with the State Health Authority (SHA).

PMJAY covers secondary and tertiary care hospitalisation — surgical and medical procedures that require admission. Outpatient consultation, OPD medicines, fertility treatment, organ transplant (initially excluded; now partially covered for cornea/kidney in many states) and cosmetic surgery are generally not covered.

A hospital is “empanelled” when it has signed an MoU with the SHA of the state, agreed to the HBP 2.2 package rates (which are typically 30-50% below private market rates), been graded by NHA's Hospital Empanelment Module (HEM) and assigned specialities it can treat under PMJAY (a hospital may be empanelled for cardiology but not for oncology). Empanelment does not mean every procedure at that hospital is covered — only the listed specialities and HBP codes.

HBP 2.2 (2024) revised the package master to add new procedures (e.g., advanced oncology like CAR-T not yet, but updated chemotherapy regimens, knee replacement, additional cardiac and neuro packages). Each procedure has a unique alphanumeric code:

• C001 — PTCA single vessel single stent (angioplasty)
• C002 — PTCA single vessel double stent
• M002 — Hysterectomy (abdominal)
• O001 — Total hip replacement
• N001 — Craniotomy for brain tumour

The package rate is all-inclusive — bed charges, surgeon's fee, medicines, implants, post-op stay (3-5 days standard), and one follow-up are bundled. The hospital cannot ask for any additional payment from the beneficiary (any “deposit” is a violation of the empanelment MoU).

• Open https://hospitals.pmjay.gov.in
• Click “Find Hospital” on the home page.
• Filter by State → District → Speciality → Hospital Type (Public / Private / Both / All).
• Optional filters: NABH-accredited only, EHCP (Empanelled Health Care Provider) status, hospital name search.
• The list returns: hospital name + address + contact number + email + empanelled specialities + bed strength + NABH/NABL accreditation status.
• Click any hospital → details page shows the HBP code list that hospital is authorised for.

• Free download from Google Play and Apple App Store (search “Mera PMJAY”, publisher: National Health Authority).
• Login via mobile number + OTP.
• Features: check eligibility, view e-card, find empanelled hospital with map view (uses GPS to show nearest first), language support (12 Indian languages).
• Useful when you do not have a laptop and want a quick map-based search.

• Toll-free, 24×7, multilingual (Hindi, English, and 11 regional languages).
• Operator can search hospitals by your district + speciality and read out the top matches, including current cashless-active status.
• Also use this number to: report a hospital that refused cashless, lodge a beneficiary grievance, check pre-authorisation status, ask for help understanding HBP code coverage.
• Alternate number for landline: 1800-111-565 (some states).

Each state runs PMJAY through its SHA, and many states have a parallel state scheme that piggy-backs on the PMJAY infrastructure (so the same empanelled list is reused, often with a higher state cover):

• Maharashtra — Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) at jeevandayee.gov.in
• Odisha — Biju Swasthya Kalyan Yojana (BSKY)
• Andhra Pradesh / Telangana — Aarogyasri (drytrust.org / aarogyasri.telangana.gov.in)
• Tamil Nadu — Mukhyamantri Comprehensive Health Insurance Scheme (CMCHIS) / Makkalai Thedi Maruthuvam
• Kerala — Karunya Arogya Suraksha Padhathi (KASP)
• Rajasthan — Mukhyamantri Ayushman Arogya Yojana (replacing Chiranjeevi)
• Karnataka — Ayushman Bharat-Arogya Karnataka (AB-ArK)

Always check both the central PMJAY portal and your state SHA portal — sometimes a hospital is empanelled under the state scheme but flagged separately from PMJAY central.

Before searching, make sure your family is on the PMJAY beneficiary list. Two ways:

• Open https://beneficiary.nha.gov.in → enter mobile + OTP → enter Aadhaar / ration card / family ID → see status.
• Or call 14555 with your name + father's name + village/town and the operator will check the SECC 2011 / state addition list.

If eligible but no card yet, generate the Ayushman card at any Common Service Centre (CSC), Ayushman Mitra desk in an empanelled hospital, or via the Ayushman App (different from Mera PMJAY — this one is for card creation).

Choose your state → district → the speciality you actually need (don't pick “All” — it returns 80+ hospitals and is unhelpful). The 22 PMJAY specialities include:

Cardiology, Cardio-thoracic & Vascular Surgery, Oncology (Medical/Surgical/Radiation), Orthopaedics, General Medicine, General Surgery, Obstetrics & Gynaecology, Paediatrics, ENT, Ophthalmology, Urology, Neurology & Neurosurgery, Burns Management, Mental Disorders, Plastic Surgery, Polytrauma, and more.

If you already know the procedure name (your treating doctor will tell you), search the HBP master to find the code. The full HBP 2.2 master is downloadable as Excel from pmjay.gov.in → Resources → Health Benefit Packages. The package rate next to the code tells you what PMJAY will pay the hospital — useful so you know in advance the implant grade / room type included.

Many cashless-active private hospitals are graded NABH Pre-Accreditation or NABH Accredited (visible on the portal). NABH grade affects the package rate — a higher grade hospital gets 10-15% more under PMJAY. From a beneficiary's view it is a quality signal.

This is the single most important step. Ring the hospital's PMJAY help desk (every empanelled hospital must have one — ask for “Ayushman Mitra” or “PMJAY desk”). Confirm:

• Cashless is currently active for your speciality (some hospitals temporarily suspend cashless when SHA payment is pending).
• They have authorised the specific HBP code your treatment falls under.
• Bed availability for the speciality ward.
• Documents to carry: PMJAY card / Aadhaar / referral note from a doctor / past medical reports.

• Show your PMJAY card + Aadhaar at the Ayushman Mitra desk.
• Ayushman Mitra raises a pre-authorisation request to the SHA via the Transaction Management System (TMS) portal with diagnosis + proposed procedure + estimated cost.
• SHA medical auditor approves (or asks for clarification) — typically within 6 hours for emergencies, 24-48 hours for planned.
• Once approved, hospital admits you — no deposit, no payment.

• Treatment is delivered as per the package. The hospital cannot demand any extra money for “better implants” or “single room upgrade” without your written consent (and even then, the PMJAY rates apply to the covered service; you only pay any voluntary upgrade).
• On discharge, hospital raises a claim with SHA (within 15 days). SHA pays the hospital directly. You get a discharge summary copy + a patient feedback form (please fill it).

One follow-up consultation is included in the package. Diagnostic tests during follow-up may not be covered — check with hospital. If your case needs a second hospitalisation later (e.g., recurrence), a fresh pre-authorisation is needed; the cover keeps refreshing up to ₹5 lakh per family per policy year.

+------------------------------------+-----------------------------------------+
| Family cover                       | ₹5,00,000 / family / year (floater)     |
+------------------------------------+-----------------------------------------+
| Family size cap                    | None (everyone in SECC 2011 family is   |
|                                    | covered, plus state-added families)     |
+------------------------------------+-----------------------------------------+
| Age cap                            | None — newborn to elder                 |
+------------------------------------+-----------------------------------------+
| Pre-existing diseases              | Covered from Day 1                      |
+------------------------------------+-----------------------------------------+
| Procedures covered (HBP 2.2)       | 1,949+ across 22 specialities           |
+------------------------------------+-----------------------------------------+
| Empanelled hospitals               | ~27,000 (public + private + NGO)        |
+------------------------------------+-----------------------------------------+
| Co-payment by patient              | ZERO (cashless, paperless at PoC)       |
+------------------------------------+-----------------------------------------+
| Pre-authorisation SLA              | Emergency = 6 hrs, Planned = 24-48 hrs  |
+------------------------------------+-----------------------------------------+
| Hospital claim payment by SHA      | 15-30 days from claim submission        |
+------------------------------------+-----------------------------------------+
| OPD / outpatient                   | NOT covered (admission required)        |
+------------------------------------+-----------------------------------------+
| Card cost                          | FREE — never pay anyone for the card    |
+------------------------------------+-----------------------------------------+
| Helpline                           | 14555 (24x7, multilingual)              |
+------------------------------------+-----------------------------------------+
| RTI fee (NHA / SHA)                | ₹10 by IPO; BPL = free                  |
+------------------------------------+-----------------------------------------+

• Hospital is “empanelled” but the specific package you need is not on its authorised list. Always confirm the HBP code at the Ayushman Mitra desk before admission.
• Hospital has temporarily suspended cashless because SHA payments are pending. Common in private hospitals, especially mid-financial year. They will say “please pay cash, we'll reimburse” — that is not how PMJAY works; do not pay. Find another hospital or escalate.
• Private hospital demands a “deposit” pre-admission — strictly against the empanelment MoU. Refuse, ask for the Ayushman Mitra, and call 14555 from the hospital lobby.
• Pre-authorisation delayed beyond SLA — usually because clinical justification was incomplete. Ask the hospital to resubmit with stronger notes; escalate to SHA grievance helpline.
• Family list (SECC 2011) doesn't include the claimant — happens for newly added family members (newborn, daughter-in-law). Use the Family ID linkage option in the beneficiary portal to add. State SHA helpline can guide.
• Wrong card details (name spelt wrong, photo mismatch). Re-issue free at any CSC.
• Tertiary care exclusions — some procedures (organ transplant, advanced oncology like proton therapy) may be partially or not covered. Check the HBP master.
• OPD treatment refused under PMJAY — correct; OPD is not covered. For OPD/diagnostic, look at state schemes (e.g., Mohalla Clinics in Delhi, Aam Aadmi Mohalla Clinics elsewhere) or AB-HWC (Ayushman Bharat Health and Wellness Centres) for primary care.

The first point. Every empanelled hospital must have one. Ask for the desk in-charge by name; get a written acknowledgement of your complaint.

24×7, free, multilingual. They open a beneficiary grievance ticket with the SHA. Note your complaint reference number.

Every SHA has an online complaint portal — links from hospitals.pmjay.gov.in → “Grievance”. Submit with hospital name, date of admission attempt, exact reason for refusal. SLA: 15 days.

Each district has a DIU under the SHA, headed by a District Programme Coordinator (DPC). Walk-in or written complaint to DIU usually triggers a hospital-level inspection within a week.

• State Health Minister grievance cells (every state has one — Twitter / portal / phone).
• CPGRAMS at https://pgportal.gov.in → Ministry of Health and Family Welfare → National Health Authority. Higher visibility; usually gets routed to the SHA CEO.

The NHA in New Delhi and every State SHA are public authorities under §2(h) of the RTI Act, 2005.

RTI helps here when:

• You want a written confirmation that a particular hospital is empanelled, since when, for which specialities, and for which HBP codes — RTI to PIO at SHA gives the empanelment MoU date and authorised speciality list.
• Your pre-authorisation was rejected and you want the clinical reason in writing — RTI to PIO SHA for the TMS rejection log entry against your case ID.
• A claim was raised by the hospital but the hospital later asked you to pay cash — RTI to PIO SHA to confirm whether the claim was approved/paid (often it was, and the hospital is double-dipping).
• Hospital insists “PMJAY payments are pending so cashless is suspended” — RTI to PIO SHA for the latest payment cycle to that hospital and the official suspension notice (if any).
• You suspect a hospital is denying admission to PMJAY beneficiaries while accepting paying patients — RTI to PIO SHA / DIU for inspection records and complaint history.

For a full copy-ready template covering claim denial / cashless refusal cases, see the dedicated guide: RTI for Ayushman Bharat claim denial — copy-ready template.

RTI does NOT help here when:

• The hospital is not empanelled and you want to force them to admit you under PMJAY — empanelment is voluntary; RTI cannot create an MoU.
• A private hospital simply chooses not to admit you (bed-availability, doctor preference, commercial decision) — that is private contract territory; not an RTI matter unless you can show discrimination.
• Your treatment is not in the HBP 2.2 master (e.g., elective cosmetic surgery, fertility treatment) — RTI cannot extend the cover.
• You want a clinical second opinion — RTI is for “information held”; it cannot give medical opinions.
• For broader complaints about hospital service quality — go to the state Clinical Establishments Act registrar / NABH; RTI is a secondary lever.

Q. My PMJAY card was issued in Lucknow. Can I use it for treatment in Mumbai?
Yes. PMJAY is portable nationwide. Any empanelled hospital in any state will accept it. The Ayushman Mitra at the destination hospital will verify your details on the central TMS portal — Aadhaar OTP is enough.

Q. Is OPD consultation covered under PMJAY?
No. PMJAY covers only inpatient hospitalisation (secondary and tertiary). For OPD, look at primary health centres, Ayushman Bharat-Health and Wellness Centres (AB-HWCs, ~1.7 lakh nationwide) or your state's free OPD scheme.

Q. Are diagnostic tests covered?
Pre-admission tests up to 3 days before admission and follow-up tests up to 15 days after discharge for the same hospitalisation are bundled into the package rate. Standalone diagnostics on OPD basis are not covered.

Q. The hospital is empanelled but says cashless is “off this week”. What do I do?
This usually means the SHA has stopped reimbursing that hospital for some reason (audit query, billing dispute). Three options: (a) call 14555 to confirm the official status; (b) try another empanelled hospital in your district; © if it's an emergency, get admitted, document the refusal in writing, file a complaint to SHA + RTI for the suspension notice.

Q. My family is not on the SECC 2011 list. Am I excluded forever?
No. Many states have expanded eligibility beyond SECC 2011 — for example, all ration card holders in Rajasthan, all citizens up to a threshold in Haryana under “Chirayu”, etc. Check your state SHA portal. Also, the central PMJAY recently extended cover to all senior citizens above 70, regardless of SECC inclusion.

Q. My PMJAY card is showing wrong details. How to correct?
Visit any CSC or empanelled hospital's Ayushman Mitra desk with original Aadhaar and the corrected detail (name spelling, photo). Re-issue is free.

Q. Is there a cap on the cost of one procedure?
The cost is capped at the HBP package rate for that procedure (e.g., angioplasty single stent ~₹40k-₹80k depending on hospital grade). Multiple procedures can be billed up to the family annual limit of ₹5 lakh.

• RTI for Ayushman Bharat claim denial — copy-ready template
• RTI in 12 simple steps — for first-time filers
• All Indian government helplines — one master directory
• RTI forms + state-wise fee chart
• All "health & hospitals" RTI guides

Last reviewed: 26 April 2026 by RTI Wiki editorial team. PMJAY Health Benefit Packages (HBP) and SHA-level empanelment lists change continuously — verify the latest on hospitals.pmjay.gov.in and your State SHA portal, or write to admin@bighelpers.in if you spot a stale figure.