RTI for Ayushman Bharat Hospital Denial and PMJAY Treatment Records

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.

• PMJAY Operational Guidelines issued by NHA.
• Tripartite Agreement between NHA, SHA and the empanelled hospital, clause on patient acceptance.
• RTI Act 2005, Sections 6 and 7(1), including the 48-hour life-and-liberty proviso.
• Article 21 of the Constitution, right to health (per Paschim Banga Khet Mazdoor Samity v State of West Bengal (1996)).
• Clinical Establishments Act 2010 (where applicable).

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.

1. Identify the right PIO. Three layers: (1) NHA, Indian Habitat Centre, New Delhi; (2) SHA of your state; (3) District Implementing Unit (usually under the Chief Medical Officer).
2. Pin the visit. PMJAY ID, hospital name and code, date and time of attendance, OPD card or token, package code if known, treating doctor.
3. Use the body's own redressal first. PMJAY helpline 14555 / 1800-111-565, SHA grievance portal, pmjay.gov.in grievance.
4. Draft the RTI asking for the empanelment status, the pre-auth trail, the denial noting, the SECC eligibility entry and the SHA grievance file.
5. Mark life-and-liberty if applicable, when treatment is being delayed for a serious condition, invoke the 48-hour proviso.
6. Pay ₹10 fee through online RTI or IPO.
7. Wait 30 days (or 48 hours).

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]

• Filing only with the hospital. Empanelled private hospitals are not directly RTI-amenable. Address NHA / SHA.
• Using the wrong card. PMJAY family ID, e-card and Ayushman Bharat Health Account (ABHA) are different. Identify the right one.
• Forgetting the SECC link. Many denials are due to “name not in beneficiary list”. Ask for the SECC link and the grievance route under Additional Beneficiary mechanism.
• Asking for “package upgrade”. PIO cannot upgrade. Ask for the package code rule and the pre-auth approver's reasoning.
• Skipping helpline 14555. Often resolves in hours; RTI is the backup.

• No reply in 30 days (or 48 hours) → First Appeal under Section 19(1).
• PMJAY grievance escalation → SHA appellate authority, then NHA grievance cell.
• Writ in High Court under Article 21 for denial of life-saving treatment.
• Consumer complaint for paid services after denial, if you paid out of pocket despite eligibility, you can seek refund through the SHA grievance cell or consumer commission.

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.

• National Health Authority: nha.gov.in
• PMJAY portal: pmjay.gov.in
• Ministry of Health and Family Welfare: mohfw.gov.in
• RTI Online: rtionline.gov.in
• CPGRAMS: pgportal.gov.in

Last reviewed: 9 May 2026.

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