Ayushman Bharat (PMJAY) claim denied — RTI

Ayushman Bharat (PMJAY) claim denied — RTI — RTI Wiki

Direct answer. File RTI to State Health Agency (SHA) / NHA. Ask eligibility status, hospital pre-auth records, treatment claim status, reason for denial, projected release.

  • Ayushman Bharat PMJAY Guidelines 2018.
  • NFSA framework — eligibility linkage.
  • SECC 2011 — beneficiary base.

5 questions to ask

  1. Eligibility (SECC-linked).
  2. Pre-auth records.
  3. Claim status.
  4. Denial reasons.
  5. Projected release.

Template

To: The Public Information Officer, State Health Authority
Subject: Application under §6 RTI Act 2005 — PMJAY claim status

My PMJAY beneficiary ID [..] claim [..] is pending/denied. Please furnish (1) eligibility, (2) pre-auth, (3) claim status, (4) denial reasons, (5) projected release.

Fee: Rs.10 by IPO/cash.

Common mistakes

  • Filing only at hospital — file at SHA + NHA.
  • Skipping eligibility proof chain.

Case law anchors

  • CIC/NHA/A/2019/000234 — PMJAY status disclosable.
  • Right to Health jurisprudence (SC).

Pro tips

  • Use beneficiary.nha.gov.in for status.
  • Pair with CM health-grievance cell.

FAQ

  • Q: Out-of-pocket payment — reimbursable? In emergencies; RTI for policy.
  • Q: State-specific augmentation? Many states add top-up; RTI for scheme.

Sources

  1. PMJAY Guidelines 2018. NFSA 2013. SECC 2011.

Last reviewed: 25 April 2026.

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