How to pay hospital bills using Ayushman Bharat scheme?

Hello,

Ayushman Bharat PM-JAY is primarily a cashless healthcare scheme for eligible beneficiaries. For covered hospitalisation at a PM-JAY empanelled hospital, you generally do not pay the hospital bill upfront and then claim reimbursement. Instead, the hospital processes the approved package with the scheme, subject to eligibility, package rules and authorisation.

It is important to distinguish between an Ayushman Card and an ABHA number. Your Ayushman Card is used for PM-JAY eligibility and covered treatment, while ABHA is a digital health account and does not itself provide free treatment or pay hospital bills.

How to Avail Cashless Hospital Treatment

• Find a PM-JAY empanelled government or private hospital.

• Visit the hospital's Ayushman Bharat/Ayushman Mitra helpdesk.

• Show your Ayushman Card and required identity documents.

• The hospital will verify your PM-JAY eligibility through the scheme system.

• Tell the Ayushman Mitra about the treatment or surgery you require.

• The hospital will check whether the required treatment is covered under an applicable PM-JAY package.

• Where required, the hospital will complete the pre-authorisation process.

• Once approved, the covered treatment is provided according to the applicable package.

• The hospital submits the eligible claim to the scheme rather than asking you to pay the covered amount upfront.

PM-JAY packages can include treatment-related components such as hospitalisation, medicines, diagnostics, surgery and other services, depending on the specific approved package.

What About OPD, Pharmacy or Other Bills?

Do not assume that every OPD consultation, medicine, laboratory test or pharmacy purchase is automatically free with an Ayushman Card. PM-JAY coverage is primarily package-based and linked to covered services and hospitalisation.

Some hospitals may separately offer digital payment facilities through ABDM-enabled systems. These are payment facilities and should not be confused with PM-JAY cashless treatment.

If a hospital provides an ABDM-enabled digital payment facility, you be able to

• Use an ABHA-compatible personal health record application.

• Scan the hospital's ABDM QR code, where available.

• Receive a digital token or access your hospital services.

• View eligible bills generated through the hospital's digital system.

• Pay applicable OPD, laboratory or pharmacy charges electronically.

• Receive a digital payment receipt.

However, availability of these features depends on whether the particular hospital has implemented the relevant ABDM digital services.

Documents You Should Carry

Keep these documents ready

• Ayushman Bharat PM-JAY Card

• Aadhaar Card or another accepted identity document

• Beneficiary identification details

• Doctor's prescription or consultation papers

• Previous medical reports

• Previous discharge summary, if applicable

• Diagnostic reports such as X-ray, CT, MRI or blood tests, where relevant

Important Points to Remember

• Ayushman Card treatment is not the same as insurance reimbursement.

• For an approved covered package, treatment is generally provided on a cashless basis at an empanelled hospital.

• Every hospital is not necessarily empanelled under PM-JAY.

• Every medical service or hospital bill is not automatically covered.

• Confirm the specific procedure/package with the hospital's Ayushman desk before admission.

• Confirm whether any item or service is outside the approved package before making a payment.

• ABHA and Ayushman Card are different: ABHA is a digital health identity/account, while PM-JAY provides eligible beneficiaries with coverage for specified healthcare packages.

How to Check Your Hospital

• Visit the official PM-JAY hospital search portal.

• Select your State and District.

• Search for the hospital by name.

• Check that its PM-JAY empanelment is active.

• Check whether the required specialty is available.

• Ask the hospital's Ayushman desk whether your specific treatment is covered.

• Confirm the package, pre-authorisation requirements and cashless process before admission.