What to Do Before Visiting the Hospital

Proper preparation can reduce delays in beneficiary verification, medical assessment and package approval.

• Confirm that the Ayushman Card is generated and readable
• Check that the beneficiary’s name and photograph are correct
• Find a currently empanelled hospital
• Confirm that the exact branch accepts PM-JAY beneficiaries
• Check whether the hospital provides the required speciality
• Call the hospital’s Ayushman help desk
• Ask which medical reports are required
• Ask whether an appointment or referral is needed
• Carry an accepted photo identity document
• Carry previous prescriptions, reports and discharge summaries

Step 1: Find an Empanelled Ayushman Hospital

Covered PM-JAY treatment should generally be obtained through a currently empanelled public or private hospital with the required speciality and treatment package.

1. Open the official hospital-search portal at hospitals.pmjay.gov.in.
2. Select the state where treatment is required.
3. Select the district or nearby location.
4. Select the hospital type where the option is displayed.
5. Select the required medical speciality.
6. Enter the hospital name when checking a specific facility.
7. Complete any displayed security verification.
8. Review the hospital-search results.
9. Open the exact hospital branch.
10. Note its address and contact information.
11. Review the available speciality information.
12. Contact the hospital before travelling.

Step 2: Call the Hospital Before Travelling

Calling is especially important for planned surgery, cancer care, cardiac treatment, dialysis, orthopaedic procedures or another speciality-dependent service.

Step 3: Carry the Required Documents

Carry identity and medical documents so the help desk and doctor can complete beneficiary verification and clinical assessment.

Step 4: Visit the Ayushman Help Desk

After arriving, ask for the hospital’s Ayushman, PM-JAY or beneficiary help desk instead of going directly to a billing counter.

1. Tell the staff that the patient is an Ayushman beneficiary.
2. Ask for the Arogya Mitra or authorised PM-JAY representative.
3. Show the digital or printed Ayushman Card.
4. Provide the accepted photo identity document.
5. Explain the patient’s medical problem.
6. Provide prescriptions and diagnostic reports.
7. Ask the representative to locate the beneficiary record.
8. Complete any identity authentication requested.
9. Ask which department or doctor should assess the patient.

What Is the Role of the Arogya Mitra?

The Arogya Mitra acts as an interface between the beneficiary, hospital and applicable PM-JAY processing system.

The Arogya Mitra may assist with:

• Searching for the beneficiary record
• Checking Ayushman Card information
• Supporting beneficiary identity verification
• Explaining the hospital’s PM-JAY process
• Directing the patient to the appropriate department
• Assisting with admission-related documentation
• Supporting package and pre-authorisation processing
• Providing complaint or support-channel information

Step 5: Complete Beneficiary Verification

The hospital must confirm that the patient is the person included in the eligible beneficiary record.

Verification may involve:

• Searching the beneficiary using the Ayushman Card or PM-JAY ID
• Matching the patient’s name and photograph
• Checking age, gender and family information
• Reviewing an accepted photo identity document
• Completing Aadhaar OTP authentication where available
• Completing face or biometric authentication where supported
• Confirming the applicable state or scheme
• Checking whether the beneficiary record is active and usable

Step 6: Complete the Medical Assessment

Beneficiary verification confirms identity, but a qualified medical team must determine whether hospital admission, surgery or another covered treatment is medically necessary.

The assessment may include:

• Review of the patient’s symptoms
• Physical examination
• Review of previous medical history
• Review of prescriptions and diagnostic reports
• Additional tests when medically required
• Confirmation of diagnosis
• Selection of the appropriate treatment plan
• Decision about admission, surgery or day-care treatment

Step 7: Confirm the Treatment Package

PM-JAY treatment is generally processed through an applicable Health Benefit Package rather than through an unrestricted payment for every hospital service.

Ask the hospital to explain:

• The proposed package name
• The package code where available
• The medical condition covered by the package
• The proposed operation or procedure
• Whether hospital admission is required
• Whether pre-authorisation is required
• Which medicines and diagnostics are included
• Whether an implant or device is included
• Whether follow-up services are included
• Which services may fall outside the package

Step 8: Hospital Submits Pre-Authorisation

Some treatment packages require the hospital to obtain approval before planned treatment begins.

The pre-authorisation request may include:

• Beneficiary-verification information
• Diagnosis and medical history
• Doctor’s clinical findings
• Laboratory or imaging reports
• Proposed procedure or treatment plan
• Package name and code
• Medical justification for admission
• Implant or device information where relevant
• Additional documents required by the package

Understanding Pre-Authorisation Status

Step 9: Receive Cashless Treatment

After beneficiary verification and required package approval, covered services should be processed cashlessly according to the approved package.

An approved package may include applicable:

• Hospital registration and admission services
• Doctor and specialist services
• Room or ward charges within scheme rules
• Nursing services
• Operation-theatre charges
• Required ICU care
• Medicines and consumables included in the package
• Required diagnostic investigations
• Approved implants or devices
• Patient food during the approved stay where included
• Applicable pre-hospitalisation services
• Applicable post-hospitalisation or follow-up services

What to Check During Hospital Treatment

The patient or attendant should maintain clear records throughout the hospital stay.

• Confirm the approved package name
• Keep the pre-authorisation reference information where available
• Ask which services are included
• Ask before purchasing medicines outside the hospital
• Ask before arranging tests outside the hospital
• Request written explanations for additional charges
• Keep receipts for every payment
• Record the names of relevant hospital representatives
• Keep copies of consent forms and treatment documents
• Do not hand over original identity documents permanently

Step 10: Complete the Hospital Discharge Process

Before leaving, collect documents explaining the treatment received and the patient’s follow-up needs.

Collect:

• Discharge summary
• Final diagnosis
• Details of surgery or treatment performed
• Medicine prescription
• Follow-up date and department
• Diet and activity instructions
• Warning signs requiring urgent review
• Copies of relevant investigation reports
• Implant or device details where applicable
• Payment receipt for any separately charged service
• Complaint or help-desk information

How Follow-Up Treatment Works

Some approved packages may include specified post-hospitalisation or follow-up services. The exact entitlement depends on the package and applicable scheme rules.

Before discharge, ask:

• Is the next consultation included?
• Are follow-up medicines included?
• Are wound dressing or suture-removal services included?
• Are follow-up diagnostic tests included?
• Where should the patient return?
• Which documents should be carried?
• When does the package-related follow-up period end?

Can You Use the Ayushman Card Outside Your State?

PM-JAY portability can allow an eligible beneficiary to obtain covered treatment at an empanelled hospital outside the home district or state.

1. Search for an empanelled hospital in the destination state.
2. Confirm that the required speciality is available.
3. Call the exact hospital branch.
4. Ask whether portability cases are currently processed.
5. Carry the Ayushman Card and photo identity document.
6. Carry all prescriptions and medical reports.
7. Visit the hospital’s Ayushman help desk.
8. Complete beneficiary verification.
9. Complete medical assessment and package approval.

How to Use the Ayushman Card in an Emergency

During a serious or life-threatening emergency, seek immediate medical assistance. Do not delay urgent care solely to complete an online hospital search or card-download process.

When practical:

• Go to the nearest suitable emergency facility
• Inform staff that the patient is an Ayushman beneficiary
• Ask whether the hospital is currently empanelled
• Ask for the Ayushman help desk
• Provide the card or beneficiary details
• Provide an accepted identity document
• Request beneficiary verification
• Ask whether an applicable emergency package is available
• Keep copies of reports, estimates and bills

What If the Hospital Refuses the Ayushman Card?

Ask the hospital for the exact reason. Refusal may result from a beneficiary mismatch, unavailable package, missing speciality, lack of medical indication or an empanelment issue.

Ask:

• Was the beneficiary record successfully found?
• Did identity authentication fail?
• Is the exact hospital branch empanelled?
• Is the hospital empanelled for the required speciality?
• Does an applicable treatment package exist?
• Was pre-authorisation submitted?
• Was the request rejected or returned for clarification?
• Can the hospital provide a written reason?
• Can another empanelled hospital provide the treatment?

What If the Hospital Demands Money?

Approved covered treatment should be cashless within the applicable package. However, some services, optional upgrades or non-covered items may fall outside the approved package.

Before making payment

1. Ask for the exact approved package name.
2. Ask whether pre-authorisation has been approved.
3. Ask which service is outside the package.
4. Ask whether the charge is for an optional upgrade.
5. Request a written estimate.
6. Request an itemised bill.
7. Speak with the Arogya Mitra or help-desk supervisor.
8. Do not pay unofficial cash without a receipt.
9. Keep copies of all payment documents.
10. Contact the official helpline or grievance portal where necessary.

How to Submit an Ayushman Hospital Complaint

A complaint may be appropriate when an empanelled hospital denies an eligible covered service, demands money for covered treatment, retains the Ayushman Card or does not provide required scheme assistance.

Keep the following evidence:

• Beneficiary name and PM-JAY details
• Hospital name and exact branch
• State and district
• Date and time of the hospital visit
• Department or help-desk information
• Name of the hospital representative where available
• Diagnosis or proposed treatment
• Package or pre-authorisation information
• Written refusal or explanation
• Estimates, bills and payment receipts
• Prescriptions and medical reports
• Photos or screenshots where lawful and relevant

Save the unique grievance or complaint number so that the complaint can be tracked later.

Ayushman Card Hospital Helpline

Beneficiaries who need official PM-JAY support may contact the national toll-free helpline.

Keep the following information ready:

• Beneficiary name
• State and district
• Ayushman Card or beneficiary ID
• Hospital name and exact branch
• Diagnosis or required treatment
• Package name or code, if available
• Pre-authorisation status
• Reason given by the hospital
• Date and time of the incident
• Complaint number, if already registered

Common Hospital Problems and Solutions

1. Beneficiary record is not found

Check the name, state, scheme and Ayushman Card information. Ask the help desk to try another supported beneficiary-search method.

2. Photograph does not match

Use an accepted identity document and check whether an official correction or Redo eKYC process is required.

3. Hospital is listed but the package is unavailable

The hospital may not be empanelled for the required speciality or may not currently provide the specific treatment. Search for another suitable hospital.

4. Pre-authorisation remains pending

Ask whether additional reports, medical justification or beneficiary information have been requested.

5. Pre-authorisation is rejected

Ask for the reason and whether the request can be corrected, resubmitted or replaced with another medically appropriate package.

6. Hospital asks the patient to buy medicines outside

Ask whether those medicines are included in the approved package. Request written instructions and retain every receipt.

7. Hospital asks for outside diagnostic tests

Ask whether the tests are included in the package and why they cannot be provided by the hospital.

8. Hospital says the card balance is unavailable

Ask the help desk to explain the beneficiary’s current coverage and package-booking information through the official system.

9. Hospital retains the original card or document

Request the return of original identity documents and the Ayushman Card before discharge.

10. Hospital refuses to provide a written explanation

Record the date, department and staff details and contact the official helpline or grievance portal.

Important Safety Precautions

• Do not use a non-empanelled hospital without confirming coverage
• Do not share an OTP with an unknown caller
• Do not publicly share the Ayushman Card or Aadhaar image
• Do not pay an agent for guaranteed hospital admission
• Do not pay cash without obtaining a receipt
• Do not purchase outside medicines without asking whether they are covered
• Do not leave original identity documents permanently with the hospital
• Do not sign blank forms
• Do not provide false beneficiary or medical information
• Do not share an ATM PIN, UPI PIN, CVV or banking password
• Do not delay emergency treatment to complete an online search

Frequently Asked Questions

Final Words

To use an Ayushman Card at a hospital, first find a currently empanelled facility with the required medical speciality. Call the exact hospital branch before travelling and carry the card, photo identity document and complete medical records.

At the hospital, visit the Ayushman help desk, complete beneficiary verification and obtain a medical assessment. Ask the hospital to explain the proposed treatment package and pre-authorisation status before planned care.

Approved covered treatment should be processed cashlessly according to the package. Collect the discharge summary and follow-up instructions, and use the official helpline or grievance portal when an empanelled hospital improperly denies service or demands money for covered treatment.