May 5, 2026 · 3:45 PM
The National Health Authority has released Q4 FY2026 data showing claim settlement time improved from 148 days to 112 days on average. However, hospitals in UP still report waits exceeding 180 days, and three major hospital chains in Delhi have suspended PM-JAY services pending payment.
Apr 30, 2026 · 11:00 AM
Following NT's report, the Parliamentary Standing Committee on Health has written to the NHA seeking state-wise claim rejection data. The NHA has 21 days to respond. This is the first time a parliamentary committee has specifically requested rejection-rate data by state.
Ayushman Bharat PM-JAY, launched in September 2018, promised cashless hospitalisation of up to ₹5 lakh per year to India's 50 crore poorest citizens. By March 2026, the National Health Authority had issued 55.4 crore beneficiary cards — but data obtained through an RTI filed by NT shows that only 8.4 crore of those cards have ever been linked to a claim, and of those, only 2.1 crore claims have been fully processed and settled.
“The card issuance number tells you about government reach. The claim settlement number tells you about actual healthcare delivery. These two numbers should be much closer together.”
— Dr. K. Srinath Reddy, President, Public Health Foundation of India
Ayushman Bharat — The Utilisation Gap
- 55.4 crore beneficiary cards issued (March 2026)
- 8.4 crore cards ever used for a claim (15.2% utilisation)
- 2.1 crore claims fully processed and settled
- Average claim rejection rate: 26% nationally
- Highest rejection: Uttar Pradesh (44%), lowest: Kerala (18%)
- 1,929 procedures covered; 72% of claims are for just 6 common procedures
Why Beneficiaries Are Not Using the Scheme
NT's investigation, which included interviews with 80 beneficiaries across Bihar, UP and Andhra Pradesh, identified three primary barriers. First, information gaps — 38% of surveyed beneficiaries did not know which hospitals near them were empanelled under PM-JAY, and 24% had been turned away by a hospital that was listed on the NHA portal but had surrendered its empanelment. Second, non-coverage of outpatient treatment means the scheme only activates on hospitalisation — leaving the majority of healthcare expenditure, which is outpatient, uncovered. Third, hospitals report NHA payment delays of 90–180 days, causing many private empanelled facilities to informally discourage PM-JAY patients.
55.4Cr
Cards issued
15.2%
Utilisation rate
26%
Claim rejection rate
₹5L
Annual cover per family
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Sunita Verma
Health & Policy Reporter
Sunita covers public health policy, hospitals and government health schemes from New Delhi.