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  भारत सरकार  GOVERNMENT OF INDIA

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PM-JAY FAQs

The TMS application is only available in English

Yes. There is no limit of family size. The neonate will be provided care provided the benefit limit is not exhausted and the neonate is added to a family with at least one PMJAY verified beneficiary

Patient mortality details may be updated in the TMS application and discharged. Payment for the services provided will be determined by the ISA/TPA after verifying the documents.

The beneficiary has to provide NHPM-ID / Ration Card / Mobile Number / Aadhaar / Other Valid Identity Proof to the Medco or AM. The details of the beneficiary if available in the BIS will be retrieved in TMS for case registration.

This provision is currently not built in TMS. The beneficiary can be re-registered correctly after discharging or cancelling registration in TMS.

Yes. If beneficiary wants an upgrade in room the all expenses for treatment will not be covered under PMJAY scheme. Admission to ICU for specified packages is allowed

No. Under PMJAY, medicines will be included in the package for the duration of treatment

No, IP and OP cases will have different registration numbers.

As of now MEDCO cannot. Currently, TMS application and HEM application have separate login IDs.

Yes, the hospital can claim if the patient has undergone treatment but does not survive. The same would be subject to verification / approval of the CPD.

The hospital is required to maintain complete confidentiality of patient information and must not be shared to unauthorized persons. For further details please refer to detailed guidelines

No. Only those specialties specified in the hospital empanelment module will be visible in the TMS.

This will be handled on a case to case basis and the required process will be escalated for resolution within the grievance framework.

Yes – Grievances against the Arogya Mitra can be escalated to the District Grievance Nodal Officer.

A dedicated Grievance Redressal Committee will be appointed at district, state and national level and all grievance will be addressed within a period of 30 days.

There is no provision of payment of transportation charges under the scheme.

Yes. There is no limit of family size. The neonate will be provided care provided the benefit is not exhausted

Normal Labour and delivery, including high risk deliveries, C-sections and associated treatments are covered under PMJAY. But JSY and another voucher scheme benefit are not given under PMJAY

No. Under PMJAY, medicines will be included in the package for the duration of treatment, including up to 15 days after discharge from hospital, as needed.

Yes. PMJAY benefits will be available from Day 1 of the roll out of the scheme for inpatient hospital care. Any inpatient hospital care for pre-existing diseases will be covered. However, OPD will not be covered.

Any surgery that is not in the package will need to be pre-authorized after which the price will be negotiated between the hospital and SHA/IC and then the procedures can be planned. This is capped to an amount of Rs 1 lakh. This option is available for surgical procedures only.

Any outpatient care, drug rehabilitation, cosmetic treatments, organ transplants and fertility treatment are not covered.

Need to codify enhancements- Days, Surgery+Surgery, Medical+Surgery

Yes. The hospital can challenge the decision in writing to the ISA/TPA. If the issues are not resolved, the same may be brought to the attention of grievance redressal committee.

Patient will not be able to receive the benefits; However, he can utilize the same for next visit.

Patient should be discharged in TMS and relevant information may be updated in the discharge summary

When Medico legal case is added as Yes, the police station number is mandatory but legal case number is optional. Both should not be mandatory

Patient mortality details may be updated in the TMS application and discharged. Payment for the services provided will be determined by the ISA/TPA after verifying the documents.

The information will need to be informed to the SHA in writing. The hospital will either be permitted to update the information through HEM portal or will be updated in backend by the SHA/ISA/TPA

No. Only those specialties specified in the hospital empanelment module will be visible in the Transaction Management Software

The new Doctor's information should be informed to ISA/IC in writing immediately after joining. If there is technical delay in updating the Doctor's information in TMS, "others" option may be selected from the doctor list in TMS. But it should only be used as a contingency option.

No, IP and OP will have different registration number.

Yes, we can use the QR code, or we can use the HHID

The state will work in trust mode until new Insurance company is on board for, the scheme.

States can explore the option of group tendering.

Need to set up a standard definition on HDU/ICU for effective settlement of claims

Government has stopped its policy for posting an all India partner

The packages rate applicable in the State where the hospital is situated will be applicable in case of portability

The home state where the benficiary originate from will pay for the treatment expenses

Treatment may be provided as per the guideline issued by NHA on usage of TMS in intermittent / poor connectivity locations

The patient may contact the toll-free helpline number 14555 for support or reach out to the Ayushman Mitra in the hospital. 

As a part of hospital empanelment process, hospitals must agree to the pre-fixed package rates, and it cannot be changed during the contract period.