Public awareness · Ayushman Bharat / PM-JAY / MJPJAY
Know your cover.
Ask with confidence.
Ten common misconceptions about cashless care, explained for patients, families and healthcare workers in Nagpur.
Official sources checked 9 September 2026. Package lists and eligibility processes can change.
Misconception 01
“An ABHA card means all treatment is free.”
An ABHA number is a digital health identifier. It is different from a PM-JAY entitlement card. Creating an ABHA number alone does not grant insurance or free treatment.
Which question helps distinguish the cards at the help desk?
Ask whether the document identifies your health records or establishes eligibility for a treatment-benefit scheme. Then request the relevant beneficiary check. Keep the ABHA question separate from the hospital’s package and authorisation process.
Misconception 02
“Ayushman Bharat pays every medical bill.”
PM-JAY supports eligible people’s covered secondary and tertiary hospital care, subject to scheme rules and available cover. It is not an unlimited promise for every service, at every hospital. Ask which scheme and treatment package apply.
Government explanation of PM-JAY ↗
How can a family get a clearer answer about a proposed admission?
Ask the scheme desk to identify the applicable scheme, treatment package and approval stage. Write down the explanation and reference provided. Use the official help route below if the answer remains unclear rather than assuming that a card alone settles coverage.
Misconception 03
“I can use it at any hospital for any specialty.”
Use the official list of empanelled hospitals and check that the required specialty and package are available. This website’s hospital directory is not proof of scheme empanelment. The Ayushman or Aarogyamitra desk can help confirm the appropriate facility.
Maharashtra · network hospitals and specialties ↗
What should be checked before travelling to a hospital for scheme treatment?
Confirm the hospital’s current participation and the relevant treatment or specialty with the official scheme resources and hospital desk. Also ask about the admission process and documents. A listing in this project’s general hospital directory is not proof of scheme empanelment.
Misconception 04
“Every OPD visit and test is covered.”
The PM-JAY hospital benefit should not be confused with universal outpatient cover. Listed day-care procedures can qualify without an overnight stay. Tests, medicines and follow-up must be assessed under the relevant package and its conditions; other public health services may offer separate benefits.
AIIMS · package and benefit guide ↗
What should someone ask when a consultation or test is prescribed?
Ask whether it belongs to an approved covered treatment episode or is being offered separately. Request a clear explanation of any charge before proceeding where practical, and use the official scheme channel to resolve conflicting coverage information.
Misconception 05
“Every family member gets a separate ₹5 lakh in cash.”
The standard PM-JAY benefit is up to ₹5 lakh per eligible family per year, shared on a family basis. It is cashless treatment cover, not money handed to the patient. Special rules apply to senior citizens aged 70 and above.
Official benefit description ↗
How can a family check the available benefit for a new treatment?
Request the current entitlement and utilisation information from the authorised scheme channel. Ask how the proposed package relates to the remaining cover. Keep the official response or reference so the family can discuss the same information with the hospital.
Misconception 06
“People aged 70 or above are excluded if they have an income.”
The 70-plus expansion is available irrespective of income. Seniors in families already covered by PM-JAY have an additional cover of up to ₹5 lakh for the eligible senior members, separate from younger family members. Other eligible senior families receive cover on a family basis. Enrolment and choices involving existing government health schemes should be checked with the official helpdesk.
What should an older person or caregiver confirm?
Check eligibility, enrolment and the applicable benefit category through the official route linked in this section. Ask which documents and treatment arrangements apply to the individual. Do not assume that information about another family member’s cover answers every question for the older person.
Misconception 07
“National eligibility rules are the whole story in Maharashtra.”
Maharashtra operates an integrated MJPJAY and AB-PMJAY arrangement. Its expanded scheme describes coverage for the state’s entire population, with documentation and category rules. Ask an Aarogyamitra to verify your category, documents, package and remaining cover under current state rules.
Maharashtra · integrated scheme information ↗
How should Maharashtra residents check which scheme route applies?
Ask the hospital’s scheme desk to check the applicable MJPJAY or PM-JAY category and documentation using current state guidance. Record the scheme name and package being discussed. Eligibility questions should be resolved through the official state or national help channel.
Misconception 08
“A covered patient must pay extra because the package is too small.”
Eligible treatment within the approved scheme package and available cover is meant to be cashless. Do not assume that an additional charge is valid. Ask for a written explanation and take an unresolved demand to the scheme helpdesk. Genuine coverage limits also need a clear explanation before any proposed paid service.
What should a patient do when asked to pay for a reportedly covered service?
Ask for the reason and an itemised written explanation, keep receipts and package references, and contact the authorised scheme grievance route. Describe the service and approval status precisely. Use the official review process rather than confronting or threatening staff.
Misconception 09
“The doctor alone can approve or refuse the scheme.”
Clinical treatment decisions, beneficiary verification and package authorisation involve different responsibilities. Ask the scheme desk whether a case is awaiting documents, authorisation or another action. Record the reference and seek an explanation; do not assume that every delay proves misconduct.
AIIMS · roles and authorisation process ↗
What information helps when an approval appears delayed?
Ask for the request reference, submission time, current status and any missing information. Confirm who will provide the next update. The treating team remains the contact for clinical urgency; a general website guide cannot decide an individual authorisation.
Misconception 10
“Threatening staff is the only way to resolve a dispute.”
You can question a bill, request an explanation and raise a formal grievance. Keep the hospital name, dates, package or authorisation reference and receipts. Contact the scheme desk and escalate through the official grievance route. Threats and assault are never acceptable.
NHA · grievance redressal guidelines ↗
What makes a scheme complaint easier to follow up?
Include the hospital, relevant dates, scheme or package reference, the disputed explanation and the action requested. Use official channels for sensitive documents and retain the complaint number. Follow up against that reference so the history stays connected.
Before planned treatment: ask four questions
- Which scheme and beneficiary category apply to me?
- Is this hospital empanelled for my treatment and specialty?
- Which package is proposed, what does it include and what is the authorisation status?
- Who can explain a proposed charge or help me raise a grievance?
Keep copies of the explanation, treatment records and receipts. If care is urgent, seek prompt clinical assessment while the hospital’s scheme team helps resolve the administrative questions.
Official help and complaint routes
Maharashtra’s official portal lists 155388 and 1800 233 2200. MJPJAY contacts, current notices and scheme documents ↗
Source documents, photographs and publisher websites remain in their original language. Directory names and addresses are retained as published.