Policy & Guidelines

1. PM-JAY Operational Guidelines
   • Guidelines on Release of Premium and Escrow account (PDF 609 KB)
   • Guidelines for Portability of Services (PDF 483 KB)
   • Guidelines on Claim Settlement (PDF 507 KB)
   • Guidelines on Process of Beneficiary Identification (PDF 3.39 MB)
   • Guidelines on Process of Empanelment for Hospital (PDF 607 KB)
   • Guidelines on Process for Hospital Transaction (PDF 760 KB)
   • Guidelines on Formation of State Health Agency and District Implementation Unit (PDF 284 KB)
   • Guidelines for Grievance Redressal (PDF 756 KB)
   • Guidelines for Claim Amount Utilisation by Public Hospitals (PDF 335 KB)
   • Capacity Building Guideline (PDF 3.40 MB)
   • BIS - Guidelines on disabling BIS e-Card (PDF 285 KB)
2. PM-JAY Process flow at Empanelled Hospital
   • PM-JAY Process Flow at Empanelled Hospitals (PDF 344 KB)
   • Annexure I Pre-Authorization Form (PDF 204 KB)
   • Annexure II - Discharge Summary (PDF 440 KB)
3. Health benefit packages & Empanelment criteria for AB-PMJAY
   • Download this Document (PDF 2.57 MB)
4. Anti Fraud Guidelines
   • Anti Fraud Guidelines(PDF 1.14 MB)
5. Claims Adjudication Manual
   • Download(PDF 2.65 MB)
6. Fraud Investigation and Medical Audit Manual
   • Download(PDF 2.05 MB)
7. PM-JAY Brand Guidelines
   • Download (PDF 11.1 MB)
8. Model Agreements for both Insurance & Assurance Model EHCP
   • Assurance Model Download (PDF 910 KB)
   • Insurance Model Download (PDF 493 KB)
9. Process for Registering a device RD Services
   • Download (PDF 131 KB)
10. Hardware Specification for Hospitals
    • Download (PDF 185 KB)
11. Model Agreement
    • Model agreement between Empanelled Healthcare Provider, SHA and insurer or ISA (PDF 390 KB)
12. Model Tender Document
    • Model Tender Document for Selection of Insurance Company for the implementation of Ayushman Bharat - Vol I (PDF 1.32 MB)
    • Model Tender Document for Selection of Insurance Company for the implementation of Ayushman Bharat - Vol II (PDF 2.27 MB)
    • Model Tender Document for Selection of Insurance Company for the implementation of Ayushman Bharat - Vol III (PDF 6.05 MB)
13. Model Tender Document for the Selection of Implementation Support Agency (ISA) for providing support services for the implementation of Ayushman Bharat Pradhanmantri Jan Arogya Yojana (AB-PMJAY)
    • Advisory on MTD for the Selection of Implementation Support Agency (ISA) Volume I (PDF 119 KB)
    • Model Tender Document for ISA Volume I (PDF 1.26 MB)
    • Model Tender Document for ISA Volume II (PDF 5.46 MB)
    • Model Tender Document for ISA Volume III version 2.0 (PDF 2.40 MB)
14. Health benefit packages & Empanelment criteria for AB-NHPM
    • Download this Document (PDF 2.57 MB)
15. Fields designated for hospital empanelment software
    • Download this Document (PDF 88.9 KB)
16. Draft Structure and Role of Trust for AB-NHPM (Comments may be forwarded at pm-nhpmission@gov.in)
    • Download this Document (PDF 383 KB)
17. Checklist for Additional Data Collection Drive in Urban Area
    • Checklist for State Secretaries (PDF 456 KB)
    • Checklist for District Collectors/Coordinators (PDF 455 KB)
    • Checklist for ULB/Ward Nodal Officers (PDF 348 KB)
18. Urban Additional Data Collection Drive
    • Background note (PDF 517 KB)
    • Presentation (PDF 2.74 KB)
    • Guidelines for Additional Collection Drive in Urban Area (PDF 283 KB)
    • Posters for Urban Additional Data Collection Drive (PDF 489 KB)
19. PM-JAY Process flow at Empanelled Hospital
    • PM-JAY Process Flow at Empanelled Hospitals (PDF 344 KB)
    • Annexure I Pre-Authorization Form (PDF 204 KB)
    • Annexure II - Discharge Summary (PDF 440 KB)
20. Guidelines for Partnership with Resource Organisations for Augmenting Capacity for the National Health Protection Mission (Samvardhan)
    • Download (PDF 1.22 MB)
21. Guidelines for Recruitment of Volunteers
    • NHA Volunteer Guidelines (PDF 788 KB)
    • Volunteer Application Form (PDF 336 KB)
22. Guidelines for Young Professional Program
    • Guidelines for Young Professional Program(PDF 557 KB)
23. Escrow Bank Account Guidelines
    • Escrow Bank Account Guidelines(PDF 273 KB)
24. Release of Grant in Aid-Trust Mode
    • Release of Grant in Aid-Trust Mode(PDF 270 KB)
25. Anti Fraud Guidelines
    • Anti Fraud Guidelines(PDF 1.14 MB)
26. NHA Data Privacy Policy Version 1.0
    • NHA Data Privacy Policy Version 1.0(PDF 502 KB)
27. Guidelines for usage of Software in Poor Connectivity Scenarios
    • Guidelines for usage of Software in Poor Connectivity Scenarios(PDF 296 KB)
28. Guidelines on Security & Privacy
    • Guidelines on Security & Privacy(PDF 918 KB)
29. Guidelines for National Institutes of Excellence
    • Download(PDF 1.27 MB)
30. Fraud Investigation and Medical Audit Manual
    • Download(PDF 2.05 MB)
31. Whistle Blower Policy
    • Download(PDF 298 KB)
32. Claims Adjudication Manual
    • Download(PDF 2.65 MB)
33. Guidebook for Streamlining Systems & Processes at Hospitals
    • Download(PDF 1.76 MB)
34. Beneficiary Empowerment Guidebook
    • Download(PDF 807 KB)
35. Constitution of Specialist Committees under AB-PMJAY
    • Download(PDF 3.45 MB)
36. COVID-19 Package under AB-PMJAY (Dated: 08/06/2020)
    • Download(PDF 513 KB)
37. COVID-19 Information under AB-PMJAY
    • NHA OM on Covid - 1 (PDF 294 KB)
    • OM Dt. 1 Dec - 2 (PDF 254 KB)
    • 2nd OM COVID-19 - 3 (PDF 310 KB)
    • 3rd OM on Covid-19, mandating tests -4 (PDF 747 KB)
    • 5th OM COVID-19 - 5(PDF 798 KB)
    • NHA OM - 6(PDF 341 KB)
38. Constitution of Review Committee under AB-PMJAY
    • Download (PDF 677 KB)
39. State wise nodal persons - SSB
    • Download (PDF 196 KB)
40. State wise nodal officers of CISF
    • Download (PDF 87 KB)

  NOTE: “The guidelines may be amended by the competent Authority in view of State specific modifications or other contingencies” Disclaimer: It may be noted that Ayushman Bharat-National Health Protection Mission (AB-NHPM) and Pradhan Mantri Rashtriya Swasthya Suraksha Mission (PMRSSM) shall now be read as Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY).