Guidelines to the Cashless Treatment of Road Accident Victims Scheme 2025

REGD. No. D. L.-33004/99 The Gazette of India CG-DL-E-06062025-263647 EXTRAORDINARY PART II—Section 3—Sub-section (ii) PUBLISHED BY AUTHORITY No. 2430] NEW DELHI, THURSDAY, JUNE 5, 2025/JYAISTHA 15, 1947 MINISTRY OF ROAD TRANSPORT AND HIGHWAYS NOTIFICATION New Delhi, the 4th June, 2025 S.O. 2489 (Ε).- Whereas, section 162 of the Motor Vehicles Act, 1988 (59 of 1988) envisages that the Central Government shall make a scheme for the cashless treatment of victims of the accident during the golden hour and such scheme may contain provisions for creation of a fund for such treatment; And whereas, the Ministry of Road Transport and Highways has notified the “Cashless Treatment of Road Accident Victims Scheme, 2025"; And whereas, the Ministry of Road Transport and Highways has formulated the Guidelines to the "Cashless Treatment of Road Accident Victims Scheme, 2025" for effective implementation of the Scheme; Now therefore, the Ministry of Road Transport and Highways hereby notifies the Guidelines to the "Cashless Treatment of Road Accident Victims Scheme, 2025" as per the Annexure to this notification and the same is also available at https://morth.gov.in/. [F. No.RT-11028/01/2024-MVL-Part (4)] MAHMOOD AHMED, Addl. Secy. Annexure GUIDELINES CASHLESS TREATMENT OF ROAD ACCIDENT VICTIMS SCHEME, 2025 Contents 1. Background 2. Eligibility criteria 3. Designated hospitals 4. Technology-based implementation 5. Transfer of victim to hospital 7. Treatment to victims 9. Hospital claim settlement 10. Accounting and utilization of funds 11. Scheme monitoring at ground level 12. Operational support by district administration 13. Grievance management 14. Fraud control Annexures STANDARD OPERATING PROCEDURES Roles and Responsibilities 1. Background 1.1. In accordance with section 162 of the Motor Vehicles (MV) Act, 1988 (“Act”) the Ministry of Road Transport and Highways (MoRTH) has launched a Cashless Treatment of Road Accident Victims Scheme, 2025 (“Scheme") for the cashless treatment of victims of road accidents caused by the use of motor vehicle(s) on any category of road. 1.2. Further, in accordance with section 164B of the Act, MoRTH has set up the Motor Vehicle Accident Fund (“Fund”) to provide for, inter alia, the treatment of victims in accordance with the scheme framed under section 162 of the Act. For the implementation of the Scheme, two accounts of the Fund, namely, 1) the Account for Insured Vehicles, and 2) the Account for Uninsured Vehicles or Hit and Run Motor Accident, shall be utilised. 1.3. These Guidelines flow from the Scheme framed under section 162 of the Act by the Central Government. 1.4. For greater convenience, the steps to be taken as per these Guidelines have been summarised for respective stakeholders and annexed as Standard Operating Procedures (SOP). 1.5. The roles and responsibilities of respective stakeholders are also annexed. 2. Eligibility criteria 2.1. Any person being a victim of a road accident caused by the use of motor vehicle (“road accident") on any road, who has sustained injuries requiring hospitalisation, shall be entitled to the benefit of cashless treatment under the Scheme in accordance with these Guidelines. In this regard, “motor vehicle” shall have the same meaning as defined under sub-section (28) of section 2 of the MV Act, 1988. 2.2. A victim of a road accident shall be entitled to cashless treatment for an amount for such period as specified in the Scheme. 2.3. The benefits under this Scheme shall take precedence over any other benefit scheme for the same or similar purpose or for medical treatment of the Central Government or the State Government or UT Administration. 2.4. Those victims whose first hospitalisation takes place after the lapse of 24 hours from the time of accident shall not be considered eligible under the Scheme. 3. Designated hospitals 3.1. The treatment shall be provided through designated hospitals under the Scheme including empaneled hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), compliant with the guidelines issued by National Health Authority (NHA) in respect of this Scheme, which shall be deemed designated for the Scheme. 3.2. Hospitals which are not empaneled under AB PM-JAY will be designated as per the guidelines and procedure issued by National Health Authority (NHA). 3.3. Hospitals which are not designated under the Scheme will also be allowed to provide treatment for stabilization of road accident victims on registration on the Transaction Management System (TMS) of NHA through the Health Facility Registry (HFR) ID. 3.4. The designated hospitals shall follow the guidelines issued by the National Health Authority (NHA) on patient admission, pre-authorisation, claims settlement and other matters related to hospitalisation and medical treatment of victims of road accidents. 4. Technology-based implementation 4.1. The Scheme shall be implemented through electronic linkage between accident victim details, designated hospital details, treatment details and standardised cost of treatment packages leading to timely payment for the cost of treatment so as to establish a complete digital trail of the treatment being provided under the Scheme. 4.2. The Transaction Management System (TMS) portal of National Health Authority and the Electronic Detailed Accident Report (eDAR) application of the Ministry of Road Transport & Highways shall be inter-linked through Application Programming Interface (API) to provide for seamless transfer of data required for management and administration of the Scheme. 4.3. The unique identifier of the accident victim in eDAR i.e. eDAR Victim ID shall be mapped against the unique identifier of a patient in TMS i.e. Patient Registration ID of TMS linked to the designated hospital ID (refer Figure 1) for ensuring that persons who are victims of road accidents can avail treatment. Figure 1. Overview of electronic linkage between eDAR and TMS - NHA - Transaction Management System (TMS) - Hospital - Treatment (patient) ID - MoRTH - Electronic Detailed Accident Report (eDAR) - Police - Victim ID 5. Transfer of victim to hospital 5.1. The victim of a road accident may be transferred either to the nearest designated hospital for treatment (refer Figure 2 in Annexure) or to any other hospital. In case the victim is taken to a hospital other than a designated hospital, then such hospital shall be responsible for providing stabilisation treatment and then arranging for ambulance services to transport the victim to the nearest designated hospital. The parameters and acceptable cost of stabilisation treatment shall be specified by the National Health Authority. An IT application shall be developed to help locate the nearest designated hospital for the purposes of the Scheme. 5.2. The victim of a road accident can be brought to the hospital with or without police assistance. The later cases would include: (i) The victim reaches the designated hospital by himself or herself; (ii) The victim is brought by an ambulance service of the hospital or a third party; (iii) The victim is brought by the owner or driver or a passenger of the motor vehicle involved in the road accident; (iv) The victim is brought by a family member or a person known to the victim; (v) The victim is brought by a Good Samaritan; (vi) The victim is referred by an official or employee of the road owning or road maintenance agency or fire & emergency services etc.; (vii) The victim is brought by any other means. 5.3. Any person may dial the Emergency Response Support System (ERSS) / 112 helpline to report a road accident (refer Figure 3 in Annexure). The responder at 112 shall obtain preliminary details about the location of the road accident, the nature of the road accident, the likely number of victims and the need for an ambulance. The responder shall provide details of the nearest designated hospital to the caller and also forward the details to the police station having jurisdiction over the accident spot. The responder shall transfer the request for an ambulance along with the details provided by the caller to 108 or any other State helpline managing the ambulance services ecosystem. 5.4. States/UTs shall ensure identification, mapping and strengthening of the ambulance ecosystem and convergence with 112 services, if not already undertaken to ensure prompt response of ambulance services for the victim of the road accident. 5.5. The cost of transportation of the victim using the ambulance services either from the location of the accident to the designated hospital or referral to a designated hospital by another hospital shall be payable in terms of the standard package approved by NHA. 5.6. A report to the Grievance Redressal Officer of the district as per the grievance management mechanism provided in para 13 of these Guidelines may be made in case a designated hospital does not admit a victim for treatment. 6. Accident and victim details 6.1. Where the local police receives information about a road accident caused by the use of a motor vehicle, the nearest available police official shall reach the accident spot at the earliest and take action to transfer the victim to the nearest designated hospital, if necessary, by obtaining details through 112 or through other technological platforms, wherever feasible. 6.2. The police official shall fill the preliminary details about the road accident to generate the eDAR victim ID(s) on eDAR application. The generated eDAR victim ID(s) shall then be fetched by the concerned hospital for mapping with treatment ID generated on TMS. 6.3. Where the victim reaches hospital without police assistance, the designated hospital shall generate the treatment ID(s) on TMS. The treatment ID(s) generated on TMS shall be sent electronically through the API interface between TMS and eDAR to the district police. An alert for purposes of intimation shall also be sent to District Collector having jurisdiction over the location of the accident and the hospital at which the victim is admitted. 6.4. In case the district police official is of the opinion that the specific location of the accident falls under another district police's jurisdiction, the accident information shall be transferred to the concerned district on eDAR within 3 hours of the request being received from TMS, post which the transfer facility shall be deactivated. An alert for purposes of intimation shall also be sent to District Collector of such new district. However, the facility to further transfer the accident information to yet another district shall not be available. 6.5. The police officers of the jurisdictional police station shall collect preliminary details about the road accident and generate the eDAR victim ID(s) along with FIR number (if available) on eDAR based on the place of occurrence of the accident, if it is prima facie established that the victim is a road accident victim. This should be ensured in not more than 24 hours from the time of receipt of the TMS ID(s). The police official shall need to only provide preliminary details on eDAR related to generation of victim ID within this period and other details can be uploaded later. The generated eDAR victim ID(s) on eDAR shall then be tagged against the patient registration ID generated on TMS. 6.6. In the period of upto 24 hours, stabilisation treatment will continue to be provided by the hospital and be eligible for receiving payment for cashless treatment under this Scheme. 6.7. During any time in this intervening period of 24 hours when the police response has not been received, if the hospital administrator deems that the condition of the victim is life threatening and that mere stablisation treatment while waiting further for police response may lead to loss of life, the same may be indicated as life threatening on TMS. In such a case, all treatment packages under the Scheme will be made available on TMS prior to receipt of police response on eDAR, subject to Scheme coverage of upto a maximum of Rs. 1.5 lakh per victim for a maximum period of 7 days from date of accident. 6.8. In case police response is not received within 24 hours of receipt of TMS ID(s), the TMS ID shall be timed out and the victim will be deemed discharged from the Scheme except in the specific set of conditions outlined in para 6.7 above wherein a further period of 24 hours will be provided for police response. Where the extended period is provided, a message shall be pushed by e-DAR to the Director General of Police of the State/UT or the Nodal Police Officer of the State not below the rank of Additional DGP to trigger the response from the concerned subordinate police officer within the additional period of 24 hours. After the extended period of 24 hours in the specific set of conditions outlined in para 6.7, the TMS ID shall be timed out and the victim deemed discharged from the Scheme. 6.9. The police official shall identify the details of the victim and upload the details on eDAR. The police official shall also endeavour to identify and inform the family members of the victim upon obtaining the personal details of the victim. 7. Treatment to victims 7.1. All hospitals designated under this Scheme, including AB PM-JAY hospitals which are deemed designated under this Scheme, shall be required to provide treatment to eligible victims as per the treatment packages specified by NHA for the purposes of this Scheme. 7.2. The initiation of the treatment and seeking pre-authorisation of packages shall begin as soon as the victim is brought to the hospital. 7.3. The pre-authorisation request from the hospital shall have to be raised as per standard procedure of NHA. However, irrespective of the pre-authorisation request, the treatment shall be initiated immediately by the designated hospital. 7.4. In case a victim is brought to the hospital by the local police and the eDAR victim ID is generated, the designated hospital shall provide treatment as per the treatment packages upto a maximum of Rs. 1.5 lakh per victim for a maximum period of 7 days from date of accident. 7.5. The designated hospital may collect information from the victim, if possible, which may include identity and details of family members to be informed. A treatment (patient) ID shall be generated on TMS by the designated hospital which shall be mapped to the eDAR victim ID provided by the police official. 7.6. Where the victim reaches hospital without police assistance, a treatment (patient) ID shall be generated on TMS and forwarded to the jurisdictional district police for preliminary confirmation of the victim being a road accident victim. In such a case, the hospital shall be eligible to receive payment for treatment packages aimed at stabilization only. 7.7 However, during any time in this intervening period of 24 hours and the specific set of conditions outlined in para 6.7, all treatment packages under the Scheme will be unlocked prior to receipt of police response on eDAR, subject to Scheme coverage of up to a maximum of Rs. 1.5 lakh per victim for a maximum period of 7 days from the date of accident. In such case the hospital shall be eligible to receive payment for the actual treatment packages utilized in the intervening period of 24 hours or extended period of 48 hours or on the receipt of police response, as the case may be whichever is earlier, subject to coverage under this Scheme, irrespective of the response provided by the police officer (approved, rejected or timed out). 7.8 Once police confirmation is received within the time period of 24 hours, the designated hospital shall continue the treatment from the treatment packages upto a maximum of Rs. 1.5 lakh per victim for a maximum period of 7 days from date of accident. 7.9. In case the police confirms that the patient is not a victim of road accident caused by the use of motor vehicle or in case no confirmation is received within the period of 24 hours, the victim shall be deemed discharged from the treatment cover under this Scheme. 7.10. In case a victim approaches a hospital which is not a designated hospital under the Scheme, the victim may be referred to the nearest designated hospital or be advised to continue treatment at the hospital at his/her own expense. Payment to such hospitals providing stabilisation treatment will be considered in accordance with the specifications and packages for stablisation developed by NHA in this regard. 7.11. Over the course of the treatment, the designated hospital may transfer the victim to another hospital through the referral system in TMS, if the hospital deems that it lacks the requisite expertise to continue treatment. However, coverage under the Scheme, i.e., upto 1.5 lakh per victim for a maximum period of 7 days from date of accident, shall be considered cumulatively across all hospitals treating the victim. 8. Discharge on treatment or on death 8.1. The patient shall be discharged in case of successful treatment before a period of 7 days from the date of road accident. The victim may also be considered as discharged from the Scheme once the treatment limit in terms of coverage amount or coverage period under the Scheme is exhausted, whichever is earlier, irrespective of further treatment being availed in the same hospital or referred hospital(s) and the payment for such treatment beyond the coverage amount or coverage period shall not be made out of funds under the Scheme. 8.2. In case of unfortunate demise of the victim during treatment under the Scheme, the same would be reflected as ‘discharged as dead' in the TMS and payment upto the coverage amount limits or coverage period upto the date of death of the victim shall be made to the designated hospital under the Scheme. However, the cost of any postmortem procedures would not be covered under the Scheme. 8.3 In case a victim who has been administered stabilization treatment desires to be discharged prior to receipt of the police response over eDAR, then the cost of such stabilization treatment shall have to be borne by the victim only. 9. Hospital claim settlement 9.1. Subsequent to the discharge of victim from the Scheme, the hospital will be required to submit the claim for payment to the concerned State Health Agency (SHA) on the TMS portal. All requisite documents, as mandated by NHA or SHA, shall have to be submitted along with the claim for payment by the designated hospital. 9.2. Where the location of the road accident and the hospital where treatment is being provided are in different States/UTs, the claim for payment shall be submitted to the SHA of the State/UT in which the treating hospital is situated, and such SHA may seek necessary information from the officials of the district in which the accident took place. 9.3. The SHA concerned shall approve the claim for payment, in full or in part, or reject the claim, in full or in part, provided reasons for rejection of the claim are provided to the hospital. 9.4. The Motor Vehicle Accident Fund Trust referred to in the Central Motor Vehicles (Motor Vehicle Accident Fund) Rules, 2022 may specify the drawing limits for the agency designated by the Central Government to make payments to hospitals against claims approved by the SHA. The limits may be reviewed periodically by the Trust after evaluating the volume of cases for that particular State / UT. 9.5 In cases where the TMS ID is timed out due to lack of response from the police officials, the cost of stabilisation treatment shall be paid to the hospital under this Scheme. However, for cases which were flagged as life threatening by the hospital administrator, the cost of actual treatment administered up to the extended period of 48 hours under the specific set of conditions outlined in para 6.7, subject to coverage under this Scheme, shall be paid to the hospital if the TMS ID is timed out due to lack of response from the police officials. 9.6. During police verification, in case it is found that victim is not a road accident victim, the victim shall be liable for bearing the entire cost of treatment and the hospital shall be informed and alerted to the police verification details through the linkage of eDAR with the TMS of NHA. 10. Accounting and utilization of funds 10.1. The claims approved by SHAs shall be settled from the relevant account established by the Motor Vehicle Accident Fund Trust. 10.2. In case it is established through eDAR linked to VAHAN, that the offending motor vehicle in the accident had a valid third party insurance coverage, the hospital claim shall be paid from the Account for Insured Vehicles maintained by the Motor Vehicle Accident Fund Trust out of the contributions made by the general insurance companies and provided to the Trust. The payment transaction in such case shall be carried out after verifying the validity of the third party insurance policy as on date of the accident, within a time period of 10 days from the claim being approved by the SHA, failing which the claim shall be deemed approved and payment to the hospital shall be made from Account for Insured Vehicles along with any interest at such rate as may be determined by the Central Government. 10.3. For all other cases i.e., where the motor vehicle involved in the accident does not have a valid third party insurance coverage or where the identity of the motor vehicle cannot be established being a hit and run case or where a response is not provided by the police over eDAR within the defined time period, the claim for payment shall be settled from the Account for Uninsured Vehicles or Hit and Run Motor Accident established out of funds provided by the Central Government from the budgetary outlay of the Ministry of Road Transport & Highways. The payment transaction in such case shall be carried out with the approval of the District Collector within a time period of 10 days from the claim being approved by the SHA, failing which the claim shall be deemed approved and payment to the hospital shall be made from budgetary funds along with any interest at such rate as may be determined by the Central Government and recovery effected from the State/UT Government. 10.4. The involvement of a motor vehicle shall be confirmed by the police on eDAR and the status of motor third party insurance of the motor vehicle involved in the road accident shall be identified on eDAR through linkage with VAHAN, based on which the relevant account of the Fund shall be identified electronically for payment to the hospital. 10.5. The Motor Vehicle Accident Fund Trust shall ensure availability of adequate funds in both accounts of the Fund for settlement of claims within the defined time period. 11. Scheme monitoring at ground level 11.1. The State Road Safety Council set up under section 215 of MV Act, 1988 shall be responsible for monitoring the implementation of the Scheme in the respective State / UT and shall take such action as it deems fit in respect of any agency of the State Government or UT Administration to ensure that the objectives of the Scheme are realised. The State Road Safety Council may raise any issue to the Steering Committee in case any clarification in terms of the Scheme guidelines or applicability is required. 11.2. The responsibility for overall monitoring and coordination of the Scheme implementation in the district shall be of the District Road Safety Committees (DRSC) set up under section 215 of MV Act, 1988. DRSCs shall make efforts to improve coverage of mandatory third party insurance in collaboration with the insurance companies and for the purpose, co-opt a representative of the insurance company nominated by IRDAI as a lead insurer in that State / District. 12. Operational support by district administration 12.1. The District Collector, District Magistrate or Deputy Commissioner, as the case may be, shall ensure proper monitoring for successful implementation of the Scheme through the DRSC and to remove any difficulty in the implementation of the Scheme at the district level. 12.2. The District Police head shall ensure that all police officials in the district are trained and sensitised to ensure immediate generation of eDAR victim ID and that a police official accompanies the victim to the hospital, so that the victim ID on eDAR is made available to the designated hospital immediately to initiate the treatment of the victim. Training on the use of eDAR and the mobile app for immediate generation of the eDAR victim ID shall be arranged by the District Police head. 12.3. The District Collector, with the help of District Police head, may assign volunteers from the District Red Cross Society or any other volunteer group for assisting victims in admission to the designated hospital. 12.4. The district administration should conduct citizen awareness campaigns and field official sensitisation sessions so that all stakeholders are well-informed of the Scheme features, eligibility criteria, designated hospitals and the respective SOPs. 12.5. The DRSC shall be responsible for sensitising the non-designated hospitals regarding the Scheme and the stabilization packages which are to be administered to a victim who approaches such non-designated hospitals. 13. Grievance management 13.1. A dedicated Grievance Redressal Officer would be appointed by District Road Safety Committee for redressal of grievances arising from the implementation of the Scheme. The name, designation and contact details, including the telephone number of the Grievance Redressal Officer shall be indicated by the District Collector on e-DAR. 13.2. In case the applicant is dissatisfied with the resolution of the grievance by the Grievance Redressal Officer or there is a delay in redressal of the grievance, such grievances shall be escalated to the concerned District Collector. A specific timeline for redressal of specific type of grievances at the level of the Grievance Redressal Officer and the District Collector shall be published by the State Road Safety Council. 13.3. The State Road Safety Council shall be the appellate authority in case the applicant is dissatisfied with the resolution of the grievance by the District Collector. 13.4. Review of grievances related to the Scheme may be taken up as an agenda item in periodic meetings of District Road Safety Committee. 13.5. NHA's helpline number (14555) shall be available and widely publicised to address the queries, public grievances, etc., of the following categories: a) Grievances from victims related to hospitalization, treatment, etc., b) Grievances from hospitals regarding settlement of claims c) Grievances from SHA, administrators, etc. 14. Fraud control 14.1. Anti-fraud guidelines, triggers, etc., developed by NHA shall be applicable for this Scheme. 14.2. Such anti-fraud triggers may be designed to cover all possible mechanisms of fraud, with special emphasis being laid on detecting fraud in cases where substantial number of victims are involved. Annexures Figure 2. General overview of Scheme workflow - Search victim details in TMS - If unavailable - Register victim (enter individual details) - If available (existing beneficiary) - Add accident details - Is accident / victim ID from eDAR available? - Yes - eDAR - Mapping of accident / victim ID on portal - TMS - Pre-auth request for full treatment by hospital - Pre-auth approval - Full treatment cover exhausted - No - TMS - Initiate stabilisation treatment - eDAR - Case referred to jurisdictional police for confirmation - Whether eligible victim? - Yes - Police to generate accident / victim ID on portal - TMS - Pre-auth request for full treatment by hospital - Pre-auth approval - Full treatment cover exhausted - No - Treatment under Scheme discontinued - Discharge from Scheme - Full treatment cover exhausted Figure 3. Transferring victim to nearest designated hospital - Call received on 112 - Collect accident details from caller - Locate nearest designated hospital based on caller's geolocation - Provide details of nearest designated hospital to caller - Inform jurisdictional police station about accident - Check if ambulance is required? - Yes - Transfer details to 108, or other helplines for ambulance - No - Victim admitted at hospital STANDARD OPERATING PROCEDURES 112 OPERATOR 1. On receiving a call from a victim or Good Samaritan regarding a road accident victim, the operator shall enquire from the caller whether information related to nearest designated hospital is required or an ambulance is to be requested or both. 2. In case the caller requests for information on nearest designated hospital: a. The details of the road accident and the injury shall be obtained from the caller and confirmation be sought that the location of the accident is the same as the one from where the call is being placed. b. The details of the nearest designated hospital along with contact details shall be identified and the name and location details of the same shall be provided to the caller. 3. In case the caller requests for an ambulance: a. The request may be forwarded to 108 or any other helpline for the ambulance b. The location details of the accident spot, nature of injury and the nearest designated hospital shall also be made available to 108 or the respective helpline. 4. The police station, under whose jurisdiction the place of occurrence of accident falls, shall be forwarded the details of the accident spot, the victim(s) details as well as the designated hospital to which the victim / Good Samaritan has been directed. 5. On closure of the incident on 112, an acknowledgement message will be sent to the caller containing details of the police station to which the case details have been forwarded. - Collect details from caller (victim, injury type, accident spot) - Locate nearest designated hospital - Guide caller to nearest designated hospital - Inform jurisdictional police station about accident - Check ambulance requirement from caller - Transfer details to 108, or other helpline for ambulances - Send acknowledgment message to caller VICTIM OR VICTIM'S FAMILY 1. The victim of a road accident or his / her family may decide to either transfer the victim to the hospital by own means or report the accident to 112 for further action. 2. In case the victim / family decides to report the accident to the authorities, he / she may either dial 112 to report the road accident: a. The victim / family shall provide preliminary details about the road accident (victim details along with location of accident) to the 112 operator and also place a request for an ambulance. - Dial 112 - Report road accident & request ambulance b. After the victim is transferred to the designated hospital by ambulance, the treatment shall be administered by the hospital. 3. In case the victim / family decides to transfer the victim by own means: a. The victim / family may seek details of the nearest designated hospitals by either dialling 112 or through technological platforms, wherever feasible. b. Based on the details provided, the victim may then be transferred to the designated hospital. c. In case the victim is transferred to the hospital which is not designated under the Scheme, initial stabilisation treatment shall be administered to the victim through the module developed by NHA and further treatment may then be sought at designated hospitals. d. In case a designated hospital does not admit the victim, the same may be reported to the Grievance Redressal Officer of the district nominated by the DRSC. e. For other hospital and treatment related grievances, the victim may call 14555. GOOD SAMARITAN 1. On noticing a victim of a road accident, a Good Samaritan may decide to either transfer the victim to the hospital by own means or report the accident to 112 for further action. 2. In case the Good Samaritan decides to report the accident to the authorities, he / she may dial 112 to report the road accident: a. The Good Samaritan shall provide preliminary details about the road accident (victim details along with location of accident) to the 112 operator and also place a request for an ambulance. 3. In case the Good Samaritan decides to transfer the victim by own means: a. The Good Samaritan may seek details of the nearest designated hospitals by either dialing 112 or through technological platforms, wherever feasible. b. Based on the details provided, the Good Samaritan may then transfer the victim to the designated hospital. - Arrange transfer of victim to designated hospital - Create eDAR victim ID and provide it to the hospital - Ensure admission and initiation of treatment c. In case a designated hospital does not admit the victim, the same may be reported to the Grievance Redressal Officer of the district nominated by the DRSC. d. For other hospital and treatment related grievances, the victim may call 14555. POLICE Accident Reporting 1. In case local police receives information about a road accident (either from a Good Samaritan, or through 112), the nearest available police official shall make efforts to reach the accident spot at the earliest: a. The details of the nearest designated hospitals may be obtained by either dialing 112 or from the mobile app or through public platforms. b. Based on the details provided (nature of injury, nearest hospital, etc.), the police official may then transfer the victim to the hospital. 2. The police official shall fill preliminary details about the road accident to generate the eDAR victim ID(s) on eDAR application. 3. On reaching the hospital, the eDAR victim ID(s) shall be made available to the hospital at the time of admission of the victim. - Real-time monitoring of eDAR for TMS requests - Transfer case if it is of another district - Verification of occurrence of accident - Create eDAR victim ID (genuine case) - Reject case on eDAR Treatment 1. On receiving a request from a hospital for confirmation of the genuineness of a road accident, the district police may either approve it, reject it or refer it to another district. 2. In case the police official deems that the place of occurrence of accident falls under another district's jurisdiction, such request can be transferred to the concerned district on eDAR within 3 hours of the request being received from TMS. Subsequent to this time period, the transfer facility will be deactivated. However, the facility to further transfer the accident information to yet another district shall not be available. 3. While transferring the request, the concerned police officials will be required to certify (through a checkbox) that the place of occurrence of the accident does not fall within the jurisdiction of his / her district. 4. Once the police official deems that place of occurrence of accident falls within his / her own jurisdiction, either on direct receipt of TMS request or transferred from another district police, the officials of the jurisdictional police station shall collect preliminary details about the occurrence of the road accident. 5. If it is prima facie established that the victim is a road accident victim: a. An eDAR victim ID(s) shall be generated based on the place of occurrence of the accident. b. The police official shall need to only provide preliminary details on eDAR related to generation of victim ID within this period and other details can be uploaded later. c. Within 24 hours of receiving the TMS ID(s), the police official shall approve the TMS request and provide an eDAR ID for the same. 6. In case the police official deems that the victim is not a victim of road accident, the TMS request shall have to be rejected within 24 hours. The patient will be deemed discharged from the Scheme. 7. In case of no response within 24 hours, the TMS request shall be timed out. 8. If a case has been deemed as life-threatening by the designated hospital, the police official shall endeavor to urgently respond to the TMS request to enable continuation of full treatment to road accident victims. 9. The police official shall also endeavour to identify and inform the family members of the victim upon obtaining the personal details of the victim. - TMS request for eDAR real time monitoring - Transfer case if it is of another district - Verification of occurrence of accident - Create eDAR victim ID (genuine case) - Reject case on eDAR HOSPITAL Treatment at Designated Hospital 1. In cases where a road accident victim is received at the hospital without police assistance: a. Stabilisation treatment shall be initiated for the victim. Simultaneously, to the extent possible and ensuring that the treatment of the victim is not hindered, the hospital may collect information from the victim such as identity details, accident spot, vehicle(s) involved (if any) etc. b. The hospital would generate the treatment ID(s) on TMS and push it to the district police through eDAR. At such time, bio-authentication will be carried out as per policy of NHA. c. While stabilisation treatment will be continued to be administered till the expiry of the package, the TMS ID shall be discontinued if no response is received from police within 24 hours of submitting the confirmation request. d. In case confirmation is received from police on the patient being a genuine victim of road accident, the eDAR victim ID shall get tagged with the TMS ID. Once such confirmation is received from police, pre-auth for the full treatment packages may be initiated. e. In case the request is rejected by police i.e., the patient is not a genuine victim of road accident, the patient will be deemed discharged from the Scheme and the cost of treatment shall be recovered from the victim by the hospital directly. f. In cases where the police confirmation request timed out or the patient passes away during the treatment, such victim shall be deemed auto-discharged from the Scheme. g. In case a victim who has been administered stabilization treatment desires to be discharged prior to receipt of the police response over eDAR, then the cost of such stabilization treatment shall have to be borne by the victim only. - Admission of all road accident victims - Create TMS ID and submit request to eDAR - Initiate stabilisation treatment - Provide full treatment for cases confirmed on eDAR - Discharge from Scheme for cases rejected on eDAR 3. In cases where a road accident victim is received at the hospital through police assistance: a. The eDAR victim ID(s) shall be fetched by the hospital on TMS for mapping it with treatment ID. b. The hospital shall raise the pre-auth request from the complete list of packages available under this Scheme. - Create TMS ID - Obtain eDAR victim ID from police official - Link TMS ID with eDAR ID - Provide full treatment cover for eligible victims 3. Over the course of the treatment, the hospital will have the facility of transferring the victim to another hospital through referral system in TMS. However, coverage under the Scheme, i.e., 1.5 lakhs for a maximum period of 7 days from date of accident, shall be considered cumulatively across all hospitals for each victim. For such referral cases, the cost of transfer of ambulance shall also be reimbursed as per standard packages of NHA. Treatment at Non-Designated Hospital 1. In case a road accident victim is received by a hospital which is not designated by State Government or UT Administration for this Scheme, such hospital may administer stabilisation treatment to the victim as per NHA guidelines. 2. Simultaneously, the hospital shall register itself on the module developed by NHA. Registering on this module shall be prerequisite for the hospital to be eligible to receive payment for the stabilization treatment as per NHA policy. However, registering on this module shall not entitle the hospital to become a designated hospital under the Scheme. 3. On administering the stabilisation treatment, the hospital may either choose to proceed with administering complete treatment to the victim at its premises or transfer the victim to the nearest designated hospital. 4. However, if the hospital proceeds with administering complete treatment at its premises itself, the cost for such treatment shall have to be recovered from the victim only. Post-Treatment 1. Once the treatment limit in terms of cover amount and cover period under the Scheme is exhausted, the victim would be deemed discharged from the Scheme irrespective of further treatment being availed through other means in same hospital or referred hospital(s). 2. In case of demise of a victim during treatment under the Scheme, the same would be reflected in the TMS. 3. Subsequent to the discharge of victim from the Scheme, the hospital will submit the reimbursement claim to the concerned State Health Agency (SHA), along with such documents as per extant guidelines of NHA. - Discharge of victim from Scheme - Reimbursement request by hospital on TMS - Review and approval by SHA - Transaction from 'Account for Insured Vehicles' - GI Council - Reconciliation - Transaction from budgetary funds - District Collector DISTRICT COLLECTOR Treatment 1. On receipt of a request for confirmation from TMS, eDAR will send an SMS alert to the concerned District Collector intimating that a victim of road accident has been admitted at a hospital under the Scheme. 2. Till such time as the response is not provided by police, the victim shall be administered stabilization treatment. 3. In case the TMS request is approved or rejected by the district police within the defined timeframe, an intimation SMS will be sent to the DC by eDAR. However, no further action will be required to be taken by the DC. 4. In case the TMS request is due to be timed out, i.e., no response is received from the district police till 3 hours of the defined timeframe, a further intimation SMS will be sent to the DC. 5. In case the TMS request is transferred from another police district, an intimation SMS will be sent to the DC. 6. The DC will then proceed to coordinate with the concerned District Police head to obtain a timely response on eDAR. 7. If the police subsequently confirm that the victim is a genuine victim of road accident, the DC will coordinate to get the eDAR victim ID generated and mapped with the TMS ID for continuation of treatment under the Scheme. 8. If the police subsequently denies that the victim is not a genuine victim of road accident, no further action is required to be taken by DC under the Scheme. However, the DC may exercise discretion to coordinate any necessary assistance to the victim through other available means i.e., State-specific Schemes, local funds, etc. - Intimation from eDAR on victim admission at hospital under Scheme - Coordinate with police for eDAR response within defined time period - Scenario 1 - Continue treatment under Scheme for confirmed road accident victims - Scenario 2 - Explore treatment under other Schemes for non-eligible victims Claim Settlement 1. The reimbursement request submitted by the hospital will be approved by the concerned SHA. 2. In case it is found that the accident is other than those involving insured vehicle (uninsured, hit and run accident, stabilization treatment at non-designated hospital, timed out due to lack of police response to TMS request), the request will get forwarded to the District Collector based on the location of the accident. 3. Thereafter, based on the details made available by SHA on TMS, the DC will approve the payment and make payment to the concerned hospital through PFMS - Review payment requests forwarded by SHA on TMS - Approve the payment request on TMS GENERAL INSURANCE COUNCIL Settlement 1. The hospital will submit request for reimbursement over TMS. 2. Subsequent to the reimbursement request being approved by the concerned SHA, the request will get forwarded to GI Council in case it is found that the offending motor vehicle has valid motor third party insurance. 3. GI Council would be provided a time of 10 days from date of receipt of claim from SHA to verify the insurance policy of the offending motor vehicle. 4. If GI Council notes that the insurance policy is active, then the same shall be flagged as ‘I' on TMS. In such case, the ‘Account for Insured Vehicles' shall be tapped by GI Council to transfer the approved payment to the hospital. 5. If GI Council notes that the reimbursement request may not be considered due to some other reasons, the same shall be flagged within TMS as ‘TBD'. However, in such case, the 'Account for Insured Vehicles' shall be tapped by GI Council to transfer the approved payment to the hospital. 6. If no response is provided by GI Council within the time period of 10 days, the request shall be deemed as 'I' and the ‘Account for Insured Vehicles' shall be auto-tapped to transfer the approved payment to the hospital. 7. The cases flagged as ‘TBD’shall be reviewed periodically by MoRTH or any entity authorized by it, which may then recommend a consolidated adjustment from budgetary funds into the 'Account for Insured Vehicles'. Fund Collection 1. Based on the Scheme implementation, GI Council shall raise funds from general insurance companies based on the requirement projected by MV Accident Fund Trust. 2. The funds shall be deposited into the account within the timeline decided by the MV Accident Fund Trust. Roles and Responsibilities MINISTRY OF ROAD TRANSPORT & HIGHWAYS 1. Scheme administration: 1.1. MoRTH shall be responsible for notifying the Scheme, including any amendments thereto, in the Official Gazette from time to time. 1.2. MoRTH shall be responsible for issuing guidelines which are supplemental to the Scheme, comprising detailed Standard Operating Procedures (SOP) and roles and responsibilities for respective stakeholders, as may be amended from time to time. 1.3. MoRTH shall be responsible for constituting the Steering Committee under the Scheme and conduct its meetings at specified intervals. 1.4. MoRTH shall be responsible for providing funding support to all the stakeholders for conducting IEC activities to create public awareness of the Scheme and its operative details as well as administrative charges to claim processing agencies. 1.5. MoRTH, through the Motor Vehicle Accident Fund Trust, shall be responsible for ensuring availability of adequate funds in the Motor Vehicle Accident Fund. 2. Technology interface: 2.1. MoRTH, through the National Informatics Centre (NIC), shall be responsible for onboarding of the police officials on Electronic Detailed Accident Report (eDAR) application developed and maintained by NIC, including any changes to be made as per requirements of stakeholders. 2.2. MoRTH, through NIC, shall be responsible for facilitating training to police officials on all eDAR related processes under the Scheme. 2.3. MoRTH will provide details of the Motor Vehicle Accident Fund account for integrating with NHA's IT platform to facilitate electronic payments to hospitals providing cashless treatment to road accident victims 2.4. MoRTH shall adopt the IT platform developed by NHA and ensure its integration with the Electronic Detailed Accident Report (eDAR) to share data related to confirmation of occurrence of road accident(s). 3. Hospital reimbursement: 3.1. MoRTH, through the Motor Vehicle Accident Fund Trust, shall be responsible for ensuring availability of funds for claim settlement to the hospitals from the Motor Vehicle Accident Fund, including charges to be paid for conducting IEC activities and claim processing. 4. Others 4.1. MoRTH shall not be liable for quality of care, medical negligence, etc., and other issues arising out of treatment at designated hospitals or for issues arising out of lack of timely response by police to request received from TMS. 4.2. MoRTH shall be responsible for providing coordination support among concerned departments, including communication of latest requirements w.r.t. Scheme, wherever required and to the extent possible. NATIONAL HEALTH AUTHORITY 1. Scheme administration: 1.1. NHA shall curate standard packages and the cost thereto for providing treatment to eligible victims under the Scheme, which may be updated from time to time. 1.2. NHA will continue to support SHA in the empanelment process by developing comprehensive guidelines for designating hospitals under this Scheme, including the hospitals empanelled under AB PM-JAY compliant with such guidelines. 1.3. NHA shall be responsible for facilitating training to SHAs and the officials and staff of the designated hospitals on the operative details of the Scheme and IT Systems. 1.4. NHA shall be responsible for designing suitable triggers, in consultation with SHA for detection of fraudulent cases through the National Anti-Fraud Unit (NAFU), for further investigation by the State Anti-Fraud Unit (SAFU). 2. Technology interface: 2.1. NHA shall be responsible for providing IT platform with functional modules for transaction and claim management for provision of emergency care under this Scheme. NHA shall be responsible for training and handholding of the SHAs and hospitals on the latest version of the Transaction Management System (TMS) developed and maintained by NHA. 2.2. NHA shall provide technical support for integration of TMS with PFMS for the settlement of claims raised by hospitals. 2.3. NHA shall provide technical support for making available the list of designated hospitals on a periodic basis to Emergency Response Support System (ERSS) of the Ministry of Home Affairs. 2.4. NHA shall support in development of a dashboard showing key indicators of the Scheme implementation as per requirements communicated by MoRTH. 2.5. NHA shall support in providing the details of designated hospitals through various public platforms on a best effort basis. 2.6. NHA shall be responsible for developing a module which can be utilized by hospitals, which are not designated but have provided stabilization treatment, to register with NHA to be eligible to receive payment as per Scheme Guidelines. 3. Hospital reimbursement: 3.1. NHA may issue directions, guidelines, etc., to SHAs on usage of TMS for approval or rejection of pre-authorisation and claims. 4. Others: 4.1. NHA shall be responsible for training of the helpline operators on the procedures and workflows thereto. 4.2. Grievance redressal and monitoring mechanism will be as applicable to AB PM-JAY scheme as per NHA guidelines, as amended from time to time. 4.3. NHA shall not be liable for quality of care, medical negligence etc. issues arising out of treatment at designated hospitals. 4.4. NHA shall provide all other relevant support necessary for the overall implementation of the Scheme. NODAL AGENCY IN STATES / UTS 1. Scheme administration: 1.1. The Nodal Agency shall be responsible for implementation of the Scheme in their jurisdiction. 1.2. The Nodal Agency shall ensure that the treatment cover under the Scheme is exhausted prior to any other schemes providing similar support. 1.3. The Nodal Agency, through concerned departments, shall create public awareness of the Scheme by carrying out various IEC activities across all districts through various mediums. 1.4. The Nodal Agency shall be responsible for identifying the designated hospitals which are capable of providing services to the road accident victims. 1.5. The Nodal Agency will also designate new hospitals, other than those empanelled under AB PM-JAY, that are capable of providing emergency medical services to the road accident victims on the basis of guidelines formulated by NHA for the Scheme, with the priority being accorded to designating hospitals in the vicinity of accident hotspots. 1.6. The Nodal Agency, shall undertake to provide the details of designated hospitals that are capable of providing emergency medical services to the road accident victims through various public platforms on a best effort basis. 1.7. The Nodal Agency, through the police department, shall be responsible for confirming the requests received from the TMS for confirmation of the genuineness of the road accident within the prescribed time period. 1.8. The Nodal Agency shall be responsible for issuing directions under local laws for mandating hospitals to provide emergency care for the victims of road accidents. 1.9. The Nodal Agency shall make all efforts to strengthen the ambulance ecosystem in the respective State and to achieve maximum integration of the same with ERSS for ensuring the minimum turnaround time in dispatch of the nearest ambulance to the accident spot. 1.10. The Nodal Agency, through SAFU, shall be responsible for investigation of the cases flagged as suspicious based on NAFU triggers, as updated from time to time. 1.11. The Nodal Agency, through SHA shall be responsible for designating hospitals which provide stabilization treatment and have registered with NHA for availing reimbursement of the cost of such treatment, as per guidelines of NHA. The Nodal Agency will ensure scrutiny of documentation and approval/rejections of pre-authorisation and claims. 1.12. The Nodal Agency is required to take necessary action in cases of irregularities, such as fraud, and to proceed in accordance with the existing guidelines for disciplinary action against hospitals, as outlined by NHA. 2. Hospital claim settlement: 2.1. The Nodal Agency, through the SHA, shall be responsible for timely submission of claim settlement request by the hospitals for treatment administered within the State as well as vetting and approval of such requests. 2.2. For claim processing and settlement, the Nodal Agency through SHA may hire Implementation Support Agency(ies) (ISA/s) / Third Party Administrators (TPA/s). ISA(s) / TPA(s) will be responsible for the accuracy of the claims and any discrepancy regarding allowance/disallowance of claims will completely be with the ISA(s) / TPA(s). NHA and SHA would be indemnified against any act of commission/ omission that occurs in bonafide discharge of responsibilities and shall not be held liable for any misconduct/bad decisions/ irregularities of ISA. Necessary clauses would be included in the agreement with ISA(s) / TPA(s) for enabling check and balances against any arbitrary action of ISA(s). 2.3. The Nodal Agency, through the State Health Agency, shall be responsible for deduction and deposit of applicable TDS including filing of tax returns for TDS deducted from the claim amount of the hospitals, including assessment and any other TDS related works. 3. Others: 3.1. The Nodal Agency shall be responsible for conducting mock drills for strengthening the Scheme implementation as per the guidelines issued by MoRTH. 3.2. The Nodal Agency shall be responsible for deciding the periodicity of localized training to be administered to hospital and ambulance staff, mock drills to be conducted, random collection of samples for fraud investigation, etc. 3.3. The Nodal Agency, through District Road Safety Committee(s) and District Collector(s), shall be responsible for formulating grievance redressal procedures for resolving the issues reported by victims, hospitals, Good Samaritans, etc., under the Scheme, including escalation matrix and timelines thereto by way of a citizen charter. 3.4. The Nodal Agency shall be responsible for formulating guidelines, training manuals, etc. for first responders in proper handling of victims while transferring the victim from the accident spot to the hospital.