Ayushman Bharat
NEW DELHI: The Parliamentary Standing Committee on Health and Family Welfare, in its 172nd Report, has recommended increasing the insurance cover under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) from the existing Rs 5 lakh to Rs 10 lakh, saying the current limit is inadequate to meet the cost of several life-saving procedures, including liver transplants, complex cardiac surgeries and immunotherapy.The committee observed that advances in medical treatment have pushed the cost of several high-end procedures well beyond the scheme’s existing coverage ceiling, leaving many beneficiaries vulnerable to substantial out-of-pocket expenditure despite being covered under PM-JAY. It recommended revising the coverage framework by introducing a differential treatment cost model for high-cost and complex procedures.”The current Rs 5 lakh coverage limit does not adequately meet the needs of most beneficiaries, as certain advanced interventions such as organ transplants like liver transplant, cardiac surgeries and immunotherapy treatments far exceed the threshold,” the report said. It reiterated its recommendation to enhance the coverage limit to Rs 10 lakh and create special high-cost packages under PM-JAY, supported through pooled financing, negotiated pricing with hospitals and manufacturers, and co-funding mechanisms with states. The panel said such a targeted enhancement would ensure that beneficiaries requiring expensive, life-saving procedures are not financially excluded while maintaining the fiscal sustainability of the scheme.PM-JAY, the country’s flagship government-funded health insurance scheme, currently provides cashless health cover of Rs 5 lakh per family annually for secondary and tertiary care. It has been implemented in 35 states and Union Territories. As of January 31, 2026, the scheme had authorised 11.46 crore hospital admissions worth Rs 1.69 lakh crore, while more than 43 crore Ayushman Cards had been issued.The committee also sought stricter enforcement of the prescribed six-hour turnaround time for approving cashless treatment requests under PM-JAY. It recommended penalty provisions for hospitals or agencies responsible for undue delays, periodic audits of pre-authorisation workflows, expansion of auto-approval to more low-risk procedures and deployment of AI-enabled case tracking to speed up approvals.In addition, the panel urged the government to intensify efforts to achieve 100% Ayushman Card saturation through targeted enrolment drives, particularly in areas with poor internet connectivity, while addressing reimbursement concerns of private hospitals to improve their participation in the scheme.
