Summary of this article
The Parliamentary Standing Committee on Health and Family Welfare recommended raising Ayushman Bharat PM-JAY cover from Rs 5 lakh to Rs 10 lakh.
The panel said the current limit is too low for high-cost treatments such as transplants, cardiac surgeries, and immunotherapy.
It also suggested special packages, pooled financing, and faster approvals to improve the scheme’s efficiency.
The Parliamentary Standing Committee on Health and Family Welfare has recommended increasing the coverage amount under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), a flagship healthcare scheme of the government. In its 172nd report, the panel proposed doubling the current insurance limit of Rs 5 lakh per family per year to Rs 10 lakh.
In its previous reports, the committee had also recommended enhancing the limit to bridge the gap between the existing coverage and the actual costs of specialised healthcare, and to ensure that beneficiaries are not left in a vulnerable condition in the face of life-threatening medical emergencies.
The committee observed that the PM-JAY has provided a vital safety net for millions; however, the current threshold (Rs 5 lakh) is increasingly insufficient due to the high cost of medical treatments, according to a report in the Times of India. High-end procedures, including liver transplant, complex cardiac surgeries, and modern immunotherapy treatments, are often costly and exceed the existing coverage limit.
The report noted that rising costs often leave families facing substantial out-of-pocket expenses despite being covered under the public healthcare scheme. To address this, the committee suggested a ‘differential treatment model’ for high-cost procedures, along with special packages, pooled financing, and negotiated pricing with hospitals and manufacturers.
The scheme is currently available across states and Union Territories and provides secondary and tertiary care, but outpatient department (OPD) consultations are not included under the scheme’s coverage.
Reportedly, the program has authorised approximately 11.46 crore hospital admissions valued at Rs 1.69 lakh crore, as of January 31, 2026, and around 430 million Ayushman cards have been issued to beneficiaries.
The committee emphasised that targeted enhancement of coverage for expensive procedures is required to prevent financial exclusion of people while maintaining the overall fiscal sustainability of the program.
Besides increasing the coverage sum, the Parliamentary panel also called for improving the operational efficiency to enhance the patient experience. For this, the panel recommended strict enforcement of a six-hour turnaround time for approving cashless treatment requests. The committee has proposed to introduce penalty provisions for hospitals or agencies responsible for undue delay in the pre-authorisation process.
According to the report, the panel suggested deployment of artificial intelligence (AI)-enabled case tracking and expansion of auto approval for low-risk procedures, along with regular audits of administrative workflows.
The panel has urged the government to speed up efforts to achieve 100 per cent Ayushman card saturation through targeted enrollment drives, especially in areas that don’t have stable Internet connectivity. Another issue highlighted by the panel is the reimbursement concerns of private hospitals. It stressed an urgent need to resolve the delayed payment issue so that private sector engagement can be increased and more options remain available to the scheme’s beneficiaries for medical treatment.
