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.Get the latest India news and live updates. Download the TOI App.About the AuthorAnuja JaiswalAnuja Jaiswal is a Senior Assistant Editor at The Times of India, with an impressive 18-year career in narrative journalism. She specializes in health and heritage reporting, expertly simplifying complex health information to make it engaging and understandable for readers. Her deep dives into heritage topics are well-researched, resulting in captivating narratives that resonate with her audience. Over the years, she has worked in Chandigarh, Chhattisgarh and West UP, gaining diverse on-ground experience that shapes her storytelling.Read MoreEnd of ArticleFollow Us On Social MediaVideosRam Temple Trust Accounts Reveal ₹3,264 Cr Donations, 32 Kg Gold & 1.5 Tonnes Of SilverUS Charges Lawrence Bishnoi And Goldy Brar For Allegedly Ordering Nijjar’s Killing In Canada4 States Sign Historic Pact To End 50-Year Narmada Project Payment Dispute In Presence Of Amit Shah9 Indian Ships Carrying 198 Seafarers Remain Near Strait Of Hormuz; Govt Says All Vessels Are SafeBaruipur Rape-Murder Accused Shot Dead In Police Encounter During Crime Scene ReconstructionWATCH: PM Modi Invokes ‘Kuch Kuch Hota Hai’; Indonesia President Admits He Has Indian DNAIndia Set To Supply Two BrahMos Missile Batteries Worth $200 Million To Indonesia: ReportThree Dead, Several Missing After Massive Landslide Near Kerala Tunnel Project SiteWhy Does Mumbai Flood Every Monsoon? 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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.
