Panel recommends raising Ayushman Bharat cover to Rs 10 Lakh
A Parliamentary Standing Committee has recommended doubling the annual health insurance cover under Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) from Rs 5 lakh to Rs 10 lakh per family.
The recommendation appears in the committee's report on the scheme, which flagged that the existing cover is inadequate for high-cost treatments such as liver transplants and advanced cancer therapies, leaving beneficiaries to bear large out-of-pocket expenses.
The committee additionally proposed pooling of resources and closer coordination with states to fund costly treatments, a strict turnaround time (six hours) for hospitals to approve cashless treatment with penalties for delay, and expansion of Ayushman Card enrolment, particularly in remote and underserved areas.
The recommendations are advisory; implementation would require approval by the National Health Authority and the Union Ministry of Health and Family Welfare.
Ayushman Bharat–PM-JAY: Structure and Coverage
AB PM-JAY is the health insurance component of the Ayushman Bharat mission, launched on 23 September 2018 at Ranchi, Jharkhand. It provides a cover of Rs 5 lakh per family per year for secondary and tertiary hospitalisation, on a family floater basis with no cap on family size or age, to the bottom 40% of the population identified via Socio-Economic Caste Census (SECC) 2011 deprivation and occupational criteria. The scheme is implemented by the National Health Authority (NHA), an attached office of the Ministry of Health and Family Welfare, and treatment is cashless and paperless at empanelled public and private hospitals.
Key Details
- Launch: 23 September 2018; nodal ministry: Ministry of Health and Family Welfare; implementing body: National Health Authority (NHA)
- Current cover: Rs 5 lakh per family per year (family floater, no cap on family size/age)
- Funding pattern: 60:40 Centre-State split for most states/UTs with legislature; 90:10 for North-Eastern and three Himalayan states (J&K, Himachal Pradesh, Uttarakhand); 100% central funding for UTs without legislature
- Beneficiary identification: SECC 2011 deprivation/occupational criteria (rural and urban)
- Since launch, over 43 crore Ayushman cards issued and more than 11 crore hospitalisations covered [as of the panel's report]
The panel's proposal to raise the cover to Rs 10 lakh directly targets the scheme's core financial-protection design — testing whether the Rs 5 lakh ceiling (fixed since the 2018 launch) still shields families from catastrophic health expenditure given medical cost inflation for high-value procedures.
Health as a Constitutional and Policy Commitment
Public health is a State List subject (Entry 6, List II, Seventh Schedule), but Article 47 (a Directive Principle of State Policy) casts a duty on the State to regard raising the level of nutrition and public health as among its primary duties. Centrally sponsored health insurance schemes like PM-JAY operate through Centre-State cost-sharing precisely because health delivery is constitutionally a state subject, while risk-pooling and standard-setting are coordinated centrally through the NHA.
Key Details
- Public Health and Sanitation: Entry 6, State List (Seventh Schedule)
- Article 47 (DPSP): State's duty to raise nutrition levels and standard of living, and improve public health
- Ayushman Bharat has two pillars: Health and Wellness Centres (primary care, renamed Ayushman Arogya Mandirs) and PM-JAY (secondary/tertiary hospitalisation cover)
Because health financing sits at the Centre-State interface, any expansion of the cover amount has direct fiscal implications for states under the existing 60:40/90:10 sharing formula — a point the panel's call for "pooling of resources" with states is designed to address.
- Current PM-JAY cover: Rs 5 lakh/family/year; panel-recommended cover: Rs 10 lakh/family/year
- Launch date: 23 September 2018, Ranchi
- Funding split: 60:40 (general states), 90:10 (NE and Himalayan states), 100% (UTs without legislature)
- Beneficiary base identified via SECC 2011; over 43 crore Ayushman cards issued and 11+ crore hospitalisations covered to date [Unverified — precise cumulative figures fluctuate by reporting date]
- Panel's proposed hospital cashless-approval turnaround: 6 hours, with penalties for delay