The committee observed that advances in medical science have significantly increased the cost of high-end treatments, pushing many procedures far beyond the scheme's existing coverage ceiling. As a result, several beneficiaries continue to face substantial out-of-pocket expenses despite being covered under PM-JAY. It recommended revising the existing coverage framework by introducing a differential treatment cost model specifically designed for high-cost and complex medical procedures.
According to the report, the present insurance limit of Rs 5 lakh does not adequately address the healthcare needs of beneficiaries requiring advanced interventions. The committee reiterated its recommendation to enhance the insurance cover to Rs 10 lakh and introduce special high-cost treatment packages under PM-JAY. It proposed that these packages should be supported through pooled financing, negotiated pricing with hospitals and manufacturers, and co-funding mechanisms involving state governments to ensure financial sustainability while expanding access to expensive life-saving treatments.
The panel stated that such a targeted enhancement would prevent beneficiaries requiring costly medical procedures from being financially excluded while maintaining the long-term fiscal viability of the flagship health insurance programme.
Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, the country's flagship government-funded health insurance scheme, currently provides cashless health coverage of Rs 5 lakh per family annually for secondary and tertiary healthcare services. The scheme has been implemented across 35 states and Union Territories. As of January 31, 2026, it had authorised 11.46 crore hospital admissions with claims worth Rs 1.69 lakh crore, while more than 43 crore Ayushman Cards had been issued nationwide.
The committee also recommended stricter enforcement of the prescribed six-hour turnaround time for approving cashless treatment requests under PM-JAY. It called for penalty provisions against hospitals or agencies responsible for unnecessary delays in granting approvals. The report further recommended periodic audits of the pre-authorisation process, expansion of automatic approval for a larger number of low-risk procedures, and deployment of artificial intelligence-enabled case tracking systems to accelerate approval timelines.
Additionally, the panel urged the government to intensify efforts to achieve complete Ayushman Card coverage through targeted enrolment campaigns, particularly in regions with poor internet connectivity. It also emphasised the need to address reimbursement concerns raised by private hospitals to encourage greater participation in the scheme and strengthen access to quality healthcare services across the country.
The committee's recommendations underscore the growing need to modernise India's flagship public health insurance programme in response to rising medical costs. If implemented, the proposed reforms could significantly improve financial protection for millions of families requiring advanced medical treatment while strengthening the efficiency and reach of PM-JAY.
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