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According to the panel’s findings, the existing ₹5 lakh cap is majorly insufficient for critical healthcare requirements
The committee presented several key reasons for suggesting this massive expansion.
The Parliamentary Standing Committee on Health and Family Welfare has recommended doubling the Ayushman Bharat (AB-PMJAY) cover from ₹5 lakh to ₹10 lakh per family per year.
However, this is currently a formal recommendation detailed in the committee’s 172nd Report, and it has not yet received final Central Government approval to become a nationwide law.
WHY THE HEALTH PANEL WANTS A ₹10 LAKH LIMIT
The committee presented several key reasons for suggesting this massive expansion:
Rising Treatment Costs: Advanced medical technologies and prolonged hospital stays have driven up the costs of critical secondary and tertiary care.
Coverage Shortfalls: The current ₹5 lakh cap frequently runs out during high-end, complex procedures.
High Out-of-Pocket Expense: Families are still forced to pay heavily from their own savings for complex treatments despite being insured.
Life-Saving Care Access: Doubling the limit ensures economically vulnerable households do not delay or avoid complex operations.
WHICH TREATMENTS NEED A HIGHER LIMIT?
According to the panel’s findings, the existing ₹5 lakh cap is majorly insufficient for critical healthcare requirements. The proposed ₹10 lakh limit would primarily benefit patients needing:
- Organ Transplants: High-cost surgeries such as kidney or liver transplants.
- Advanced Cardiac Interventions: Complex open-heart surgeries and cardiac treatments.
- Cancer Immunotherapy: Advanced oncology care and specialized targeted therapies.
- Critical Care: Long-term intensive care unit (ICU) management and complex surgeries.
OTHER CRITICAL ADMINISTRATIVE PROPOSALS
Apart from doubling the financial coverage, the July 2026 report outlines vital structural reforms to make healthcare seamless:
Stricter enforcement of a maximum six-hour turnaround time for approving hospital cashless requests.
Implementing strict penalty provisions for empanelled hospitals or management agencies that cause undue approval delays.
Deploying AI-powered tracking mechanisms and expanding auto-approvals for low-risk, standard treatments.
Launching targeted enrolment drives to achieve 100% card registration, especially in remote regions with low internet connectivity.
HOW THE PANEL PLANS TO FUND IT
To make the increased financial load sustainable for the country without draining resources, the committee proposed a hybrid funding model:
Special High-Cost Packages: Segregating complex surgeries into a designated category.
Pooled Financing: Utilising centralized healthcare fund pools to balance out high-value claims.
Price Negotiations: Capping rates via direct negotiations with pharmaceutical manufacturers and major hospital networks.
State Co-funding: Sharing the additional financial premium costs through strategic partnerships with individual state governments.
WHAT IT MEANS FOR YOU TODAY
As of July 2026, the official nationwide limit for an Ayushman Card remains ₹5 lakh per family per year. While the central expansion awaits cabinet clearance, certain local exceptions already exist:
States like Gujarat have independently doubled the benefit to ₹10 lakh for their residents via state-backed funding.
In Delhi, state provisions can add a separate layer to hit an effective ₹10 lakh limit.
Families with members aged 70 and above receive a distinct top-up cover explicitly for those eligible seniors.
About the Author
At the news desk for 20 years, the story of her life has revolved around finding pun, facts while reporting, on radio, heading a daily newspaper desk, teaching mass media students to now editing speci…Read More
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