New Delhi, March 15 (H.S.): The Parliamentary Standing Committee on Health and Family Welfare has released its grant demand report for 2025-26. Under the chairmanship of Prof. Ram Gopal Yadav, the committee has recommended expanding the scope of the Ayushman Bharat health insurance scheme. It has suggested reducing the eligibility age limit for the Ayushman Vay Vandhan Card from 70 years and above to 60 years. The report states that social and economic status of individuals should not be a barrier to this.
The committee praised the government for recently including 4.5 crore families and 6 crore senior citizens aged 70 and above under the AB-PMJAY Vay Vandhan Scheme. It found that an amount of ₹1,443 crore has been earmarked for the treatment of senior citizens aged 70 years and above holding an Ayushman Vay Vandana Card. The committee believes that to better serve the public interest, the age criteria for the Ayushman Vay Vandhan Card should be rationalized to 60 years and above, without considering their social and economic status.
The committee also recommended that the department initiate a public awareness campaign regarding AB-PMJAY so that the targeted beneficiaries are not left out of coverage. In light of the heavy expenditures on essential health services, the committee recommended that health care coverage should be revised from the current ₹5 lakh per family per year to ₹10 lakh per family per year.
The committee also found that several high-level interventions or procedures, and even high-level diagnostics, are not included in AB-PMJAY. It recommended that the number of packages and procedures covered under the scheme should be reviewed. New packages and procedures related to the treatment of serious illnesses, which have high treatment costs, and expensive high-level tests or diagnostics such as radiological diagnostics (including CT, MRI, and nuclear imaging) should be included in AB-PMJAY instead of being booked as add-on packages.
The committee has found cases of delays in the settlement of claims from empaneled hospitals under the AB-PMJAY scheme, and appropriate revisions in package rates have not been made in several states. As a result, patients are facing inconvenience due to the denial of treatment by many empaneled hospitals. Therefore, the committee believes that states or Union Territories that have not revised package rates can be persuaded by the department to revise them to rates similar to those revised by some states in 2022. In addition to the above, the committee recommends that the department review and streamline the process related to the settlement of claims submitted by hospitals on the panel within a specified timeframe.
Recommendations for CGHS:
The committee has continued to recommend that the department simplify referral procedures in CGHS cases, as there is a significant need to reduce the burden on patients and their families by eliminating the need for repeated visits to dispensaries during illness. The committee has noted the provision allowing CGHS pensioner beneficiaries aged 70 and above to consult specialists directly without the need for a CGHS referral. However, the committee has reiterated its recommendation from the 155th report to further review the guidelines and benefit all CGHS pensioner-beneficiaries aged 60 and above for continuous medical care. Allowing direct consultations with specialists in listed private hospitals without a CGHS referral will ensure care stability and continuity within the existing system, where pensioner-beneficiaries aged 60 and above already receive cashless treatment from these hospitals.
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Hindusthan Samachar / Jun Sarkar
