Mahatma Jyotirao Phule Jan Arogya Yojana: Eligibility & Benefits!

The Maharashtra government is helping families struggling with critical illnesses under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). This crucial scheme provides medical support via a network of facilities. MJPJAY aims to provide relief and hope to many needy families by reducing the financial burden of medical treatment.

What is the Mahatma Jyotirao Phule Jan Arogya Yojana?

Mahatma Jyotirao Phule Jan Arogya Yojana is the Government of Maharashtra’s main health insurance plan, providing full cashless services for recognised ailments through a network of providers in both the public and private sectors.  The initiative’s goal is to make healthcare more inexpensive and accessible for individuals.

This scheme, known as the Rajiv Gandhi Jeevandayee Arogya Yojana earlier, started on July 2, 2012, in 8 Maharashtra districts. It was later increased to 28 districts on November 21, 2013.

On April 1, 2020, the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) merged with the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). This merger was intended to improve healthcare services by increasing access to medical treatment for low-income households.

Related Scheme: Swadhar Yojana

Benefits of the Scheme

Comprehensive Coverage

• Get hospitalisation coverage of up to ₹1,50,000 per family every policy year.
• For renal transplants, this limit increases to ₹2,50,000 per family.

Family Floater Plan

• The coverage is available to all family members.
• Use the total limit (₹1,50,000 or ₹2,50,000) together or individually during the policy year.

Extensive Medical Insurance

• This is a cashless medical insurance scheme.
• Includes 34 specialised medical and surgical treatments.

Specific Procedures for MJPJAY Beneficiaries

• Beneficiaries get access to 996 medical and surgical procedures, as well as 121 follow-up treatments.
• 131 processes are restricted only to government facilities.

Specialized Categories Covered

What does the package cover?

• Bed charges in the General Ward.
• Nursing and board costs
• Surgeons’ and anaesthetists’ fees
• Medical practitioners and consultants’ fees
• Oxygen, O.T., and ICU charges
• Costs for surgical equipment, medications, disposables, consumables, and implants
• Blood transfusion costs (according to state policy)
• X-rays and diagnostic tests.
• Food for Inpatients
• One-time transportation costs via state transport or second-class rail fare (from hospital to home).
• Coverage for problems during therapy.
• In the event of death, transportation from the hospital to the village/township is provided. 

Eligibility

• Category A

Families having an annual income of up to ₹1,00,000 with a Yellow, Antyodaya Anna Yojana (AAY), Annapurna, or Orange ration cards issued by the Civil Supplies Department of the Maharashtra government are eligible for the initiative in all 36 districts of Maharashtra.

• Category B

Farmer households having White ration cards from 14 agriculturally challenged districts in Maharashtra, including Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal, and Wardha, are eligible for the plan.

• Category C

1. Children from government orphanages, students from government-run Ashram schools, female residents of government Mahila Ashrams, and senior persons residing in government old age homes are eligible for the initiative.

2. Journalists and their dependent family members, as certified by the Directorate General of Information and Public Relations (DGIPR) are eligible for the plan.

3. Construction workers and their families, who have a live registration with the Maharashtra Building & Other Construction Worker Welfare Board are eligible for the plan.

Application Process

To get the benefits from MJPJAY, applicants can visit a network hospital to get treatment:

Visit a Network Hospital

• Recipients must visit a network hospital in the area.
• The hospital’s Arogyamitras will help you.
• The Network Hospital hosts health camps where you can obtain a referral letter based on your diagnosis.

Enrolment and registration

• The Arogyamitra examines your valid ration card and photo ID.
• They will enroll you and record your information.
• The medical coordinator enters admission notes and tests into the hospital’s database. 

Create an e-preauthorization request

• If your procedure falls under the specified 996 (MJPJAY) or 1209 (PMJAY) procedures, the hospital will submit an e-preauthorization request together with the relevant paperwork.

Review of the Preauthorization Request

• Medical specialists analyse the request.
• If the requirements are met, preauthorization is granted.
• If rejected, it is sent to a technical committee for additional consideration.
• The final decision is made by ADHS (Additional Director of Health Services).

Procedure Scheduling

• Once the preauthorization is approved, the procedure should be completed within 30 days at a private hospital & 60 days at a public hospital.
• If not completed within this time window, the preauthorization will be terminated automatically.
• Emergency procedures can be approved via phone.

Cashless Treatment

• The Network Hospital offers cashless medical and surgical treatments.
• The medical coordinator updates the portal with new treatment notes daily.

Post-Procedure Documentation

• The hospital uploads diagnostic results and discharge summaries that have been signed by officials.
• Follow-up procedures, if necessary, will be communicated to you upon discharge.
• Arogyamitra will educate you on any necessary follow-up measures.

Free Follow-Up Services

• Free follow-up consultations, diagnostics, and medications are available for up to ten days after discharge.

Claim Settlement

• The insurer reviews the bills by established rules and settles claims at agreed-upon rates.
• Senior Citizenship Cards (issued by State or Federal Governments)

Documents Required

• Aadhaar Card or Aadhaar Registration Slip (must have beneficiary’s photo)
• PAN Card
• Voter ID
• Driving License
• School/College ID
• Passport
• Freedom Fighter ID Card
• Health Card (RGJAY/MJPJAY)
• Handicap Certificate
• Nationalized Bank Passbook (must have photo)
• Senior Citizen Card (issued by Central or State Government)
• Defense Ex-Servicemen Card (issued by Sainik Board)
• Marine Fishery Identity Card (issued by Ministry of Agriculture/Fisheries Department, Maharashtra)
• Any other photo ID proof (issued by the Government of Maharashtra or the Government of India)

MJPJAY plays an important role by offering reasonable medical treatment and helping families so they won’t bear high hospital charges.

Frequently Asked Questions