Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility Coverage and More

MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana) – Complete Guide

Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a flagship health insurance scheme in Maharashtra, launched by the Government of Maharashtra to provide free, quality, cashless healthcare to low-income families.

The scheme is named after Jyotirao Phule, a 19th-century Maharashtrian writer and social reformer who worked for the upliftment of the poor, women, and marginalized sections of society.

What is MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana)?

The MJPJAY scheme is a state-run health insurance programme designed on the lines of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). It offers end-to-end cashless healthcare services for designated diseases through a wide network of empanelled public and private hospitals.

• While AB-PMJAY is a Central Government scheme, in Maharashtra it has been integrated with MJPJAY since April 1, 2020.

Funding:

• MJPJAY is fully funded by the Government of Maharashtra.
• PMJAY is funded jointly by the Centre and Maharashtra in a 60:40 ratio.

Coverage:

• The State Health Assurance Society (SHAS) provides coverage under assurance mode.
• The government also pays an insurance premium of ₹797 per family/year to United India Insurance Company on behalf of eligible families.

Features of MJPJAY

The Mahatma Jyotiba Phule Jan Arogya Yojana comes with unique features to support low-income households:

• 100% premium paid by the Government of Maharashtra.
• Coverage of ₹1.5 lakh per family per year, extendable to ₹2.5 lakh for renal transplants.
• Family floater policy (covers all family members).
• Cashless treatment for surgeries, therapies, diagnostics, medicines, and follow-up consultations.
• Coverage of pre-existing diseases from Day 1.
• Government and select private hospitals empanelled under the scheme.
• Health camps organised at government hospitals for beneficiaries.
• Integration with Ayushman Bharat (PMJAY) for additional coverage up to ₹5 lakh per year.

Benefits of MJPJAY

The MJPJAY benefits are extensive and cover critical healthcare needs:

• Hospitalisation for 996 medical & surgical interventions and 34 designated diseases through cashless facilities.
• 121 follow-up procedures included.
• Under PMJAY, policyholders get access to 1,209 + 213 medical & surgical procedures and 183 follow-ups.

Reserved procedures:

• 131 procedures under MJPJAY reserved for government hospitals.
• 37 procedures under PMJAY reserved for government hospitals.

Eligibility for MJPJAY

Beneficiaries under Mahatma Jyotiba Phule Jan Arogya Yojana eligibility include:

Category A

• Families with valid Yellow, Orange, Antyodaya, and Annapurna ration cards with photo ID proof.

Category B

• Farmers with white ration cards from 14 agriculturally distressed districts of Maharashtra, with 7/12 extract or certificate from revenue officers.

Category C

• Beneficiaries identified by the State Health Assurance Society (SHAS) using its mechanism (e.g., health/ID card).

PMJAY Eligibility (integrated with MJPJAY)

• Families from Socio-Economic Caste Census 2011 (SECC 2011) database with e-cards.
• Aadhaar card generally used as ID (alternative IDs accepted).
• Poor households in both urban (occupational categories) and rural (D1–D7 deprivation categories) are included.
• Around 83.72 lakh households in Maharashtra are automatically included.

What is Covered Under MJPJAY?

The MJPJAY disease list covers a wide range of treatments:

• Hospitalisation, diagnostics, medicines, therapies, consultations, surgeries, and follow-ups.
• Specialities covered: burns, cardiology, cardiovascular surgery, critical care, dermatology, endocrinology, ENT surgery, general medicine, neurology, oncology, nephrology, orthopaedics, paediatrics, pulmonology, mental health, obstetrics & gynaecology, and more.

Package benefits include:

• Bed, nursing & boarding charges
• Surgeon & anaesthetist fees
• Oxygen, ICU, OT charges
• Drugs, implants, consumables
• Blood transfusion, X-rays, diagnostics
• Patient food
• Transport (government transport costs)
• Funeral expenses in case of death

What is Not Covered Under MJPJAY?

• Some common conditions not covered: adult cataracts, hernia, appendicitis, pneumonia, diarrhoea, diabetes, snakebite (except in emergencies).
• Ambulance charges are excluded.
• Private hospitals cannot perform 131 MJPJAY-reserved and 37 PMJAY-reserved procedures, which are limited to government hospitals.

How to Register for MJPJAY (Online & Offline)?

To apply for MJPJAY registration online, beneficiaries must connect with Arogyamitras (scheme facilitators) available at government and network hospitals.

• Find Arogyamitra contact details here → MJPJAY Arogyamitra List
• Arogyamitra will help with document submission, health card issuance, and online registration.
• E-authorisation approval is generated for cashless treatment.

Documents Required for MJPJAY

• Yellow, Orange, Antyodaya, or Annapurna ration cards.
• White ration cards (farmers from 14 distressed districts).
• Aadhaar card, voter ID, PAN, driving licence, school ID, senior citizen card, bank photo passbook, ex-serviceman ID, handicap certificate, etc.
• MJPJAY/PMJAY e-card & photo ID for online verification.

Claim Procedure under MJPJAY

1. Visit an empanelled hospital or nearest Arogyamitra.
2. Diagnosis & pre-authorisation generated by the insurer.
3. Approval issued → cashless treatment begins.
4. Post-treatment, the hospital submits claim documents.
5. The insurer settles the claim with the hospital.
6. Beneficiaries can avail 10 days post-hospitalisation care.

List of Hospitals under MJPJAY

The MJPJAY hospital list includes government, charitable, and private hospitals across Maharashtra.

• Hospitals under Public Health Dept., Municipal Corporations, and Medical Education Dept.
• Private hospitals (multi-speciality with minimum 30 beds & ICU / single-speciality with minimum 10 beds).
• Managed by Coordination Empanelment & Disciplinary Committee.
• Access full hospital list here: MJPJAY Empanelled Hospital

MJPJAY Toll-Free Number & Contact Details

• Toll-free helplines: 1800 233 2200 / 155388
• Email ID: ad@jeevandayee.gov.in
• Office Address:
  MJPJAY Project Office, ESIC Hospital, 3rd Floor,
  Ganpat Jadhav Marg, Near Worli Naka, Worli, Mumbai 400018
• Official contact page: MJPJAY Contact Us
• About Arogyamitra: Know More

Conclusion

The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) plays a crucial role in ensuring universal healthcare access for Maharashtra’s underprivileged families. By integrating with Ayushman Bharat (PMJAY), it further enhances coverage and ensures access to both government & private hospitals for cashless treatment.

👉 Whether you’re checking MJPJAY registration online, verifying approval status, or exploring scheme benefits, this health insurance scheme ensures that low-income families get access to quality medical treatment without financial stress.

Frequently Asked Questions (FAQs)

1. Do I need a ration card for MJPJAY registration?
   Yes, ration cards (Yellow, Orange, Antyodaya, Annapurna) plus photo ID are required.
2. Are ambulance charges covered?
   No, ambulance charges are not included.
3. What is the maximum insurance cover under MJPJAY?
   ₹1.5 lakh per family per year, extendable to ₹2.5 lakh for renal transplants.
4. Does MJPJAY cover COVID-19 treatment?
   Yes, COVID-19 (Coronavirus) treatment is covered.
5. What if treatment costs exceed MJPJAY limits?
   Extra expenses must be borne by the patient.