Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

• Medical aid plan introduced by the Maharashtra Health Ministry.
• Was introduced for providing cashless health services to lower income groups
• The beneficiaries can only be citizens of Maharashtra.

• 1.5 Lakh Cover: 1.5 lakh Cover provided every year for the entire family
• Medical Treatment: Covers costs of consultations, diagnostics, treatment, surgeries & medications.
• Family Cover: Cover is provided on an individual & family basis.
• No Premium: The State Government pays the premium.
• No Waiting Period: Pre-existing illnesses covered from Day 1.
• Free Check-ups: Free health care check-ups at government hospital camps.
• Quality Treatment: Good medical treatment under empanelled private & government hospitals.

• 971 medical procedures.
• Listed therapies
• Listed surgeries
• 121 follow-ups
• General surgery
• Radiation surgery
• Ophthalmology surgery
• Paediatric surgery
• Plastic surgery
• Orthopaedic surgery
• Cardiac surgery
• Cardiothoracic surgery
• Gynaecology
• Obstetrics surgery
• ENT surgery
• Renal transplant up to Rs 2.5 lakh
• Post-hospitalization expenses up to 10 days

All standard medical care is covered except for 131 planned procedures. These procedures will only be conducted at the private or government empanelled hospitals under this scheme.

• Discectomy
• Appendectomy
• Cholecystectomy
• Hernia
• Abdominal hysterectomy
• Vaginal hysterectomy

• Families falling under Maharashtra state’s ‘identified distressed districts’
• Should have a Yellow or Orange or White Ration Card.
• Or should have Annapurna Card or (AAY) Card i.e. Antyodaya Anna Yojana.
• Farmers from Washim, Yavatmal, Parbhani, Wardha, Osmanabad, Nanded, Latur, Jalna, Beed, Hingoli, Buldhana, Akola, Aurangabad & Amravati.
• Farmers are identified based on their Ration Card (white), 7/12 extract, beneficiary name or family head or certificate from the respective Talathi or Patwari.

Documents required For MJPJAY - Mahatma Jyotiba Phule Jan Arogya Yojana

• Aadhar Card
• Driving License
• Voter ID
• Pan Card
• Bank Passbook with Photograph (Nationalized bank)
• School or College ID
• Handicap Certificate
• Government Local bodies or Tahsildar’s stamps & signatures on the respective applicant’s photograph. (Only for urban areas)
• Freedom Fighter Card
• Senior citizen card by state or central government
• Passport
• Ex-service card by Sainik board
• Photo ID proof Indian Government
• Photo ID proof by Maharashtra Government
• Marine Fishers ID

• One should go to the nearby Women or District or Network or General Hospital & meet Arogyamitra to commence the application.
• If one goes to a Government Health Facility, he or she will be provided with a referral card.
• He or she needs to present this card to the respective Network Hospital.
• With the card, he or she also submits the doctor’s preliminary diagnosis carried out at the respective Government Health Facility.
• One can also go to the Health Camps by Network Hospitals & acquire the referral card.
• He or she has to then give the referral card with their Orange or Yellow Card.
• One can also provide his or her Annapurna Card or Antyodaya.
• Once all the above details are procured, the check-up and diagnosis will start.
• On the basis of the diagnosis, he or she will be asked to get admitted to the Hospital.
• The insurance company will send an E-authorisation request.
• MJPJAY will review this request as well.
• Medical Specialists from the insurer will also review this request for authorization.
• The authorization will get done within 24 hours.
• It will be done instantly in an emergency case where it will be marked as “EM”.
• After authorisation approval, hospitalization or cashless treatment will be provided.
• The respective hospital will forward all the relevant documents like discharge summary, diagnostic reports & original bills to the insurer for claim settlement.
• The insurer will review all the documents.
• Based on its review, it will approve the claim.
• Post claim approval, it will clear the hospital bill payment.
• The respective network hospital will then provide free doctor consultations, prescribed medicines & relevant diagnostics up to ten days after discharge.