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Mahatma Jyotiba Phule Jan Arogya Yojana 

Launched by the Government of Maharashtra, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) provides coverage for several healthcare expenses arising due to hospitalisation of the insured for a sum insured amount of Rs. 1.5 Lakh per annum. The yearly coverage of Rs. 1.5 Lakh can be availed by an individual or the entire family through cashless hospitalisation.

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**Tax benefits are subject to changes in Income Tax Act.

Mahatma Jyotiba Phule Jan Arogya Yojana - MJPJAY

Salient features of MJPJAY are as follows:

  • Health insurance premium and coverage charges are borne by the State Government of Maharashtra
  • Sum insured of Rs. 1.5 lakh per annum for a family
  • The scheme can be used either on an individual basis r a family floater basis
  • The scheme covers surgeries, medications, diagnostics, follow-up consultations, and treatment
  • Cover for all pre-existing diseases from the first day
  • Treatment under several private hospitals as well as government-empanelled hospitals
  • Access to health camps conducted at government hospitals

Inclusions Under Mahatma Jyotiba Phule Jan Arogya Yojana

Mahatma Jyotiba Phule Jan Arogya Yojana covers the insured for 971 surgeries/therapies/procedures and 121 follow-up packages in 30 specialized categories. These include the following:

  • ENT surgery, general surgery, orthopedic surgery and procedures, gynecology and obstetrics surgery, cardiac and cardiothoracic surgery, pediatric surgery, plastic surgery, radiation surgery, ophthalmology surgery, etc.
  • Renal transplant operation with an upper limit of Rs. 2.5 lakh
  • 132 procedures performed by government medical colleges or impanelled government hospitals
  • Post-hospitalisation expenses for medicines and consultation are covered for up to 10 days from the date of discharge

Diseases Covered Under Mahatma Phule Jan Arogya Yojana

Apart from pre-existing diseases, Mahatma Jyotiba Phule Jan Arogya Yojana covers individuals from the following diseases and treatments:

ENT surgery

General surgery

Ophthalmology surgery

Gynecology and Obstetrics Surgery

Surgical Gastroenterology

Orthopedic Surgery and Procedures

Cardiac and Cardiothoracic Surgery

Genitourinary System

Pediatric Surgery

Medical Oncology

Plastic Surgery

Burns

Surgical Oncology

Neurosurgery

Critical care

Radiation Oncology

Prostheses

Polytrauma

Infectious disease

General medicine

Pediatrics Medical Management

Nephrology

Cardiology

Neurology

Dermatology

Pulmonology

Rheumatology

Gastroenterology

Endocrinology

Interventional Radiology

Exclusions Under Mahatma Jyotiba Phule Jan Arogya Yojana

Mahatma Phule Jan Arogya Yojana covers all acceptable healthcare expenses except planned 131 procedures including hernia, vaginal or abdominal hysterectomy, cholecystectomy, discectomy, etc. These shall only be performed at government-empanelled hospitals or government medical colleges.

Eligibility for Mahatma Jyotiba Phule Jan Arogya Yojana

The eligibility criteria for Mahatma Jyotiba Phule Jan Arogya Yojana is as follows:

  • Families who are a part of identified distressed districts of Maharashtra
  • Should have white/yellow/orange Ration Card, Annapurna Card, and Antyodaya Anna Yojana Card (AAY)
  • Farmers from the agriculturally distressed districts like Latur, Washim, Akola, Aurangabad, Beed, Jalna, Nanded, Hingoli, Osmanabad, etc.
  • The farmers are identified on the basis of the 7/12 extract, the White Ration Card, and the name of the beneficiary/head of the family or certificate from the concerned Talathi or Patwari.

How to Enrol Under Mahatma Jyotiba Phule Jan Arogya Yojana?

The enrolment process for the MJPJAY scheme is as follows:

  • Approach nearby districts/networks/women/general hospitals and meet Arogyamitra to initiate the application.
  • On visiting a government health facility, a referral card will be provided, which can be shown to the network hospital along with preliminary diagnosis conducted by doctors at the government health facility Provide the referral card with a yellow/orange card.
  • You can also produce an Antyodaya or Annapurna Card instead of a ration card after producing the details, check-ups and diagnosis will be initiated.
  • On the basis of which, you will be admitted to the hospital the health insurance company will be sent an e-authorisation request which will be reviewed by Mahatma Phule Yojana as well the request will be approved if all conditions are being met.
  • Authorization will be done. Cashless treatment can then be availed.
  • The hospital will send original bills, discharge summaries, diagnostic reports, and other relevant documents to the insurance company for claim settlement.
  • The insurance company will review the documents, approve the claim, and pay at the hospital.
  • Free consultations, medicines, and diagnostics can be availed at the network hospital for up to 10 days after discharge.

Documents Needed to Apply For Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Apart from a ration card, any of the following KYC documents are required to be submitted for MJPJAJ Scheme identification:

  • PAN card
  • Voter ID
  • Aadhaar card
  • Driving licence
  • Handicap certificate
  • School/college ID
  • Nationalised bank passbook with photograph
  • Passport
  • Government local bodies/tehsildar’s stamps (for urban areas) and tehsildar’s stamps (for rural areas) signatures on the applicant’s photograph
  • Freedom Fighter ID card
  • Defence ex-service card issued by Sainik Board
  • Senior citizen card issued by central and state government of India
  • Marine Fisher identity card
  • Any photo ID proof issued by the Government of Maharashtra/Government of India.

Note that if photo and name are not available in the case of a newborn child, then submit the photo of the child with either of the parents with the child's birth certificate and a white yellow/orange ration card.

How to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana Card?

To apply for an MJPJAY card, approach the nearby general, district/women/network hospital. The representative of the scheme, Arogyamitra will facilitate in getting the health card.

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FAQ About Mahatma Jyotiba Phule Jan Arogya Yojana 

  • Does Mahatma Jyotiba Phule Jan Arogya Yojana Scheme cover me for treatment related to COVID-19 (coronavirus)?

    Yes. Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY) covers you for expenses incurred due to treatment required due to a positive diagnosis of COVID-19 (coronavirus).

  • What is the maximum insurance cover under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY)?

    The maximum cover under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY) is Rs. 1.5 lakh per family. Note that in case of renal transplant, the maximum limit is Rs. 2.5 lakh per operation. 

  • Should I pay any extra money for treatment under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY)?

    No. You are not required to pay anything extra at the hospital to avail services that are covered under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY). 

  • Is hernia covered under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY) scheme?

    Under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY), most medical expenses are covered except a few, of which hernia is one. 

  • What is the turn-around time for a decision on pre-authorization under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY) scheme?

    The turn-around time for a decision on pre-authorization under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme (MJPJAY) scheme is 12 hours. In case of emergencies, the medical or surgical pre-authorization approval is taken by MCO over the telephone.