Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY): A Comprehensive Guide

What is the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)? The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is Maharashtra’s flagship government-funded health insurance scheme. It provides cashless, comprehensive medical treatment for all residents of the state to protect families from catastrophic healthcare expenses. Originally launched in 2012 as the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) and renamed in 2017, the scheme was fully integrated with Ayushman Bharat–PMJAY on July 1, 2024. This marked a shift to universal coverage for the entire state population. Since July 1, 2024, the integrated scheme provides universal health coverage for all residents of Maharashtra, not just “economically weaker sections/distressed farmers.”

Medical costs remain one of the biggest financial burdens for Indian families, with data showing that nearly 47.1% of healthcare expenses are still paid out-of-pocket. For certain low-income families and farmers in Maharashtra, even a single hospitalization can push individuals into debt. This is the gap the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) seeks to close.

At Ditto, we regularly advise families who struggle to understand government health schemes and often miss out on benefits simply due to a lack of awareness. 

In this guide, we’ve broken down the details of MJPJAY coverage, exclusions, required documents, and step-by-step claim procedures so that you can make informed decisions.

If you are still confused about the kind of insurance you want for your family, book a call or WhatsApp us to speak to our advisors at Ditto.

What is the Eligibility Criteria for Mahatma Jyotiba Phule Jan Arogya Yojana?

To avail of benefits under the integrated PMJAY and MJPJAY scheme, applicants must belong to the following categories:

• Category A: Families with Yellow, Annapurna Yojana, Antyodaya Anna Yojana (AAY), and Orange Ration Cards.
• Category B: White Ration Card holders, such as government and semi-government employees. Families without any ration card but having a domicile certificate of Maharashtra are also eligible. 
• Category C: Students in government and recognized Ashram schools, children in recognized orphanages, and women in government-supported ashrams are eligible. This category also applies to senior citizens in recognized old age homes and journalists and their dependents.
• Category D: Road traffic accident victims, regardless of their place of origin, can receive treatment in Maharashtra hospitals.
• Category E: Families with specified ration cards from the Maharashtra-Karnataka border districts (Karwar, Belgaum, Kalburgi, Bidar).

What Does Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Offer?

Under the current benefit structure, MJPJAY provides:

• ₹5 lakh per family per year (floater) for Categories A, B, C, and E, and ₹1 lakh per person per year for Category D (road accident victims from outside Maharashtra/India). 
• The scheme covers 1,356 procedures across 34 specialties, including cancer treatment, cardiac surgeries, renal care, neurosurgery, burns, and more.
• It also offers 262 follow-up packages for post-hospital care and has 119 procedures reserved exclusively for government hospitals to strengthen the public healthcare system. 
• All pre-existing diseases are covered from Day 1, and the scheme also ensures portability of PMJAY benefits across India.

What is Covered and Not Covered under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

The MJPJAY scheme offers several unique features that make it indispensable for low-income families. However, it has its own set of inclusions and exclusions, as mentioned below:

What’s Covered Under MJPJAY:

• Cashless hospitalization at empanelled hospitals.
• Surgeries and therapies across 34 specialties.
• Cancer treatment as per approved packages.
• Renal transplant, cardiac surgeries, neuro, orthopaedic, paediatric, and burns treatment.
• Bed charges, drugs, consumables, implants, diagnostics, and ICU/OT charges.
• Food during hospitalization.
• One-time transport home after discharge.
• Transport of the body in case of death.

What’s Not Covered Under MJPJAY: 

• Treatments not mentioned on the approved package list.
• Cosmetic or experimental procedures.
• Expenses above the approved package rate (if patient opts for non-standard care).
• Non-empanelled hospital treatments.
• Room upgrades beyond general ward entitlement.

Remember: Only Government-approved/empanelled hospitals are eligible for coverage, which is subject to certain treatment protocols. If a patient undergoes multiple procedures during the same visit, the first procedure is paid in full, and any additional procedures are paid at half the rate.

Documents Required for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Category	Required Documents
PMJAY (Category A)	Ayushman Card accompanied by an ID proof.
MJPJAY (Category A)	Ayushman Card or Ration Card (Yellow, Antyodaya Anna Yojana (AAY), or Annapurna Ration Card- Orange) accompanied by an ID proof.
MJPJAY (Category B)	Ayushman Card or White Ration Card. Domicile Certificate or Tahsildar Certificate along with a self-declaration and valid ID proof (if White Ration Card isn’t available) White Ration Card along with a self-declaration and valid ID proof (for government and semi-government employees).
MJPJAY (Category C)	Ayushman Card issued by the relevant organization, accompanied by a valid proof of identity.
MJPJAY (Category D)	(For road accident victims from outside Maharashtra or India) A geo-tagged photograph of the patient taken at the hospital. Aadhaar card, PAN card, Voter ID, or Passport of the victim. A copy of the hospital’s letter sent to the police regarding the road accident.
MJPJAY (Category E)	Antyodaya Anna Yojana Ration Card, Annapurna Ration Card, or a Priority Household Ration Card issued by the Government of Karnataka. Self-declaration in the specified format along with proof of identity.

Pro Tip: These documents are to be submitted at the time of registration, either online or at the nearest empanelled hospital, with the help of the Aarogyamitra, a frontline health service professional who assists the scheme beneficiaries. The type and number of documents required may vary based on the beneficiary category under which someone is applying.

Did You Know? Recent state reforms have created a reserve fund to cover high-cost, rare procedures (like heart, lung, liver, and bone marrow transplants) beyond ₹5 lakh. Under the expanded MJPJAY and Ayushman Bharat PMJAY schemes,20% of claim settlements will now be diverted to this unique fund that will be managed by the State Health Assurance Society (SHAS).

How to Enroll in Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

To enroll in MJPJAY, eligible residents of Maharashtra can follow this step-by-step procedure:

1) Collect Required Documents

a) Gather documents such as ration card (Yellow/Orange/AAY/Annapurna), Aadhaar card, photo ID (Voter ID, PAN, Passport), relevant farmer or special category certificate, and recent photographs.

2) Offline or Online Registration

• Proceed with an offline registration for the scheme via Arogyamitra. Alternatively, seniors can also enroll via the PMJAY scheme, which is available online. 
• Fill out the application form with mandatory personal, family, and contact details.
• Upload scanned copies of the required documents.
• Select your beneficiary category (BPL, distressed farmer, senior citizen, etc.) and choose the empanelled hospital where you wish to avail benefits.
• Submit the application. An acknowledgement or registration number will be issued for follow-up.
• On verification, the MJPJAY card is sent to your address or can be collected at a designated center.

3) Offline Registration (Hospital/Health Camp)

• Visit the nearest empanelled government or private hospital or health camp.
• Approach the Aarogyamitra desk (scheme facilitator) for assistance. Submit your documents for verification.
• Aarogyamitra verifies your eligibility using your ration card and photo ID/proof and registers your details in the system.
• The hospital initiates the admission and pre-authorization for the treatment under MJPJAY.
• Once verified, you receive a referral card/health card at the hospital for future use.
• All subsequent treatments and follow-up packages can be accessed upon presentation of the MJPJAY card.

What are the Claim Procedures for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

The claim procedure under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is designed to be simple and cashless for eligible beneficiaries. Here is a step-by-step overview:

• Choose an Empanelled Hospital
  Beneficiaries must receive treatment at an empanelled public or private hospital under MJPJAY.
• Register and Verify Eligibility
  On arriving at the hospital, present your MJPJAY card, ration card, and photo ID to the Aarogyamitra desk or hospital administration. Your eligibility will be verified electronically.
• Pre-Authorization Process
  For planned hospitalization or surgeries listed under MJPJAY packages, the hospital initiates a pre-authorization request online to the State Health Assurance Society. This approval is mandatory for cashless treatment.
• Approval and Admission
  Once pre-authorization is granted, the patient is admitted to the hospital, and cashless treatment is facilitated within the package cost limits.
• Treatment and Discharge
  After treatment and hospitalisation, the hospital submits the claim documents online to the State Health Assurance Society for reimbursement. Patients are generally not required to pay except for non-covered services or above-package costs.
• Post-Hospitalization Care
  Beneficiaries can avail post-hospitalization consultations and medicines for up to 10 days as part of MJPJAY packages.
• Claim Settlement
  The hospital’s claim is processed and settled by the government insurance agency or nodal agency managing the scheme funds. This is transparent and monitored for fraud prevention.

For assistance, beneficiaries can call the toll-free numbers 155 388 or 1800 233 2200. If call centre helplines are not working due to technical issues, emergency support is available at 9702135277 / 7208076239.

Pro Tip: Always insist on going through the Aarogyamitra desk because they handle all paperwork and ensure you are not wrongly charged.

Ditto’s Take on Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

MJPJAY is an excellent move by Maharashtra toward universal health coverage for its citizens. Its unification with Ayushman Bharat PMJAY, as of July 2024, simplified benefits and expanded access. This makes it easier for families to access care under one platform rather than juggling two schemes.

However, MJPJAY is not a complete substitute for private insurance, especially for those who prefer premium private-room care, faster services, or more flexibility. If you can afford it, supplementing MJPJAY with a retail health insurance plan makes more sense to cover gaps or premium services.

Practically, the scheme also struggles with timely private hospital enrollment and chronic payment delays. This often leaves hospitals financially strained and limits patient access to care.

Why Talk to Ditto for Your Health Insurance?

At Ditto, we’ve assisted over 7,00,000 customers with choosing the right insurance policy. Why customers like Nasik below love us:

✅No-Spam & No Salesmen

✅Rated 4.9/5 on Google Reviews by 5,000+ happy customers

✅Backed by Zerodha

✅100% Free Consultation

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY): Final Thoughts

Access to quality healthcare services is a fundamental human right. With schemes such as the MJPJAY, the government is taking conscious steps to ensure medical facilities reach every member of society, regardless of their economic status.

While the MJPJAY scheme extends medical facilities to the weaker section of society, you can easily avail of a health insurance plan for your family and yourself, even if you are not covered under the scheme.

If you are still confused about the kind of insurance you want for your family, book a call or WhatsApp us to speak to our advisors at Ditto.

FAQs