ABOUT SCHEME:

Government of Maharashtra started Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) (while Rajiv Gandhi Jeevandayee Arogya Yojana) from 2nd July, 2012 in eight districts on pilot basis and then it was expanded in all districts of Maharashtra from 21st November, 2013. This flagship health scheme was initially started for low income families and then added other categories from time to time.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched by the Government of India on 23rd September 2018. Earlier the households included were based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. Government of India and Government of Maharashtra have been sharing cost of implementation in the ratio of 60:40.

Integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Matri Jan Arogya Yojana (AB-PMJAY) have been implemented in revised form across the state from 1st April, 2020. The scheme provides end to end cashless quality medical services for identified diseases through empanelled hospitals.

Government of Maharashtra has taken decision vide GR dated 28th July, 2023 to implement MJPJAY for all families in the state and expanded the scope of existing scheme. Accordingly, integrated scheme is being implemented from 1st July, 2024 with expanded scope. Integrated Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana & Mahatma Jyotirao Phule Jan Arogya Yojana is Govt. funded largest cashless health care scheme in India. The scheme covers all population of Maharashtra and providing health coverage of Rs.5 lakh per family per year for secondary and tertiary healthcare requiring hospitalization.

Key Features of Integrated Scheme:-

➢ Universal Health Coverage for all citizens of Maharashtra

➢ Cashless secondary and tertiary healthcare procedures in network hospitals

➢ Provides health coverage of Rs.5 lakhs per year on a family floater basis which means that it can be used by one or all members of the family

➢ Medical services of surgeries/treatments requiring hospitalization under 34 Specialties

➢ All pre–existing conditions are covered from day one.

➢ MJPJAY Beneficiary can avail cashless treatment in any Govt./Pvt. network hospital in State.

➢ Benefits of PMJAY scheme are portable across the country

➢ Dedicated call centre for scheme where beneficiary can get information of scheme and raise grievance of services under the scheme.

➢ Scheme is fully paperless and run on dedicated portal.

➢ Arogyamitra deployed at every network hospital to help and facilitate to beneficiary

➢ Patient can avail treatment in emergency through intimation by telephone or email.

Details of expanded scheme are follows:

Beneficiaries:

AB-PMJAY(Category-A):

• Households recorded in the Social, Economic and Caste Census, 2011 (SECC) • Antyodaya Anna Yojana (AAY) and Priority House Holder (PHH) Families tagged from National Food Security Act (NFSA)

MJPJAY
Categories	Description of Beneficiaries
Category A	Families holding Yellow, Antyodaya Anna Yojana (AAY), Annapurna Yojna and Orange Ration Card.
Category B	• White ration card holder families (including Govt./Semi Gov employees). • A family without having any kind of ration card but having domicile certificate of Maharashtra
Category C	• Students in Govt. and Govt. recognized Ashram School • Children in Govt. and Govt. recognized Orphanages • Women in Govt. and Govt. recognized Women's Ashram • Sr. citizens in Govt. and Govt. recognized old age homes • Journalists and their dependent family members as per criteria of Directorate General of Information and Public Relations Office. • Construction workers and their families (who are resident of outside of Maharashtra) registered with Maharashtra Building and Other Construction Workers Board.
Category D	Road traffic accident victims from outside Maharashtra and outside India who met with an accident on roads in Maharashtra
Category E	Families holding below mentioned ration cards from 865 villages of Belgaon, Karwar, Kalburgi and Bidar Districts of Maharashtra- Karnataka border 1) Antyodaya Anna Yojana (AAY) 2) Priority House Holder (PHH) 3) Annapurna Yojna

Eligibility and Identification
PMJAY (Category A)	Ayushman Card along with valid Id Proof
MJPJAY (Category A)	Ayushman card or Ration Card(Yellow, Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange) along with valid ID proof
MJPJAY (Category B)	Ayushman card or white Ration Card. In absence of White Ration Card, Domicile Certificate or Tahsildar Certificate along with Self-Declaration and valid ID proof In case of Govt./Semi Govt. employee, White Ration card and Self-In case of Govt./Semi Govt. employee, White Ration card and Self-Declaration with valid ID proof
MJPJAY (Category C)	Ayushman card or valid ID card issued by respective organisation and valid ID proof
MJPJAY (Category D)	Geo tagged photo of patient in the hospital, copy of the letter of information to be issued by the hospital to the police regarding the road accident and victim’s Aadhar Card or Voter ID or PAN Card or Passport.
MJPJAY (Category E)	Antyodaya Anna Yojana ration card, Annapurna ration card and Priority household ration card issued by competent authority of Karnataka Government along with self-declaration in the prescribed format and valid ID proof

Annual Health coverage:-

✓ For category A to E (Excluding D) - Rs.5 lakhs per family per year for both the schemes on floater basis

✓ For category D - Rs.1 lakh per person per year.

Medical Benefits:-

• For category A to E (Excluding D) - 1356 Health Benefit Packages under 34 specialities

• For category D – 184 Health Benefit Packages for Road accident patient

Follow-up treatment:-262 Health Benefit Packages for both schemes

Treatment reserved for Govt. Hospitals:-119 Health Benefit Packages for both the schemes

Benefit under Health Packages : Packages include bed charges in General ward, Nursing and boarding charges, Surgeons and Anaesthetists charges, Medical Practitioner and Consultants fees, Oxygen, O.T. & ICU Charges, Cost of Surgical Appliances, Cost of Drugs, disposables, consumables, implants, Cost of Prosthetic Devices, Cost of Blood Transfusion (Blood to be provided as per policy of State Government), X-Ray and Diagnostic Tests, food to inpatient, one time transport cost by State Transport or second class rail fare (from Hospital to residence of patient only). The package covers the entire cost of treatment of patient from date of reporting to his discharge from hospital including complications if any, making the transaction truly cashless to the patient. In instance of death, the carriage of dead body from network hospital to the village/ township would also be part of package.

Coverage under Insurance and Assurance Mode:

Mode	Coverage
Insurance coverage through United India Insurance Company Ltd. (UIICL)	• Rs.1.50 lakhs for category A • Rs.4.50 lakhs for Kidney Transplant
Assurance through State Health Assurance Society	• Above Rs.1.50 lakhs to Rs.5 lakhs for Category A • Rs.5 lakhs per family per year for Category B, C, E • Rs.1 lakh per person per year for Category D

Count of Beneficiary families:

Around 2.72 Cr families (12.50 Crores population) covers under the integrated scheme.

Scheme	Insurance Mode	Assurance Mode	Total
PMJAY	93.05 lakhs	-	93.05 lakhs
MJPJAY	1.44 Cr	34 lakhs	1.78 Cr
Total	2.38 Cr	34 lakhs	2.72 Cr

Insurance Provider :-

United India Insurance Company is proving health insurance coverage up to Rs.1.50 lakhs (Rs.4.50 lakhs for Renal Transplant) for beneficiary families under Category A. State Health Assurance Society is paying insurance premium per family per year on behalf of insured families as determined by Government.