Ayushman Bharat PM-JAY Maharashtra

How Ayushman Bharat-Mahatma Jyotirao Phule Jan Arogya Yojana works in Maharashtra

In Maharashtra, Ayushman Bharat PM-JAY operates through an integrated framework alongside the state’s flagship scheme under the local name Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). The Scheme is governed by the State Health Assurance Society (SHAS) under the Public Health Department of Maharashtra.

SHAS looks after everything from hospital empanelment to post-treatment claim settlements. It also maintains standard operations across network facilities.

Key Highlights- PM-JAY Maharashtra

Who Is Eligible for PM-JAY in Maharashtra

1. Beneficiaries (Ration Card Holders)

   • Households under Below Poverty Line (BPL): Households which are in categories of Yellow & Antyodaya Anna Yojana (AAY) Ration Card Holders.
   • Households having an Annual Income of not more than ₹1 lakh are known as Orange and Annapurna Ration Card Holders.
   • According to Socio Economic Caste Census (SECC) 2011, all households are automatically covered in the data.

2. Special & Vulnerable Categories

   • Farmers of Distressed Areas: Farmers with White ration cards residing in 14 agriculturally distressed areas in Maharashtra (for example, Amravati, Yavatmal, Wardha, Nanded, Beed, and others).
   • Registered Construction Labour: Registered construction labour (and their dependent family members) with the Maharashtra Building and Other Construction Workers Welfare Board.
   • Inmates of State Institutions: Children from approved orphanages, students of Ashram Shalas, inmates of Mahila Ashrams, and senior citizens from government homes for senior citizens.
   • Victims of Accidents: Victims of accidents on roads in the state of Maharashtra, irrespective of whether they belong to Maharashtra or not.
   • Government-Accredited Journalists: Government-accredited journalists and their dependent family members.

Benefits and Coverage under PM-JAY in Maharashtra

1. Financial Coverage

   • Coverage Limit: Maximum of ₹5 lakhs per family member per year on a family floaters' plan (applicable to one/family member).
   • 100% Cashless & Paperless Treatment: No upfront cost required by beneficiary for any covered medical procedure in any public/private hospital facility.
   • Coverages: Coverages against all pre-existing ailments immediately after enrolment (without any waiting period).
   • Scope of Inpatient Coverages
   • Hospitalisation Cost: Full coverage against costs incurred for ICU & bed charges, Surgeon/consultant fee & nursing service charges.
   • Medical & Surgical Supplies: Complete coverage for all diagnostic services, laboratory investigations, drugs, consumables & surgical implants.
   • Post Discharge Services: Up to 10 days of post-hospitalisation consultations, follow-up consultations & medications.
   • Transportation Allowances: Fixed allowances available for patients admitted to network hospitals.

2. Coverage of Procedures & Speciality

   • Coverage of Procedures: 2,399 Medical & Surgical Procedures across 38 Speciality Clinics.
   • Main Specialities Included: Cardiology, Oncology (Chemotherapy, Radiation, Surgery), Orthopaedics, Nephrology (Dialysis, Kidney Transplants), Neurosurgery, Pediatrics & Poly Trauma.

Documents Required to Apply for PM-JAY Maharashtra

1. Documents to Prove Family's Eligibility (Choose One)

   • Ration Card: Valid yellow ration card, valid orange ration card, or Annapurna ration card.
   • ABHA/PMJAY Card: Valid Ayushman Bharat Health Account (ABHA) ID, or PMJAY Family ID.
   • Special Category Certificate: Labourers of Construction, Orphanage inmate certificate, or Distress land of Farmer certificate.

2. Document to Prove Member's Identity (Choose One)

   • Aadhar Card (Preferred for immediate e-KYC)
   • Voter ID Card
   • Driving License
   • PAN Card

How to Apply Step by Step for an Ayushman Card in Maharashtra

1. Method 1: Apply Online through the Beneficiary Portal / App

   Step 1: Go to the NHA Beneficiary Portal

   Now go to the official National Health Authority (NHA) Beneficiary Portal (beneficiary.nha.gov.in) or download the Ayushman App on your Android Smartphone.

   Step 2: Log in as Beneficiary

   • Click on the Beneficiary option on the home screen.
   • Enter your 10-digit mobile number, click on Verify, and enter the OTP that you have received on your mobile.

   Step 3: Search for Household Eligibility

   • Select Maharashtra as your State.
   • Choose your scheme (e.g. MJPJAY).
   • Select your District and search using one of the following parameters:
   • Ration Card / Family ID Number (Yellow, Orange, or AAY card)
   • Aadhaar Number
   • PMJAY ID / Name & Location

   Step 4: Complete e-KYC Verification

   • Once your family details will appear on the screen, locate your name and click on e-KYC.
   • Choose your preferred e-KYC authentication mode:
     • Aadhaar OTP (Requires a mobile linked to Aadhaar)
     • Iris Scan or Fingerprint
     • Face Authentication (via the Ayushman App)
   • Capture a live photograph of the applicant as prompted by the portal.

   Step 5: Verification & Approval

   • Check your contact details and address, then click on Submit.

   The application will be automatically/manually matched with the state health records.

   Step 6: Download the Ayushman Card

   • Once approved (often instantly or within 24–48 hours), log back into the portal.
   • Click Download Ayushman Card next to your verified name to get your digital PDF card.

2. Method 2: Apply On-Site (Hospital Helpdesk / CSC Kiosks)

   In case you prefer an offline application, or you need to get hospitalised instantly, follow these steps:

   • Go to Network Facility: You can visit any panel hospital, be it public or private or a nearby Maha e-Seva Kendra/Common Service Centre (CSC).
   • Contact Arogyamitra: The Arogyamitra is present at the Helpdesk of the hospital for AB-PMJAY/MJPJAY.
   • Submit your Documents: Show your Original documents:
     • Aadhaar Card (or valid Photo ID)
     • Ration Card (Yellow, Orange, AAY, or Annapurna)
   • Biometric Authentication: Your fingerprint or iris scan will be used for authentication, along with an OTP, on Arogyamitra's portal.
   • e-Card Generation: Once your application is approved instantly, your e-card will be generated.

Finding PM-JAY Hospitals in Maharashtra

• Go to the MJPJAY-PMJAY Hospital List in jeevandayee.gov.in or visit hospitals.pmjay.gov.infor the nation-wide list.
• Filter the search based on district, as hospital empanelment lists under the scheme have been released individually for all 36 districts of Maharashtra
• Confirm the hospital's current empanelment status and which of the 2,399 packages it's specifically empanelled for, since not every hospital offers every procedure

Helpline and Support

Other Government Schemes

• Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY): Cashless health scheme in the state of Maharashtra for Below Poverty Line and Above BPL families up to ₹1.5 lakh.
• Pradhan Mantri Matru Vandana Yojana (PMMVY): A cash incentive program to compensate for income loss during pregnancy and lactation period and provide nutritional benefits to pregnant and lactating mothers.
• Ayushman Bharat Yojana: Central government scheme for health insurance with coverage up to ₹5 lakh per year per family.
• Pradhan Mantri Suraksha Bima Yojana: Acentral government Health scheme providing coverage of up to ₹2 lakh for accidental death or permanent disability.