The cost of medical treatment of critical illnesses is increasingly becoming nightmarish for low-income families, but not anymore! Chief Minister Devendra Fadnavis’s government has announced a significant decision to expand the scope of the state health insurance scheme and, most importantly, coverage for the critical and rare surgeries that often exceed the Rs 5 lakh per family ceiling. This move will enhance the scope and value of treatment coverage under the existing Maharashtra health insurance scheme. There will also be simplification in the admission process for patients. There will be no need to run around for paperwork; empanelled hospitals will now be responsible for submitting proposals and required documents on behalf of beneficiaries.
Number of treatments increased from 1,356 to 2,399
Currently, the state-run Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and the center’s Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) are combined to provide a comprehensive health coverage of 5 lakh per family per annum. While the scheme presently covers 1356 medical conditions, it has been decided to expand both schemes to increase this number to 2399, thus bringing a large number of diseases and high-end procedures under the coverage, which are usually offered by the private insurance companies against costly premiums.
Government Assistance for Expensive Treatments: A Reserve Fund for 9 Critical Treatments
The state government has identified 9 vital and high-end surgeries that cost significantly higher than the Rs 5 Lakh capping fixed in the state health insurance policy. These include complex procedures such as heart, lung, liver, bone marrow transplants, and more, which can be financially devastating for a low-income family. To support these types of rare and highly expensive medical procedures, the government has decided to create a reserve fund. As per the cabinet decision, 20% of the claim amount disbursements provided to the government hospitals against treatments under the state health policy will be diverted to this corpus fund. The citizens of Maharashtra covered under the ABPMJAY and MJPJAY schemes can now avail of medical assistance of up to 20 Lakh for advanced procedures; poor and needy patients in the state will no longer be deprived of expensive medical treatment due to lack of financial resources. The below list shows the nine critical medical procedures with the maximum coverage limit for each.
- Heart transplant ₹15 lakh,
- Lung transplant ₹20 lakh,
- Heart and lung transplant ₹20 lakh,
- Liver transplant ₹22 lakh,
- Bone marrow transplant (allogeneic) ₹9.5 lakh,
- Bone marrow transplant (unrelated) ₹17 lakh,
- Bone marrow transplant (haplo) ₹17 lakh,
- Transcatheter aortic valve implantation (TAVI) ₹10 lakh,
- Transcatheter mitral valve replacement (TMVR) ₹10 lakh.
Inclusion of New Treatments in the Scheme
Many new treatments have been included in both the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the Mahatma Jyotirao Phule Jan Arogya Yojana, and will be available at the designated government and private hospitals across the state. This will benefit a larger number of patients from both urban and rural areas of the state. In addition, 25 new treatments have been added to the services provided at the Primary Health Centers. The state government has also made necessary changes in the policies for proper implementation of the revised scheme. Besides improving the incentive structure for the doctors and the hospital staff, the mechanism for funding infrastructure development like upgrading Primary Health Centers (PHCs) and building critical care blocks and integrated laboratories across the state has been established. Guidelines regarding the creation of a reserve fund to support rare disease treatments, originally published in 2019, have been amended; now 20 percent of the claim by the government hospitals under the ABPMJAY and MJPJAY schemes will go to build a reserve corpus to fund the treatment costs exceeding 5 lakh. All empanelled charitable hospitals have been mandated to participate in the government health schemes to ensure broader, non-restrictive public access.
The state government had previously decided to constitute a study committee comprising doctors from various fields to revise the list of treatments under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana and the Mahatma Jyotirao Phule Jan Arogya Yojana. Accordingly, the Devendra Fadnavis government had formed a 14-member committee under the chairmanship of the Health Services Commissioner via a government order dated April 17, 2025. Health experts from the private sector were included in this committee. By comparing the Pradhan Mantri Jan Arogya Yojana and Mahatma Jyotirao Phule Jan Arogya Yojana with other central and state government health schemes, the committee prepared the updated list of treatments for the state’s scheme. Furthermore, the committee recommended coverage for treatments costing over ₹5 lakh for rare diseases.
Private hospitals will be promoted to 30 bed hospitals
The government has announced plans to empanel private and multispeciality hospitals of 30-100 bed capacities in areas where there are no government hospitals around. This will be done by taluka-wise mapping of hospitals covered under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Mahatma Jyotirao Phule Jan Arogya Yojana. Similarly, emphasis will be laid on increasing the number of Arogya Mitras in rural areas so that information and services of these schemes can reach more and more people. Patients in need will get timely and proper assistance through these Arogya Mitras in their localities regarding the right hospitals and admission.
Through these schemes, Maharashtra will become one of the leading states in the country that provides maximum health security. The Fadnavis government’s decision to improve scope and introduction of special fund for complex surgeries under the public health schemes will especially impact the lives of economically weaker sections of the state. In order to spread awareness and make the services more transparent and effective, it has also been decided to make use of apps and AI based chatbots. This will help the beneficiaries to easily access information about schemes, treatment and hospitals.
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