Mahatma Jyotiba Phule Jan Arogya Yojana Explained

Mahatma Jyotiba Phule Jan Arogya Yojana

Launched on July 2, 2012, Mahatma Jyotiba Phule Jan Arogya Yojana (previously Rajiv Gandhi Jeevandayee Arogya Yojana) is a flagship health insurance scheme by the State Government of Maharashtra. Under the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), families that are Below Poverty Line (BPL) and Above Poverty Line (APL) are eligible for free medical care and hospitalisation in Maharashtra. The health insurance scheme covers beneficiaries residing in all the 36 districts of Maharashtra.

Why was Mahatma Jyotiba Phule Jan Arogya Yojana Launched?

The MJPJAY scheme was launched with the objective to improve access to quality healthcare for low-income families in the state, where the beneficiary families will be able to receive medical services free of cost on 30 different types of specialities; 971 procedures, surgeries, and therapies; and 121 follow up packages. Mahatma Jyotiba Phule Jan Arogya Yojana covers all hospitalisation costs of the beneficiary family up to ₹1.5 lakh if they undergo medical treatment in any empanelled hospital. Moreover, a beneficiary with a pre-existing disease is also covered if the medical procedure is approved.

Mahatma Jyotiba Phule Jan Arogya Yojana – Benefits & Features

Mahatma Jyotiba Phule Jan Arogya Yojana has many valuable features and health insurance benefits for the families in Maharashtra with a valid orange, yellow and white ration card. Some of these benefits are:

• The insurance scheme is similar to a family floater – where any or all members can avail free hospitalisation up to a maximum of ₹1.5 Lakh.

• There is no waiting period for persons with pre-existing diseases under this scheme.

• Beneficiaries don’t have to pay anything if they visit an empanelled hospital from the Mahatma Jyotiba Phule Jan Arogya Yojana hospital list.

• For patients undergoing renal transplant surgery, the maximum limit of coverage is up to ₹2.5 Lakh.

• There are close to 500 healthcare providers in the hospital list of the Mahatma Jyotiba Phule Jan Arogya Yojana where beneficiaries can avail free medical treatment.

• Beneficiaries can also avail free follow-up consultations and attend free medical camps.

• Unlike traditional health insurance plans, Mahatma Jyotiba Phule Jan Arogya Yojana covers plastic surgery procedures too.

Coverage Details of Mahatma Jyotiba Phule Jan Arogya Yojana

The State Government of Maharashtra allows beneficiaries to undergo 971 surgical procedures, therapies and treatments under this scheme. Out of the 971 procedures, 131 have to be undertaken only in an empanelled government hospital or medical college. It also includes 121 follow-up packages.

Under Maharashtra’s Mahatma Jyotiba Phule Jan Arogya Yojana health insurance scheme, BPL and APL families can get free hospitalisation for 30 specialities such as:

• General surgery

• ENT surgery

• Ophthalmology surgery

• Gynaecology and obstetrics surgery

• Cardiac and cardiothoracic surgery

• Paediatric surgery

• Plastic surgery

• Burns

• Nephrology

• Endocrinology

However, the MJPJAY does not cover the treatment for certain illnesses like:

• Diarrhoea

• Snakebite (Exception: ventilation support for snakebite)

• Pneumonia

• Appendicitis and Hernia (unless it is an emergency)

Eligibility Criteria to Enrol for MJPJAY

• For Customers

1. Families belonging to Maharashtra with a Yellow Ration Card, Antyodaya Anna Yojana Card (AAY), Annapurna Card and Orange Ration Card are eligible to register for Mahatma Jyotiba Phule Jan Arogya Yojana.
2. Also, farmers from 14 agriculturally distressed districts of Maharashtra holding a white ration card are eligible.

• For Agency

1. The agency must be registered under the Companies Act, 1956.
2. It must have an OSP licence to provide services at the specific location.
3. The agency should have had an average annual turnover of more than ₹15 Crore in the last four years.
4. It should have a positive net worth.

• For Hospital

1. The hospital must have at least 50 inpatient beds with adequate staff.
2. It must have different general wards for males and females.

Documents Required for MJPJAY Scheme

The following documents are required to avail this health insurance scheme:

• Yellow, orange or white ration card

• Any photo ID including:

• Voter’s ID

• Aadhaar card

• Driving licence

• School ID

• PAN card

How to Enrol for Mahatma Jyotiba Phule Jan Arogya Yojana?

• Approach the nearest empanelled hospital in your area.

• Beneficiaries should furnish the specific ration card or AAY or Annapurna Card before diagnosis and check-ups are done.

• The patient is admitted, and an e-pre-authorisation request is sent to the insurance company associated with the scheme. The request is also reviewed by the Mahatma Jyotiba Phule Jan Arogya Yojana Society.

• Empanelled doctors, specialists and the insurer verify the claim and approve if all conditions are met.

• Cashless treatment and surgery are provided to the beneficiary.

• The beneficiary can avail free follow-up consultations, medicine and diagnostic services up to a period of 10-days from the date of discharge.

Check here: Rs. 1 Crore Health Insurance Plan

Mahatma Jyotiba Phule Jan Arogya Yojana - Claim Settlement Process

Below is the step-by-step claim settlement process for Mahatma Jyotiba Phule Jan Arogya Yojana:

1. Visit the nearest MJPJAY network hospital and get a diagnosis for your medical condition.

2. The network hospital will request the insurance provider for a pre-authorisation.

3. The treatment for the diagnosed medical condition will commence as soon as the pre-authorisation is received. If you get a diagnosis at a non-network hospital, the Arogyamitra will issue a referral card which you can use to avail cashless treatment at an empanelled hospital.

4. Upon completion of the medical treatment, the network hospital will share all the necessary documents with the insurance provider.

5. The insurance provider will approve the claim after verifying all the details.

In Conclusion

Mahatma Jyotiba Phule Jan Arogya Yojana is a great scheme for underprivileged members of the society. However, if you are not a BPL or APL family, you cannot take advantage of this scheme. If you and your family are not adequately protected by health insurance in a time when contagious diseases run amok, you are putting their life and your finances in jeopardy. Hence, you must cover yourself and your family with adequate health insurance. So, wait no more! Buy a health insurance plan on Bajaj MARKETS today and secure yourself and your loved ones.