Mahatma Jyotirao Pule Jan Arogya Yojana is the flagship health insurance scheme of the Government of Maharashtra. The scheme provides end-to-end cashless services for identified diseases through a network of service providers from the Government and Private sector. The scheme earlier was known as Rajiv Gandhi Jeevandayee Arogya Yojana which was started on 2nd July 2012 in eight districts and then was expanded to 28 districts of Maharashtra from 21st November 2013.
The Mahatma Jyotiba Phule Jan Arogya Yojana is a scheme backed by the Maharashtra State Government. It was launched with the aim to offer health insurance benefits to individuals and families in households that are below and close to the poverty line. Earlier named as the Rajiv Gandhi Jeevandayee Arogya Yojana, it provides free medical access and care to economically challenged people in the State of Maharashtra through various government hospitals for numerous surgeries, diseases and therapies.
Overview
he State Government of Maharashtra inaugurated the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in order to improve the access to healthcare for individuals and families belonging to Below Poverty Line (BPL) and Above Poverty Line (APL) households. On the 1st of April, 2017, the Scheme was effectively renamed to the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). This health insurance plan is fitting for families with an annual income below the threshold of INR 1 Lakh. The Maharashtra State Government pays INR 333 as premium for an insurance cover of up to INR 1.5 Lakhs. An individual or an entire family may avail the total insurance coverage on a floater basis.
Insured members are offered the facility of cashless hospitalisation at any of the hospitals under the Scheme’s network. There is no waiting period applicable for pre-existing covers. Renal Transplant procedures are covered up to INR 2.5 Lakhs as the immunosuppressive therapy is to be carried on for a year or so. This Scheme may be availed by individuals who have either of the two cards:
- Orange Ration Card for individuals and families Above Poverty Line
- Yellow Ration Card for individuals and Below Poverty Line
Mahatma Jyotiba Phule Jan Arogya Yojana provides for over 972 surgeries and treatments along with 121 follow-up packages in 30 various specialised categories such as cardiology, neurology, ENT surgery and more. For 10 days after the date of discharge, The network hospitals will offer free follow-up consultations, medicines, and diagnostics post 10 days from the date of discharge as indicated by the Scheme. The insurance company providing this health cover shall ensure that a minimum of one free medical camp is organised each week by each network hospital.
Benefits
- The scheme provides coverage for meeting all expenses relating to the hospitalization of beneficiaries up to ₹ 1,50,000/- per family per policy year. For Renal Transplants, this limit has been enhanced up to ₹ 2,50,000/- per family per policy year.
- The benefit is available to every member of the family on a floater basis, i.e., the total coverage of ₹ 1,50,000/- or ₹ 2,50,000/- as the case may be, can be availed by one individual or collectively by all members of the family in the policy year.
- Burns
- Cardiology
- Cardiovascular and Thoracic surgery
- Critical Care
- Dermatology
- Endocrinology
- ENT surgery
- General Medicine
- General Surgery
- Haematology
- Infectious diseases
- Interventional Radiology
- Medical Gastroenterology
- MEDICAL ONCOLOGY
- Neonatal and Pediatric Medical Management
- Nephrology
- Neurology
- Neurosurgery
- Obstretrics and Gynecology
- Ophthalmology
- Orthopedics
- Pediatric Surgery
- Pediatric Cancer
- Plastic Surgery
- Polytrauma
- Prosthesis and Orthosis
- Pulmonology
- Radiation Oncology
- Rheumatology
- Surgical Gastroenterology
- Surgical Oncology
- Urology (Genitourinary Surgery)
- Mental disorders
- Oral and Maxillofacial Surgery
Eligibility
For Individuals and Family
Every family or individuals from families who are below the poverty line or merely above the poverty line are eligible to avail this Scheme. Therefore, individuals/ families who have either of the Orange Ration Card or the Yellow Ration Card may be a part of this scheme.
For Agencies
- An agency must be registered under the Companies Act of 1956.
- An agency must have a valid Other Service Providers License to offer services at the said location.
- An agency must have an average annual turnover that crosses the threshold of INR 15 Crores in the previous 4 financial years.
- An agency must have a positive net worth.
For Hospitals
- A hospital of the Scheme’s network is required to have a minimum of 50 inpatient beds with appropriate space and enough staff.
- A hospital is required to have individual general wards for males and females.
Documents
- Voter’s Identity Card
- Driving License
- School Identity Card
- PAN Card
- Other identity cards issued by an authorized officer.
Registration Process
- Families and individuals may approach a hospital in the Scheme’s network that is nearest to their area. If a customer visits a facility that is not within the Scheme’s network, then a referral card after initial diagnosis by the doctor should be submitted to the network hospital. The patient’s medical information relevant to the visit will be captured in the Scheme’s database.
- Customers will then required to provide the referral card along with their yellow or orange ration card. An Antyodaya or Annapurna Card may also be produced instead of the ration card as such. Post submitting their documents, their diagnosis and check-ups will be conducted. Such medical information will be recorded in the relevant database.
- The patient will then be admitted, based on the diagnosis, in the network hospital. A digital pre-authorisation request will be forwarded to the insurance company. The Rajiv Gandhi Arogya Yojana Society will even review the same.
- Specialists and expert doctors of the Mahatma Jyotiba Phule Jan Arogya Yojana along with the insurance company, will review and examine the request. If the necessary conditions are met, the case will be approved. In cases of emergency, this will be executed immediately and will have the validity of a week.
- Cashless treatment and surgery will be offered, and relevant information and details will be documented.
- All the essential bills, reports concerning the procedures will be forwarded to the insurer. This is done to claim settlement post procuring all the required signatures. Discharge and follow-up information of the patient will be available on the Mahatma Jyotiba Phule Jan Arogya Yojana portal.
- Every network hospital is required to offer free follow-up consultations, medicines and diagnostics as indicated by the Scheme that lasts for 10 days from the date of discharging the relevant patient.
FAQs
What is the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?
The Mahatma Jyotiba Phule Jan Arogya Yojana is a health insurance scheme launched by the Government of Maharashtra, India, to provide financial protection to families living below the poverty line (BPL) and certain eligible families above the poverty line (APL) against high medical expenses.
Who is eligible to benefit from the MJPJAY?
Eligibility criteria typically include families falling under specific socio-economic categories such as BPL and APL, identified based on predetermined criteria by the state government. Usually, there is a predefined list of eligible families.
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