Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) {महात्मा ज्योतिबा फुले जन आरोग्य योजना}

Updated on May 22, 2020

The state government of Maharashtra launched the Mahatma Jyotiba Phule Jan Arogya Yojana to provide free and quality medical care to low-income families. This scheme will offer free medical care, especially speciality services that require hospitalization for consultations, surgeries as well as therapies during an identified network of health care providers. The Mahatma Jyotiba Phule Jan Arogya Yojana is the extended version of the moniker Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).

The Mahatma Jyotiba Phule Jan Arogya Yojana will provide the amount of Rs.1, 50,000 per family per year for all the expenses for medical care during hospitalization of the beneficiary through an accident or any other reason. The annual coverage of Rs.1, 50,000 can get by the beneficiary’s family with cashless hospitalization.

What is Covered?

There are about 971 therapies, surgeries, procedures as well as 121 follow-up packages in 30 specialized are covered under the Mahatma Jyotiba Phule Jan Arogya Yojana. These include:

  • Orthopaedic surgery and procedures
  • General surgery, ENT surgery, gynaecology and obstetrics surgery cardiac and cardiothoracic surgery
  • Ophthalmology surgery, pediatric surgery, radiation surgery, plastic surgery, etc.
  • The maximum limit for renal transfer operation is Rs.2, 50,000.
  • Consultation, as well as medicines post-hospitalization, is enclosed for up to 10 days from the date of discharge of the patient.

What is not Covered?

Under the scheme, almost all adequate medical care is covered. But except some surgeries and operations that are mentioned below:

  • Vaginal or abdominal hysterectomy
  • Hernia
  • Cholecystectomy
  • Appendectomy
  • Discectom

These are performed only at government empanelled hospitals as well as government medical colleges.

Features of Mahatma Jyotiba Phule Jan Arogya Yojana

All the crucial features of Mahatma Jyotiba Phule Jan Arogya Yojana are mentioned below:

  • The state government of Maharashtra will pay all the health insurance coverage as well as premium charges.
  • The amount of Rs.1, 50,000 will be given to the one family for a year.
  • The benefits of this scheme can be taken by an individual or on a family floater basis.
  • There are a lot of operations and surgeries are covered under this scheme like diagnostics, medications as well as follow-up consultations, and treatment.
  • All pre-existing diseases are enclosed from day one.
  • Several private hospitals are also included under this scheme, along with government empanelled hospitals.
  • Access to health camps organized at government empanelled hospitals.

Benefits

There are a lot of benefits provided under this scheme by the government. The benefits of Mahatma Jyotiba Phule Jan Arogya Yojana are mentioned below:

  • About 971 types of surgeries, therapies, procedures in 30 specialized categories are covered under this scheme.
  • About 121 types of follow-up procedures in 30 specialized categories are covered under this scheme.
  • Under this scheme only empanelled government hospitals, as well as medical colleges, will able to perform 132 reticent government procedures.
  • The renal transplant maximum ceiling is at Rs.2, 50,000.

Diseases and Treatments Covered

Almost all the diseases, as well as surgeries, are covered under the scheme. And all the pre-existing diseases are covered under this scheme from day one. List of all the diseases mentioned below:

  • General Surgery
  • Ophthalmology Surgery
  • ENT Surgery
  • Gynaecology and Obstetrics Surgery
  • Surgical Gastroenterology
  • Orthopaedic Surgery and Procedures
  • Cardiac and Cardiothoracic Surgery
  • Genitourinary System
  • Pediatric Surgery
  • Surgical Oncology
  • Neurosurgery
  • Medical Oncology
  • Plastic Surgery
  • Radiation Oncology
  • Burns
  • Prostheses
  • Polytrauma
  • Critical Care
  • Infectious Disease
  • General Medicine
  • Pediatrics Medical Management
  • Nephrology
  • Cardiology
  • Neurology
  • Dermatology
  • Pulmonology
  • Rheumatology
  • Gastroenterology
  • Endocrinology
  • Interventional Radiology

Eligibility Criteria

The beneficiary must have to fulfil the eligibility criteria to get the benefits of this scheme. Entire eligibility criteria for Mahatma Jyotiba Jan Arogya Yojana (MJPJAY) mentioned below:

  • The families who are part of the identified distressed districts of the state of Maharashtra are eligible to apply under the scheme.
  • The beneficiary should have a White/Orange/Yellow Ration Card, Antyodaya Anna Yojana Card (AAY), or Annapurna Card.
  • The farmers who belong to various districts like Amaravati, Aurangabad, Akola, Buldhana, Hingoli, Beed, Jalna, Latur, Nanded, Osmanabad, Wardha, Parbhani, Yavatmal, and Washim can also apply under this scheme.
  • The identification of the farmers from these districts will be made based on their White Ration Card or the head of the family or certificate from the concerned Patwari or Talathi.

How to Register?

The beneficiary has to follow the simple process to get enrolled under this scheme. All the steps to get registered under the Mahatma Jyotiba Jan Arogya Yojana are mentioned below:

  • The individuals, as well as families who want to apply for the scheme, have to visit nearby Network/District/Women/General hospital and meet Arogyamitra to start the application process.
  • A referral card will be provided to you if you visit a Government Health Facility. This referral card will represent the Network Hospital along with the preliminary verdict by the doctors.
  • You can also be able to get the referral card by attending Health Camps organized by the Network Hospital.
  • The beneficiary is mandatory to provide a referral card with his Yellow or Orange Card. The candidates have an option to provide Antyodaya or Annapurna Card on the place of a ration card.
  • Once you complete this process, then the diagnosis, as well as check-ups, will be started.
  • You will be admitted to the Network Hospital based on the diagnosis of disease.
  • After this, an E-authorization request will be sent to the insurance company as well as the same request will be reviewed by the MJPJAY as well.
  • Medical Specialists of the insurance company, as well as MJPJAY, will monitor the request for authorization. Then if all the conditions will meet your request will be approved. 
  • The authorization process will be completed within the 24 hours by Medical Specialists of the insurance company as well as MJPJAY. This process can be completed immediately in case of an emergency.
  • After the authorization process completion, cashless treatment or hospitalization will be extended to the beneficiary. 
  • The insurance company will get the entire original bills, diagnostic reports, discharge summary, and other relevant documents by the hospital.
  • After this, the insurance company will check the documents as well as approve the claim and clear the expense to the hospital.
  • The network hospital will provide free consultations, medicines as well as diagnostics for up to 10 days after discharge of the patient under this scheme.

Documents Required

The candidates have to submit some necessary documents to complete the registration process. The list of documents is mentioned below:

  • For the identity verification process the candidate has to submit a ration card (Orange/Yellow/White), as well as KYC documents like Pan Card, Driving License, Aadhaar Card, Voter ID, Handicap Certificate, Nationalized Bank Passbook with Photograph, School/College ID, etc.
  • The urban areas people have to submit the Government Local bodies or Tahsildar’s stamps as well as signatures on the applicant’s photo.
  • The rural areas people have to submit Tahsildar’s stamp as well as signature on the applicant’s photograph.
  • Passport photocopy
  • Freedom Fighter ID card
  • Senior citizen card that is issued by central and state government of India
  • Defence ex-service card issued by Army board
  • Any photo ID proof issued by Govt. of Maharashtra
  • Marine Fishers Identity card
  • In the case of a newborn child if you do not have the photo of the child on the valid Yellow or Orange Ration card, then you can submit the picture of the child along with either of the parents along with White/Orange/Yellow ration card as well as the child’s birth certificate.

How to Register for Mahatma Jyotiba Jan Arogya Yojana Card?

The candidates need to visit the nearby General, Women/District/Network hospital to apply or to get the Mahatma Jyotiba Jan Arogya Yojana card. The main motive of this scheme is to provide financial support as well as free access to health care to the poor and the vulnerable sections of the society and especially to those people who belong to the BPL and APL families. The representative of this scheme is Arogyamitra, and it will make this process easy for you to get Mahatma Jyotiba Jan Arogya Yojana card. If you are visiting the Government Health Facility to get the card, then you have to submit a referral card to the Network hospital to start a preliminary diagnosis by the doctors. You are also allowed to attend Health Camps conducted by the Network hospitals to get health care under this scheme.

You can always visit their official website www.jeevandayee.gov.in to learn more about the card.

Claim process

Steps to get the claim for Mahatma Jyotiba Phule Jan Arogya Yojana are mentioned below:

  • At first, analysis is conducted to discover the condition.
  • Treatment will be started immediately if the diagnosis is made in a network hospital. The process will begin as soon as the pre-authorization is received from the insurance company.
  • If the diagnoses in not able to conduct in a network hospital, then a referral card will be given by the Arogyamitra to start the treatment at the registered hospital. 
  • The e-authorization form will be provided to the network hospital by the insurance company through online mode.
  • After receiving the authorization from the insurance company, the empanelled hospital will start the treatment of the patient. 
  • After the completion of the treatment, surgery, as well as operation of the beneficiary the network hospital, has to provide documents such as medical bills, diagnostics, discharge summary to the insurance company to get the claim.
  • After this, the insurance company will verify as well as match all the documents, and then they will approve the claim settlement.
  • The network hospital is mandatory to provide free consultations, diagnostics well as medicines for the 10 days from the date of discharge.

Frequently Asked Questions

Q. Should the beneficiary have to pay any extra money for treatment?

No, the beneficiary does not have to pay any extra money to the hospital for the services as well as treatment under this scheme. All the expenses will be bear by the state government of Maharashtra.

Q. Is hernia disease covered under the Mahatma Jyotiba Phule Jan Arogya Yojana scheme?

No, Hernia is not covered under the scheme. But diaphragmatic Hernia in paediatrics is covered under this scheme.

Q. Is appendicitis covered under the scheme?

No, appendicitis also not covered under this scheme. Only appendicle damage is covered under the scheme.

Q. What is the time for pre-authorization?

The period for pre-authorization is 12 hours.

Q. Is the ambulance charge also included in the scheme?

No, the ambulance charges are not included under this scheme. The patient has to bear the ambulance charges himself.

Q. Does Mahatma Jyotiba Phule Jan Arogya Yojana scheme cover COVID-19 (Coronavirus) treatment?

Yes, the MJPJAY scheme covers the treatment of pandemic disease COVID-19 or the novel coronavirus.


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WRITTEN BYVarsha Verma

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