Mahatma Jyotiba Phule Jan Arogya Yojana

What is Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

The Maharashtra State Government originally introduced the Rajiv Gandhi Jeevandayee Arogya Yojana in July 2012. It was renamed as the Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY) On April 1, 2017. MJPJAY was launched to offer cashless healthcare services to the underprivileged and vulnerable sections of society in case of severe conditions requiring hospitalization.

Highlights of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Below mentioned are the significant highlights of the Mahatma Phule Jan Arogya Yojana:

Eligibility Criteria for Mahatma Phule Jan Arogya Yojana (MPJAY)

Below mentioned are the eligibility criteria for Mahatma Phule Jan Arogya Yojana (MPJAY):

• Mahatma Phule Jan Arogya Yojana (MPJAY) offers health coverage to families who are a part of identified distressed districts of Maharashtra.
• The beneficiary should have an Antyodaya Anna Yojana Card (AAY), yellow/white/orange Ration Card, and Annapurna Card.
• Farmers should belong to the agriculturally distressed districts.

Salient Features of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Below mentioned are some of the salient features of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

• Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) provides INR 1.5 lakh of the sum insured per annum per family.
• Mahatma Phule Jan Arogya Yojana (MPJAY) offers coverage for the cost of surgeries, medications, treatment, diagnostics, and consultations.
• Mahatma Phule Jan Arogya Yojana (MPJAY) offers coverages for a family floater and individual basis.
• The insured does not have to pay any premium or treatment charge as the State Government of Maharashtra pay for it.
• All pre-existing diseases will be covered from day one.
• Insured can attend one medical camp annually, which will be free of cost.
• Apart from government hospitals, various private hospitals are also empanelled in their network where you can take cashless medical treatment.

What is Covered Under the Mahatma Phule Jan Arogya Yojana (MPJAY)?

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) offers coverage for the following medical expenses:

• Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) covers 971 medical surgeries/therapies/procedures and 121 follow-up packages in 30 specialized categories.
• It includes ENT surgery, General surgery, Gynecology, Obstetrics surgery, Orthopedic surgery, Cardiac and Cardiothoracic surgery, Pediatric surgery, Ophthalmology surgery, Plastic surgery, Radiation surgery, etc.
• Renal transplant operation up to a limit of INR 2.5 lakh.
• Post-hospitalization expenses are covered for 10 days.

List of Diseases and Treatments Covered Under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Below-mentioned is the list of diseases and treatments covered under the Mahatma Jyotiba Phule Jan Arogya Yojana MJPJAY:

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

How to Enroll under the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

Below mentioned is the enrollment process for the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

• Applicants can meet the Aarogyamitra at the nearest district/general/network/women's hospital to initiate the application.
• You will be given a health card that you can be shown to the empanelled network hospital for the recommended treatment.
• Then, you need to show your orange/yellow ration card or Annapurna Card in case a ration card is unavailable.
• An e-authorization request will be sent to the insurance company, and MJPJAY will review the same request.
• The cashless treatment will start once the verification is done.
• The hospital will provide the original bills and documents to the insurer for claim settlement. The hospital will issue the payment after the records are examined, and the claim is accepted.

Moreover, the network hospital provides free consultation, medicines, and diagnostics for 10 days from discharge.

How Can You Apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Card?

To apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) card, you need to visit the nearest government health facility where you can take help from Aarogyamitra who is the representative of the MJPJAY scheme. The Aarogyamitra will help get the Mahatma Phule Jan Arogya Yojana (MPJAY) Card.

Required Documents To Apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

You need to submit the following KYC documents along with the ration card:

• PAN card
• Aadhaar card
• Voter ID
• Nationalized bank passbook with photograph
• Defense Ex-Service Card
• School or college ID
• Driving license
• Handicap certificate
• Passport
• Tehsildar's stamps on the applicant's photograph
• Photo ID issued by the Government of India or the Government of Maharashtra
• Senior citizen card issued by the Central or State Government of India
• Freedom fighter ID card

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Claim Process

You can raise your claim under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) by following the steps given below:

• A diagnosis is conducted to identify the condition.
• Once the pre-authorization has been obtained from the insurance provider, treatment will start right away if the diagnosis is made in a network hospital.
• If the diagnosis is not made in the network hospital, Arogyamitra will offer a referral card to start the treatment at the empanelled hospital.
• The insurance provider will provide online e-authorization to the network hospital.
• The treatment will start after the hospital receives the authorization letter from the insurance company.
• After the treatment is completed, the hospital will share all relevant documents, such as medical bills, discharge summary and diagnostics, with the insurance company.
• The insurance company will start the verification of the documents.
• Once the verification is complete, the insurance company will approve the claim settlement.

Mahatma Phule Jan Arogya Yojana (MPJAY) Contact Details:

Below is the helpline number and the address of Mahatma Jyoti Phule Jan Arogya Yojana (MJPJAY):

Toll-Free Number: 1800-233-2200 / 155 388

Address:

• Mahatma Jyotiba Phule Jan Arogya Yojana,
• State Health Assurance Society,
• ESIS Hospital Compound,
• Ganpat Jadhav Marg,
• Worli,
• Mumbai – 400018

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