The Indian government has launched various government health insurance schemes over the years to improve unprivileged people's lives. Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is also one of them. It is one health insurance scheme that aims to provide quality healthcare services to economically backward people.
In this article, you will learn about the features, eligibility criteria and benefits of the Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY).
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:
|Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)
|Maharashtra Health Ministry
|Objective of the Scheme
|Providing cashless healthcare services to the unprivileged people
|Citizens of Maharashtra
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
- Medical Oncology
- Radiation Oncology
- Critical Care
- Pediatrics Medical Management
- Infectious Disease
- General Medicine
- Interventional Radiology
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
- 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
- Mahatma Jyotiba Phule Jan Arogya Yojana,
- State Health Assurance Society,
- ESIS Hospital Compound,
- Ganpat Jadhav Marg,
- Mumbai – 400018
Some Other Government Schemes in India
Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) FAQs
- What is Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?
Ans. Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a government-sponsored health insurance scheme launched by the Government of Maharashtra in India. It aims to provide cashless healthcare services and financial protection to eligible families for secondary and tertiary hospitalization expenses.
- Who is eligible for MJPJAY?
Ans. The MJPJAY scheme targets vulnerable and economically weaker sections of society. Eligibility is determined based on the Socio-Economic Caste Census (SECC) database. Families falling under defined categories of the SECC database, such as deprived rural households, labourers, urban poor, and others, are eligible for MJPJAY.
- What are the benefits covered under MJPJAY?
Ans. MJPJAY covers various medical treatments and procedures, including hospitalization costs, surgeries, diagnostics, medicines, and follow-up care. The scheme covers various illnesses and medical conditions, including pre-existing diseases.
- How do you Avail yourself of the benefits under MJPJAY?
Ans. To avail of the benefits under MJPJAY, eligible beneficiaries can visit empanelled hospitals and present their MJPJAY health card or provide their MJPJAY identification details. The hospital will verify the eligibility and provide cashless treatment as per the scheme's guidelines.
- Is there any enrollment process for MJPJAY?
Ans. Eligible families are identified through the SECC database, and health cards are issued to them. The concerned authorities manage the enrollment process, and eligible families are automatically enrolled in the scheme.
- Are there any costs involved for beneficiaries under MJPJAY?
Ans. Beneficiaries under MJPJAY are entitled to cashless treatment for covered medical procedures and hospitalization expenses. However, there may be some nominal charges for specific services, such as user fees or additional amenities requested by the patient.
- Are all medical treatments covered under MJPJAY?
Ans. MJPJAY covers a wide range of medical treatments and procedures. However, certain exclusions and limitations may apply. It is advisable to refer to the official guidelines and documents of MJPJAY or consult with the empanelled hospitals for a detailed list of covered treatments.
- Can MJPJAY be availed of in any hospital?
Ans. MJPJAY can be availed of in empanelled hospitals only. These hospitals agree with the scheme to provide cashless treatment to eligible beneficiaries. It is important to visit an empanelled hospital to avail of the benefits under MJPJAY.
- Can beneficiaries avail of treatment outside their home state under MJPJAY?
Ans. MJPJAY provides portability, allowing beneficiaries to receive treatment in empanelled hospitals outside their home state. However, certain conditions and procedures must be followed to ensure seamless treatment and reimbursement.
- How can beneficiaries obtain information about MJPJAY?
Ans. Beneficiaries can obtain information about MJPJAY through various channels. They can visit the official MJPJAY website, contact the helpline number, or seek assistance from the empanelled hospitals for any queries or information related to the scheme.