MJPJAY: Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility, Benefits, Coverage

Team AckoAug 23, 2024

To offer free access to good medical care to all ration cardholders in the state, the Maharashtra government launched the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). The primary goal of this health care scheme is to give access to free medical care to the underprivileged and the vulnerable sections of society. This article ventures into the eligibility criteria, coverage and benefits of the MJPJAY scheme.

Contents

• What is Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?
• Beneficiaries Under the Mahatma Jyotiba Phule Jan Arogya Yojana
• What is Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?
• What is Not Covered?
• Features and Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):
• List of Diseases and Treatments Covered Under MJPJAY:
  • Eligibility for Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):
• How to Enrol in Mahatma Jyotiba Jan Arogya Yojana (MJPJAY) Scheme?
  • Documents Required to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):
  • How to Apply for Mahatma Jyotiba Jan Arogya Yojana Card Online?
  • Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Application Form:
• Claim Procedures of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):
• Mahatma Jyotiba Phule Jan Arogya Yojana Hospital List:
• Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Toll-Free Number and Address:
• The Bottom Line
• Frequently Asked Questions:

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

With an objective to offer free and quality medical care to low-income families, the MJPJAY was launched by the state government of Maharashtra. The scheme offers free medical care especially speciality services which require hospitalisation for consultations, surgeries and therapies through an identified network of health care providers. It was initially launched with the moniker Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY).

The MJPJAY shall provide coverage for meeting all expenses for medical care during hospitalisation of the beneficiary with a sum insured amount of Rs.1,50,000 per family per year. The annual coverage of Rs.1,50,000 can be availed by an individual or the entire family through cashless hospitalisation.

Beneficiaries Under the Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Jyotiba Phule Jan Arogya Yojana aims to provide quality healthcare to economically disadvantaged sections of society in Maharashtra. Three broad categories of beneficiaries are eligible for coverage under this scheme.

The first category (Category A) includes families that hold certain types of ration cards issued by the Civil Supplies Department of the Government of Maharashtra. Specifically, this covers families with Yellow ration cards, Antyodaya Anna Yojana (AAY) cards, Annapurna cards, or Orange ration cards (for families with annual income up to Rs 1 lakh). 

The second category (Category B) covers farmers and agricultural workers from 14 agriculturally distressed districts of Maharashtra. The specific districts are Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal and Wardha. Only families holding white ration cards in these districts are eligible under this farmer category.

The third category (Category C) brings together diverse beneficiaries, including children in government orphanages, students studying in government Ashram schools, female inmates taking shelter in government Mahila Ashrams, senior citizens residing in government nursing homes, journalists and their dependent families as approved by the DGIPR department, and finally construction workers along with their family members registered with the Maharashtra Building and Other Construction Worker Welfare Board.

What is Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?

The coverage under the Mahatma Jyotiba Phule Jan Arogya Yojana includes about 971 therapies/surgeries/procedures and 121 follow-up packages in 30 specialised categories. These include:

• Orthopaedic surgery and procedures, general surgery, ENT surgery, gynaecology and obstetrics surgery, cardiac and cardiothoracic surgery, ophthalmology surgery, paediatric surgery, radiation surgery, plastic surgery, etc.

• The government has reserved 132 procedures which are to be performed by empanelled government hospitals or government medical colleges.

• The upper limit for renal transplant operation is Rs.2,50,000.

• Consultation and medicines post-hospitalisation is covered for up to 10 days from the date of discharge.

Also, check: Arogya Sanjeevani Health Insurance

What is Not Covered?

Under the scheme, all acceptable medical care will be provided except for the planned 131 procedures such as vaginal or abdominal hysterectomy, hernia, cholecystectomy, appendectomy, discectomy, etc shall be performed only at government empanelled hospitals or government medical colleges.

Features and Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

Below are the salient features of the MJPJAY:

• The health insurance coverage and premium charges are borne by the State Government of Maharashtra.

• Sum insured amount of Rs.1,50,000 per year per family.

• The scheme can be utilised by an individual or on a family floater basis.

• Covers surgeries, diagnostics, medications and follow-up consultations and treatment.

• All pre-existing diseases are covered from day one.

• Apart from government empanelled hospitals, several private hospitals are included.

• Access to health camps conducted at government empanelled hospitals.

Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

The MJPJAY scheme offers several benefits to people belonging to the BPL and APL families. Below are the benefits of the scheme:

• It covers about 971 types of surgeries/therapies/procedures in 30 specialised categories.

• It covers about 121 types of follow-up procedures in 30 specialised categories.

• Only empanelled government hospitals and medical colleges will perform 132 government reserved procedures.

• Renal transplant upper ceiling is at Rs.2,50,000.

List of Diseases and Treatments Covered Under MJPJAY:

All pre-existing diseases are covered from day one under the scheme, below is the list of diseases and treatments covered under the MJPJAY:

• General Surgery

• Opthamology Surgery

• ENT Surgery

• Gynecology and Obstetrics Surgery

• Surgical Gastroenterology

• Orthopaedic Surgery and Procedures

• Cardiac and Cardiothoracic Surgery

• Genitourinary System

• Paediatric 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

Also, read: COVID-19 Insurance Policy

Eligibility for Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):

Below is the eligibility criteria of Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):

• Families who are part of the identified distressed districts of the state of Maharashtra.

• Should hold White/Orange/Yellow Ration Card, Antyodaya Anna Yojana Card (AAY) or Annapurna Card.

• Farmers from several agriculturally distressed districts such as Amaravati, Aurangabad, Akola, Buldhana, Hingoli, Beed, Jalna, Latur, Nanded, Osmanabad, Wardha, Parbhani, Yavatmal and Washim.

• The basis of identifying farmers from these agriculturally distressed districts is based on the 7/12 extract, their White Ration Card and the name of the beneficiary or the head of the family or certificate from the concerned Patwari or Talathi.

How to Enrol in Mahatma Jyotiba Jan Arogya Yojana (MJPJAY) Scheme?

Below is the enrollment process for the MJPJAY scheme in the state of Maharashtra:

• Step 1: Individuals or families shall approach nearby Network/District/Women/General hospital and meet Arogyamitra to initiate the application for the scheme.

• Step 2: If you visit a Government Health Facility, a referral card will be provided to you which can be presented to the Network Hospital along with the preliminary diagnosis by the doctors conducted at the Government Health Facility.

• Step 3: You can also attend Health Camps organised by the Network Hospital and get the referral card.

• Step 4: You are then required to provide the referral card along with your Yellow or Orange Card. You can also produce your Antyodaya or Annapurna Card instead of a ration card.

• Step 5: Once you have produced the above details, diagnosis and check-ups will be initiated.

• Step 6: Based on the diagnosis, you will be admitted to the Network Hospital.

• Step 7: An E-authorisation request will be sent to the medical insurance company and the same will be reviewed by the MJPJAY as well.

• Step 8: Medical Specialists of the insurance company and MJPJAY will review the request for authorization and approve the request if all conditions are met. This authorization will be done in 24 hours and immediately in case of an emergency with the authorization is marked as “EM”.

• Step 9: With the authorisation approved, cashless treatment or hospitalisation will be extended to you. 

• Step 10: The hospital will send all the original bills, diagnostic reports, discharge summary, and other relevant documentation to the insurance company for the settlement of the claim.

• Step 11: The insurance company will review the documents and approve the claim and clear the payment to the hospital.

• Step 12: The network hospital will provide free consultations, medicines and diagnostics under the scheme for up to 10 days from the date of discharge.

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

For identification purpose, apart from the ration card (Orange/Yellow/White), you need to submit any of the following KYC documents:

• Pan Card

• Driving Licence

• Aadhar Card

• Voter ID

• Handicap Certificate

• Nationalised Bank Passbook with Photograph

• School/College ID

• For urban areas, Government Local bodies/Tahsildar’s stamps and signatures on the applicant’s photograph.

• For rural areas, Tahsildar’s stamp and signature on the applicant’s photograph.

• Passport

• Freedom Fighter ID Card

• Senior citizen card issued by central and state government Of India

• Defence ex-service card issued by Sainik board

• Any photo ID proof issued by Govt. of Maharashtra/ Govt. of India.

• Marine Fishers Identity card. 

In the case of a newborn child wherein, the name and photo are not available on the card or on the valid Yellow or Orange Ration card, submit the photograph of the child along with either of the parents along with White/Orange/Yellow ration card and the child’s birth certificate.

How to Apply for Mahatma Jyotiba Jan Arogya Yojana Card Online?

To apply or to get the Mahatma Jyotiba Jan Arogya Yojana card, you need to approach the nearby General, Women/District/Network hospital. Arogyamitra, who is the representative of the scheme, shall facilitate in getting the health card for you.

Please note, if you visit the Government Health Facility, you will be provided with a referral card to the Network hospital to initiate preliminary diagnosis by the doctors. You can also attend Health Camps conducted by the Network hospitals and can get the health card.

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Application Form:

The main objective of the government to launch this health scheme is to provide free access to health care to the poor and the vulnerable sections of the society, especially those who belong to the BPL and APL families.

To apply for the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) scheme, beneficiaries should approach nearby General, Women, District or Network hospitals to enrol themselves.

Also Explore: International Travel Health Insurance

Claim Procedures of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

Below is the claim procedure of MJPJAY scheme:

• Step 1: A diagnosis is conducted to find out the condition.

• Step 2: Treatment will begin immediately if the diagnosis is made in a network hospital as soon as the pre-authorisation is received from the insurance company.

• Step 3: If the diagnosis is not conducted in a network hospital, then a referral card will be provided by the Arogyamitra to begin the treatment at the empanelled hospital. 

• Step 4: The network hospital will obtain e-authorisation from the insurance company through online mode.

• Step 5: Upon receiving the authorization from the insurance company, the empanelled hospital will commence the treatment. 

• Step 6: Once the treatment and surgery are completed, the hospital will share all the relevant documents such as medical bills, diagnostics, discharge summary to the insurance company.

• Step 7: The insurance provider will verify all the relevant documents and approve the claim settlement.

• Step 8: The network hospital will offer consultations, diagnostic and medicines for up to 10 days from the date of discharge.

Mahatma Jyotiba Phule Jan Arogya Yojana Hospital List:

A large number of hospitals have been approved to provide healthcare under the MJPJAY scheme. The complete list is available

Also, read: Benefits of Buying Health Insurance Policy Online

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Toll-Free Number and Address:

Below is the MJPJAY helpline number and the address

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

The Bottom Line

The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) represents a significant step towards ensuring that quality healthcare is accessible to the economically weaker sections of Maharashtra. By offering comprehensive coverage for a wide range of medical procedures, treatments, and follow-up care, this scheme ensures that financial constraints do not hinder the health and well-being of vulnerable populations. With the state government bearing the cost of insurance premiums and providing a substantial cover amount, MJPJAY exemplifies a model of inclusive health care.

Also check: Travel Medical Insurance

Frequently Asked Questions:

Below are some of the frequently asked questions about the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme:

Below are some of the frequently asked questions about the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme

Should I pay any extra money for treatment?

Under the scheme, you should not pay any extra money to the hospital for services approved under the packages.

Is hernia covered under the MJPJAY scheme?

No. Hernia is not covered under the scheme. However, diaphragmatic hernia in paediatrics is covered.

Is appendicitis covered under the scheme?

No. Only appendicular perforation is covered under the scheme.

What is the turn-around-time for pre-authorization?

The TAT is 12 hours.

Is ambulance charges included in the scheme?

No. Patient has to bear the ambulance charges.

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

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

Who is eligible to apply for the MJPJAY scheme?

Families holding White/Orange/Yellow Ration Cards, Antyodaya Anna Yojana (AAY) Cards, or Annapurna Cards in Maharashtra are eligible. This includes farmers from specific distressed districts as outlined by the scheme.

Can individuals from any district in Maharashtra apply for MJPJAY?

Yes, individuals and families from all districts of Maharashtra who meet the eligibility criteria can apply for the scheme. However, special attention is given to those from identified distressed districts.

How can I find out if a hospital is empanelled under the MJPJAY?

The list of empanelled hospitals is available on the official MJPJAY website. Additionally, Arogyamitra stationed at network hospitals can provide this information.

What documents are required for enrollment in the MJPJAY scheme?

Required documents include a valid ration card (White/Orange/Yellow), KYC documents (Aadhaar Card, PAN Card, Voter ID, etc.), and, in the case of newborns, a birth certificate along with a photograph of the child with either parent.

Are there any limits on the number of family members who can use the MJPJAY coverage?

The scheme provides a sum insured of Rs. 1,50,000 per family per year, which any or all eligible family members can avail. There is no specific limit on the number of members who can benefit as long as the total claim does not exceed the insured sum.

Are there any costs involved in getting the MJPJAY card?

There are no charges for obtaining the MJPJAY card. The scheme aims to provide free access to healthcare for eligible families.

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