Mahatma Jyotiba Phule Jan Arogya Yojana | Mahatma Jyotiba Phule Jan Arogya Yojana Benefits | Mahatma Jyotiba Phule Jan Arogya Yojana disease list | Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility | Mahatma Jyotiba Phule Jan Arogya Yojana contact number
Mahatma Jyotiba Phule Jan Arogya Yojana is a health insurance policy introduced by the Maharashtra state government. As the name suggests, this yojana was introduced with the aim to provide quality medical care, cashless hospital insurance to Below Poverty line (BPL) and Above Poverty Line (APL) families; excluding white cardholders, as identified by the civil supplies department of the state.
MJPJAY was initially introduced as Rajiv Gandhi Jeevandayee Arogya Yojana in July 2012. It was introduced in eight districts in Maharashtra, i.e., Thane, Nanded, Amravati, Solapur, Raigad, Sholapur, Gadchiroli, Mumbai, and Dhule. Looking at the success of this scheme as it carried out more than one lakh procedures in the next year, the state government decided to launch it in all the 35 districts of Maharashtra in November 2013. The hospital cashless settlements will be handled by United India Insurance Company Limited. This scheme is based on the Aarogyasri health insurance scheme of Andhra Pradesh. This scheme was renamed from RGJAY to MJPJAY in April 2017.
In the year 2018, the AB-PMJAY was launched in collaboration with theAyushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) and was executed in a combined insurance and assurance mode.
On April 1, 2020, the state began the Integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). This will be on 60 : 40 funding by the Pradhan Mantri Jan Arogya Yojana and Government of Maharashtra.
|Start Date||2nd July 2012|
|Launched by||Ministry of Health Maharashtra|
|Introduced by||Government of Maharashtra|
|Mode of application||Offline|
Mahatma Jyotiba Phule Jan Arogya Yojana Benefits
- The scheme covers 1100 types of surgeries/procedures/therapies under 30 categories.
- It also covers follow-up procedures under 30 categories. This procedure is for 10 days after the discharge from the hospital.
- All pre-existing diseases are covered from day one.
- State government bears the cost of insurance premium and treatment charges.
- Beneficiaries can avail insurance amount up to Rs. 1.5 lakhs annually per family per year . It can be claimed for an individual or on floater basis for a family.
- For Renal Transplant this limit has been enhanced up to ₹ 2,50,000 per family per policy year.
- The beneficiaries have access to one health camp per year, free of cost.
- The empanelled hospitals will provide the beneficiary with immediate cashless service.
- Under Ayushman Bharat PM-JAY Sum insured of 5 Lakh rupees is covered per family per policy year for secondary and tertiary care hospitalization in any network hospitals
- Families coming from the identified distressed districts of Maharashtra.
- Families having either yellow/orange(annual income up to INR 1 lakh) ration card, Antodaya anna yojana card Or Annapurna card can apply.
- Farmers from 14 distressed districts of Maharashtra. White ration card is required for them.
Offline Application Process
- Visit a nearby Network/District/Women/General hospital and meet an Aarogyamitra who is available 24×7 in the hospitals.
- Show your photo ID proof to them.
- The Aarogyamitra volunteer will get you and your family registered after checking all the details.
- You will be provided with a referral card. This as to be shown at the network hospitals when admitted
- The beneficiary can now visit any of the empanelled hospitals and get your diagnosis and treatment.
- Your application process is complete and you have successfully registered under this scheme. Now, you are eligible to claim in the network Hospitals.
Along with a ration card, Any of the following photo ID proofs can be submitted
- Yellow/orange/white ration card
- Aadhar card
- Pan card
- Driver’s licence
- Voter ID card
- Bank passbook with photograph
- School or college ID
- Senior citizen card
- Handicap certificate
- Marine fishers ID card
- Freedom fighter ID card
- Any other photo ID proof issued by the Maharashtra state Government or the Government of India.
- Authorized birth certificate along with a photo with either of the parents and parents’ yellow/orange/white ration card is mandatory to register a new-born child.
How to Register a Claim?
The beneficiary can register a claim when they get admitted to the hospital and follow the below steps.
- Get your medical condition diagnosed in any of the network hospitals or centres.
- Register the claim in the insurance department. A pre-authorization request will be sent to the insurance company and MJPJAY by the hospital authorities for approval.
- If all the documents are correct and all the conditions are met, your request will get approved. Authorization will be completed with 24 hours and with applications marked as “EM”, in case of emergency, they’re attended to immediately.
- After the approval, cashless treatment or hospitalization process will commence.
- Hospital will send all the relevant documents, such as reports, bills, etc. to the hospital for the settlement of the claim.
- The insurance company will review the documents, approve the claim, and clear the payment to the hospital.
- Post Treatment, the beneficiaries can opt for follow-up procedure for up to 10 days.
|Contact Numbers||155-388, 1800-233-2200|
|Address||State Health Assurance Society, ESIS Hospital Compound, Ganpat Jadhav Marg, Worli Naka, Worli Mumbai – 400018, Maharashtra.|
What are the categories under which surgeries/therapies/procedures and follow-up are provided?
They are as follows:
- GENERAL SURGERY
- ENT SURGERY
- OPHTHALMOLOGY SURGERY
- GYNAECOLOGY AND OBSTETRICS SURGERY
- ORTHOPEDIC SURGERY AND PROCEDURES
- SURGICAL GASTROENTEROLOGY
- CARDIAC AND CARDIOTHORACIC SURGERY
- PEDIATRIC SURGERY
- GENITOURINARY SYSTEM
- SURGICAL ONCOLOGY
- MEDICAL ONCOLOGY
- RADIATION ONCOLOGY
- PLASTIC SURGERY
- CRITICAL CARE
- GENERAL MEDICINE
- INFECTIOUS DISEASES
- PEDIATRICS MEDICAL MANAGEMENT
- INTERVENTIONAL RADIOLOGY
Is COVID treatment provided under this scheme?
Yes, COVID treatment is covered under this scheme.
What are the enrolment guidelines?
You can find the enrolment details from this link
What are the package costs?
You can find the package cost details from this link
How can I check the network hospital list?
Network Hospital list can be checked from this link
How to find the Health Services Near me?
You can find district wise hospitals on Google Map by clicking this link
How can one register a complaint?
You can contact an Aarogyamitra or call on the toll-free contact numbers mentioned above.
Does it cover Appendicitis treatment?
No. Though appendicular perforation is covered.
Is there any defined length of admission period to avail of the cashless treatment?
No. there is no pre-mentioned length of stay.it depends on the treatment and the condition of the patient.
Who must pay the ambulance charges?
Ambulance charges will be borne by the patient.
If a patient comes to a hospital in case of emergency for an ailment which is not covered by the scheme, what happens then?
The patient will have to bear the charges for the treatment.
For more information/clarification or any other further doubts, please follow this link