Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

The Mahatma Jyotirao Phule Jan Arogya Yojana, a flagship health insurance initiative by the Government of Maharashtra, offers comprehensive cashless services for identified diseases through a network of providers in both the public and private sectors. This initiative aims to ensure affordable and accessible healthcare for the citizens of Maharashtra, particularly those from economically disadvantaged backgrounds. Under MJPJAY, beneficiaries can avail of medical treatment at empaneled hospitals and healthcare facilities, both in the public and private sectors, without having to bear the financial burden upfront.

In this article, we will discuss the benefits, coverage, eligibility, and more about Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).

Also check: Ayushman Card Download

What is MJPJAY?

Previously known as the Rajiv Gandhi Jeevandayee Arogya Yojana, Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) began in eight districts on July 2, 2012, and expanded to 28 districts on November 21, 2013. The scheme's primary goal is to offer cashless access to quality medical care for beneficiaries dealing with catastrophic illnesses. This includes hospitalisation for surgeries and therapies within specified specialty services. This assistance is facilitated through a network of healthcare providers.

The Mahatma Phule Yojana covers all medical expenses incurred during hospitalisation, providing a sum insured of Rs. 1.5 lakh per family per policy annually. This coverage can be utilised by an individual or the entire family through cashless hospitalisation services.

MJPJAY (Mahatma Jyotiba Phule Yojana): Overview

MJPJAY: Features and benefits

Given below are the key features and benefits of Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY):

• The scheme covers all hospitalisation expenses for the beneficiary, up to Rs. 1.5 lakh per family per policy each year.
• For renal transplant, the limit for hospitalisation expenses has been enhanced upto Rs. 2.5 lakh per family, per policy annually.
• The benefit is accessible to every family member on a floater basis. The total coverage of Rs. 1.5 lakh or Rs. 2.5 lakh, depending on the case, can be utilised by one person or shared among all family members during the policy year.
• MJPJAY beneficiary gets benefit of 996 medical and surgical procedures with 121 follow up procedures.
• The scheme provides coverage for surgeries, diagnostics, medications, and follow-up consultations and treatment.
• 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.
• Free health camps shall be conducted by network hospital.

Eligibility criteria for Mahatma Jyotiba Jan Arogya Yojana

Given below is the eligibility criteria for the Mahatma Jyotiba Jan Arogya Yojana (MJPJAY):

• Valid Yellow, Orange, Antyodaya, and Annapurna ration card holders.
• The State Health Assurance Society (SHAS) shall decide the eligibility of beneficiaries based on any identity card/health card or any other identification mechanism.
• Farmers from agriculturally distressed districts are identified based on their 7/12 extract, White Ration Card, and the name of the beneficiary or head of the family, or a certificate from the relevant Patwari or Talathi.

List of diseases and treatments covered under MJPJAY

There are over 30 specialised diseases and treatments which are covered under MJPJAY scheme:

List of documents required for Mahatma Jyotiba Jan Arogya Yojana

Apart from the yellow/orange/white cards, there are other documents required for MJPJAY. Given below is the list of the same:

• Aadhaar card
• PAN card
• Voter Id
• Driving license
• School/College Id
• Passport
• Freedom Fighter ID card
• Health card of RGJAY / MJPJAY
• Handicap certificate
• Nationalised bank passbook with photo
• Senior citizen card issued by Central Government or State Government
• Defense ex-servicemen card issued by Sainik Board
• Marine Fishery Identity card
• Any photo ID proof issued by Government of Maharashtra/ Government of India

Read more: Ayushman Bharat Yojana – Registration, eligibility and apply

How to register for Mahatma Jyotiba Jan Arogya Yojana (MJPJAY)?

The registration process for MJPJAY scheme is simple. You can follow the steps given below to enrol for Mahatma Jyotiba Jan Arogya Yojana:

• Beneficiaries can visit nearby empanelled network hospital or attend health camps. Arogyamitras at hospitals assist beneficiaries and provide referral letters based on diagnosis.
• Arogyamitras at network hospitals enroll patients, examining valid ration cards and Photo ID. Medical Coordinator captures admission notes and test results in the dedicated database.
• Hospital raises e-preauthorisation request for eligible procedures under MJPJAY (996).
• Insurer's medical specialists review and approve pre-authorisation. Rejected requests are referred to a technical committee for review. ADHS-SHAS makes the final decision on approval or rejection.
• The procedure must be performed within specified timelines, with a turnaround time of 12 hours for decisions. Emergency Telephonic Intimation (ETI) is used for urgent approvals.
• Network hospital provides cashless medical/surgical treatment. The medical coordinator updates daily treatment notes on the portal.
• Network hospital uploads diagnostic reports, discharge summary, and payment acknowledgements. Follow-up procedures are communicated to patients at the time of discharge.
• Free follow-up consultation, diagnostics, and medicines are provided up to 10 days post-discharge.
• Insurer scrutinises bills and pays claims within 15 working days. Claim settlement module is part of SHAS portal, operated by the Insurer.

Also, the reports will be available for scrutiny on the State Health Assurance Society (SHAS) login.

List of empanelled hospitals

Given below is the list of government and private hospitals empanelled under MJPJAY:

.For detailed list of empanelled hospitals, you can visit the official website
(https://www.jeevandayee.gov.in/RGJAYDocuments/Empanelled_Hospitals_Under_MJPJAY.pdf)

Significance of health insurance policies

Health insurance policies play a crucial role in providing financial protection and access to quality healthcare services. They mitigate the risk of high medical expenses during emergencies, ensuring individuals and families can afford necessary treatments without facing financial hardship. Additionally, health insurance promotes preventive care, early detection, and management of health issues, leading to improved health outcomes. By covering a range of medical services and treatments, these policies contribute to the overall well-being and economic stability of individuals, families, and society.

Government and private health insurance policies both hold significance in providing essential healthcare coverage. Government policies like the MJPJAY scheme ensure access to healthcare for vulnerable populations, promoting social equity and public health. They often cover basic medical needs and preventive services. Private health insurance policies offer more comprehensive coverage, providing choices and additional benefits for individuals and families willing to pay premiums.

Read more: Beneficiary NHA Portal For Ayushman Bharat Yojana