About MJPJAY Scheme
Mahatma Jyotirao Poole Jan Arogya Yojana is a flagship health insurance scheme of the Government of Maharashtra. The scheme provides cashless services for identified diseases through a network of public and private sector service providers such as financial assistance to families for medical treatment, including hospitalization expenses, diagnostic tests, and prescription drugs.The scheme was earlier known as Rajiv Gandhi Jeevandayi Arogya Yojana which started on 8th July 2012 in eight districts and then expanded to 28 districts of Maharashtra from 21st November 2013.The scheme is named after Mahatma Jyotiba Phule, a social reformer and leader in the Indian independence movement.
The Pradhan Mantri Jan Aarogya Yojana is jointly funded by the Government of India and the Government of Maharashtra in the ratio of 60:40. Earlier 971 operations were done for these diseases but now 1034 types of operations will be done.
Objectives of the scheme
- To provide cashless quality medical services to the beneficiaries under the scheme
- Reducing The Mortality Rate Of The State
- To Ensure The Health Protection Of Every Poor And Helpless Family Of Maharashtra
Eligibility Criteria
- Applicants must be a residential people of Maharashtra
- Applicant must attend his/her 18 years age
Only the following category will be able to apply in the scheme
| Categories | Description of Beneficiaries |
| Category A | Families holding Yellow ration card, Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange ration card (annual income up to INR 1 lakh) issued by Civil Supplies Department, Government of Maharashtra for 36 districts of Maharashtra. |
| Category B | White ration cardholder farmer families from 14 agriculturally distressed districts of Maharashtra (Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal, and Wardha). |
| Category C | 1. Children of Government Orphanages, Students of Government Ashram Shala, female inmates of Government Mahila Ashram & senior citizens of Government old age homes. 2. Journalists & their dependent family members approved by DGIPR 3. Construction workers and their families having live registration with Maharashtra Building & other Construction Workers Welfare Board. |
Benefits
The policy included in this scheme provides coverage to cover all the expenses related to the hospitalization of the beneficiary up to Rs 1,50,000 / – per family per year. And this limit for renal transplants has been increased to Rs 250,000 per household per policy year
The benefit of this project could be a total annual coverage of ₹ 1.5 lakhs or ₹ 2.5 lakhs available for each beneficiary family. which may be available by one person or all family members collectively for that year.
| ENT surgery | General surgery | Ophthalmology surgery |
| Gynecology and Obstetrics Surgery | Surgical Gastroenterology | Orthopedic Surgery and Procedures |
| Cardiac and Cardiothoracic Surgery | Genitourinary System | Pediatric Surgery |
| Medical Oncology | Plastic Surgery | Burns |
| Surgical Oncology | Neurosurgery | Critical care |
| Radiation Oncology | Prostheses | Polytrauma |
| Infectious disease | General medicine | Pediatrics Medical Management |
| Nephrology | Cardiology | Neurology |
| Dermatology | Pulmonology | Rheumatology |
| Gastroenterology | Endocrinology | Interventional Radiology |
Required Documents
- Aadhaar card / Aadhaar registration slip with photo of the beneficiary
- PAN card
- Voter ID
- Driving license
- School / College ID
- Passport
- Muktijoddha ID card
- Health card of RGJAY / MJPJAY
- Certificate of Disability
- Passbook of nationalized bank with photo
- Senior Citizens Card issued by Central Government or State Government
- Defense Ex-Servicemen Card issued by the Soldiers Board
- Marine Fisheries Identity Card (Issued by the Department of Agriculture / Fisheries, Government of Maharashtra).
- Proof of any photo ID issued by Government of Maharashtra / Government of India
Bima Package Details
General Ward Bed Charges, Nursing and Boarding Charges, Surgeon and Anesthetist Charges, Medical Practitioner and Consultant Fees, Oxygen, OT and ICU Charges, Surgical Appliances Costs, Drug Costs, Disposables, Consumables, Implant Costs Devices, Blood Transfusion Costs ( blood will be supplied as per State Govt policy), X-ray and diagnostic test, food for the patient, one-time transport cost of State transport or second class rail fare (only from hospital to patient’s residence)) The package covers the entire cost of the patient’s treatment.
How to Apply
- Step1- Beneficiaries should contact the nearest empanelled network hospital which has already set up as Arogya Mitra by the Govt, the mentioned Arogya Mitra hospitals will provide benefits to the beneficiaries.
- ➢ Beneficiaries can also attend health camps conducted by nearby network hospitals and get referral letters based on diagnosis.
Step 2– Arogyamitra of network hospital checks valid ration card and photo ID and enrolls patient with registration.
➢ The admission credentials are verified against the dedicated database by the Medical Coordinator of the network hospital as per the scheme requirements.
Step 3- The network hospital uploads the diagnostic report after completing the treatment or surgical procedure, duly signed by the officials appointed by the hospital along with acknowledgment of payment of discharge summary, transport cost and other documents as per operational guidelines.
➢ If the procedure falls under the category of follow-up procedure, the follow-up details will be communicated to the patient at the time of discharge from the hospital. It will be the physician’s responsibility to educate the patient about follow-up procedures (if applicable) and related details.
Step 4- Insurer scrutinizes bills in light of operational guidelines and mandatory investigations and pays claims as per agreed package rates and hospital grade. The insurance company will settle the hospital claims online within 15 working days after receiving the complete claim documents from the network hospital
➢ The claim settlement module with electronic clearance and payment gateway will be part of the workflow of the State Health Assurance Society (SHAS) portal and managed by the insurer.
➢ Reports will be available for verification at State Health Assurance Society (SHAS) login.
Health Camp:
Free health camps will be conducted by network hospitals at taluka headquarters, main village panchayats and municipalities. At least one free health camp is conducted by each network hospital every month at a location recommended by the District Monitoring Committee/District Coordinator.
Healthcare providers:
- The hospitals listed under the scheme include both government and private hospitals. Government hospitals include public health departments, medical education and research departments, municipal corporations and hospitals under municipalities.
- Government and private hospitals, both multi-specialty and single-specialty, may be listed as per the requirements and directives of the Coordination Empanelment and Disciplinary Committee chaired by the Chief Executive Officer of the State Health Assurance Society. For multi-specialty private hospitals, there is a minimum criteria of 30 beds including ICU (with some relaxations), while for single specialty hospitals 10 beds and other criteria will apply.
Current bed occupancy and hospital list link – https://www.jeevandayee.gov.in/#
Maharashtra Govt has enabled pradhan Mantri ayushman Bharat at 2020 1st April
FOR MORE DETAILS ABOUT THE SCHEME VISIT THE OFFICIAL WEBSITE