How to Check MJPJAY Approval Status?

MJPJAY Status Check: Know Your Approval in Minutes

The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a public health insurance scheme specifically tailored for the poor and vulnerable sections of society. To ensure that all ration cardholders in Maharashtra can avail of quality health care, the state government launched MJPJAY with the goal of offering free medical care for a variety of serious ailments.

Read ahead to get a brief idea of this scheme, along with its objectives, features, coverage range, and enrolment procedure.

What is the Objective of the MJPJAY Scheme?

The main objective of this scheme is to deliver free, high-quality healthcare services to economically weaker sections of society. This initiative is focused on providing specialized medical treatments that often require hospitalization, surgeries, or therapies, all at no cost to the patient.

Under MJPJAY, each eligible family is entitled to cashless treatment up to ₹1,50,000 per year, which can be used by one member or shared among all family members during the policy period. It aims to reduce the financial burden of serious illnesses and improve access to essential healthcare services across the state.

What are the Features of the MJPJAY Scheme?

The MJPJAY scheme provides a variety of health benefits to assist families with serious medical issues. Below are the major features of this scheme:

• Coverage is offered on a floater basis, which means any individual or multiple family members can use the total amount during the policy period based on their medical needs.
• The scheme covers the cost of surgeries, diagnostic tests, prescribed medicines, and post-treatment follow-ups.
• Free health camps are regularly organized by the empanelled hospitals to help identify and assist potential beneficiaries.

What is Covered Under the MJPJAY Scheme?

The MJPJAY scheme offers extensive health insurance coverage that takes care of a wide range of medical needs. Here is what is included under the scheme:

• The plan covers 971 approved medical procedures, surgeries, and treatments, along with 121 follow-up care packages.
• It includes various specializations, such as general surgery, ENT procedures, gynaecological and obstetric surgeries, cardiac and cardiothoracic operations, orthopaedic treatments, plastic surgery, pediatric surgeries, ophthalmic procedures, and radiation treatments.
• The scheme covers kidney transplant surgeries and has a financial limit of up to ₹2.5 lakh per case.
• Additionally, post-discharge care is covered for up to 10 days, which includes follow-up doctor visits and prescribed medications.

How to Apply for the MJPJAY Scheme?

Here is a step-by-step procedure you need to follow to apply for the MJPJAY scheme:

Step 1: Visit a Designated Hospital or Health Camp

Go to your closest MJPJAY-enrolled hospital or join scheduled health camps. Trained Arogyamitras help qualified patients receive medical approval through referral letters after medical reviews.

Step 2: Enrolment by Arogyamitras

Medical staff known as Arogyamitras at the network hospital execute enrollment registration by confirming ration card and photo identification validity for patients. The medical coordinators maintain a digital record of admission information together with all diagnostic findings in the system.

Step 3: Submission of Pre-authorization Request

The hospital launches an electronic request for the pre-authorization of MJPJAY-covered procedures through the designated code 996.

Step 4: Assessment of Pre-authorization

Medical experts appointed by the insurer examine the pre-authorization request. If declined, the request is escalated to a technical committee, with the final decision resting with the ADHS-SHAS authority.

Step 5: Timely Approval and Emergency Handling

It is essential that procedures commence within the prescribed time frame. Pre-authorization decisions are typically made within 12 hours. In emergency cases, approval may be expedited via Emergency Telephonic Intimation (ETI).

Step 6: Access Cashless Treatment

Approved patients receive surgical or medical care free of cost at the empanelled hospital. Medical coordinators consistently log daily treatment progress into the system.

Step 7: Post-Treatment Documentation

The hospital uploads all essential documents, including diagnostic reports, discharge summaries, and payment confirmations. Patients are also advised on any follow-up care needed.

Step 8: Post-Discharge Services

Beneficiaries are entitled to complimentary follow-up consultations, diagnostic tests, and prescribed medications for up to 10 days after discharge.

Step 9: Claim Processing and Settlement

The insurer carefully audits the submitted bills and processes payments within 15 working days. This is managed through the SHAS portal’s claim settlement module and overseen by the insurance provider.

Who is Eligible to Apply for the MJPJAY Scheme?

The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is designed to support various groups across Maharashtra. Here are the categories of individuals and families who are eligible to benefit from this healthcare scheme:

1. Category A

• Households possessing Yellow, Antyodaya Anna Yojana (AAY), Annapurna Yojna, or Orange ration cards are covered under this category.

2. Category B

• Families with White ration cards, which also include employees from government and semi-government sectors.
• Households that do not possess any ration card but hold a valid domicile certificate issued by the state of Maharashtra.

3. Category C

This category includes individuals associated with government or government-recognized institutions:

• Pupils studying in Ashram schools.
• Children residing in officially recognized orphanages.
• Women staying in registered women’s shelters.
• Senior citizens living in certified elderly care homes.
• Accredited journalists and their dependent family members, as recognized by the Directorate General of Information and Public Relations.
• Registered construction workers and their families are originally from outside Maharashtra but are listed with the Maharashtra Building and Other Construction Workers Board.

4. Category D

• Victims of road accidents who are residents of other states or countries but were involved in the incident within Maharashtra are entitled to assistance under this category.

5. Category E

Families from the 865 border villages of Belgaon, Kalburgi, Karwar, and Bidar (areas adjoining Maharashtra and Karnataka) holding any of the following ration cards qualify:

1. Antyodaya Anna Yojana (AAY)
2. Priority Household (PHH)
3. Annapurna Yojna

What are the Documents Required for the MJPJAY Scheme?

To apply for the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), applicants must provide valid proof of identity along with documents that confirm eligibility. Below is a list of accepted photo ID documents:

1. Aadhaar card or Aadhaar enrollment slip with the applicant’s photograph. If an Aadhaar card is not available, any official document used to obtain one will be considered acceptable.
2. Voter Identification card
3. Driver’s license
4. PAN card
5. School or college identification card
6. Freedom Fighter ID card
7. Passport
8. Health cards issued under RGJAY or MJPJAY schemes
9. Disability certificate
10. Senior citizen card provided by either the central or state government
11. Photograph-bearing passbook from a nationalized bank
12. Ex-servicemen ID card issued by the Sainik Welfare Board
13. Any government-issued photo ID from the Government of Maharashtra or the Government of India.
14. Marine fisheries identity card issued by the Ministry of Agriculture or the Fisheries Department, Government of Maharashtra

What is the Process for checking the MJPJAY Approval Status?

To find out the approval status under the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY), follow the steps outlined below:

Step 1: Visit the Official Portal

Go to the official website of the MJPJAY scheme.

Step 2: Navigate to the Status Section

Look for the option labelled either ‘Approval Status’ or ‘Check Status’ on the homepage or in the menu.

Step 3: Enter Required Details

Fill in the necessary details as requested, which could include your application number, ration card number, or any other identifier.

Step 4: Submit the Information

Tap on the button that says ‘Check Status’ or ‘Submit’ to proceed.

Step 5: View Your Status

Your application or approval status will then be displayed on the screen.

What are the Benefits of MJPJAY?

The Mahatma Jyotiba Phule Jan Arogya Yojana provides comprehensive health protection to eligible families across Maharashtra. Here are the key features and benefits of the scheme:

1. Comprehensive Financial Protection

Every eligible family covered under MJPJAY is entitled to a maximum amount of annual health insurance coverage worth ₹5 lakhs. This includes a wide range of medical care services, both secondary and tertiary in nature.

2. Cashless Medical Services

One of the major benefits is the option for cashless treatment at empanelled hospitals. This eliminates the stress of initial payments, enabling patients to recover without concern for immediate cost.

3. Wide Range of Treatments

The plan provides insurance for about 971 medical procedures, surgeries, and therapies in 30 various medical specialities, from cardiology and orthopaedics to gynaecology. Follow-up care is also provided via 121 post-operative care packages.

4. Cover for Pre-existing Medical Conditions

Patients are entitled to treatment of pre-existing ailments from the day of admission. This inclusion ensures that chronically ill or previously diagnosed patients are not prevented from receiving treatment.

5. Post-Hospitalization Support

This scheme extends its benefits beyond hospital discharge by providing coverage for consultations and prescribed medications for up to 10 days. This ensures continuity of care and supports the patient’s recovery process.

6. Trusted Government-Linked Facilities

Some medical interventions are performed exclusively in government-empanelled hospitals or associated medical colleges. This guarantees that beneficiaries enjoy quality and credible care within the public health system.

The MJPJAY scheme plays a vital role in delivering affordable and accessible healthcare to low-income families across Maharashtra. Offering cashless treatment, extensive coverage, and inclusion of pre-existing conditions ensures timely and quality medical care.

If you have applied for the scheme, use the simple online steps above to check your approval status and take full advantage of the benefits available to you and your family.