What is the MJPJAY Scheme?

MJPJAY Scheme Overview

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 Enrol in the MJPJAY Scheme?

Here is a step-by-step you need to follow to enrol in the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY):

● Step 1: Visit your nearest network, district, general, or women’s hospital. There, you can meet with an Arogyamitra, who will assist you in starting the enrollment process.

● Step 2: If you begin your application at a government health facility, you will receive a referral card after a doctor conducts a basic medical assessment. This card must be taken to a network hospital for further treatment.

● Step 3: You may also get a referral card by attending health camps organized by any participating network hospital.

● Step 4: When visiting the network hospital, you will need to submit the referral card along with either your yellow or orange ration card. Alternatively, you may present an Antyodaya or Annapurna card.

● Step 5: After your documents are verified, the hospital will proceed with medical examinations and diagnosis.

● Step 6: If treatment is required, you will be admitted to the network hospital for care.

● Step 7: The hospital will send an e-authorization request to the insurance company. This request has also been reviewed by the MJPJAY authorities.

● Step 8: Medical experts from the insurance provider and MJPJAY will evaluate the request. If all the conditions are satisfied, they will approve the treatment within 24 hours. In emergency cases, approval is granted immediately and marked as ‘EM’ for emergency.

● Step 9: Once authorization is granted, you will receive cashless treatment or hospitalization at the hospital.

● Step 10: After the treatment is completed, the hospital will submit all original documents, including bills, diagnostic reports, and the discharge summary, to the insurance company for claim processing.

● Step 11: The insurance company will verify and approve the claim, then release the payment directly to the hospital.

● Step 12: Post-treatment, you are entitled to free consultations, diagnostic tests, and medicines for up to 10 days after discharge under the MJPJAY scheme.

Overall, the MJPJAY scheme actively empowers poor families in Maharashtra by providing them with quality, cashless healthcare without any financial burden. From hospitalization and surgeries to follow-up treatments, the program covers it all.

By following a simple enrolment process and using valid documents, individuals can receive timely healthcare and focus on recovery instead of costs.