Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY)

Mahatma Jyotirao Phule Jan Arogya Yojana Explained

With the cost of living rising exponentially, it is becoming increasingly harder for poor people in India to access proper healthcare. To help with this situation, the Maharashtra government launched the Mahatma Jyotirao Phule Jan Arogya Yojana. This scheme is specially designed to offer health insurance to low-income families who may not be able to afford it otherwise.

The scheme aims to provide cashless, high-quality medical care for serious illnesses that require hospitalization, therapy, or surgery through a network of healthcare providers. In addition, this government-sponsored Maharashtra health insurance is only dedicated to low-income families. Keep reading to learn all the crucial aspects of the MJPJAY yojana, like features, eligibility criteria, application procedure and more.

The scheme aims to provide cashless, high-quality medical care for serious illnesses that require hospitalisation, therapy, or surgery through a network of healthcare providers. In addition, this government-sponsored Maharashtra health insurance is only dedicated to low-income families. Keep reading to learn all the crucial aspects of the 

Overview of MJPJAY

 What is MJPJAY?

Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a health insurance scheme by the Maharashtra Government for people with local income. 

Accordingly, an insurance cover of Rs.1.50 lakh per family per year was provided for 996 treatments in the Mahatma Jyotirao Phule Jan Arogya Yojana. In addition, health coverage of Rs.5.00 lakh per family per year was applicable for 1209 treatments through Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana. 

This cashless insurance covers hospitalization, surgeries, and therapies for both minor and serious illnesses, constituting a comprehensive healthcare package.

Launch of MJPJAY

MJPJAY yojana was first launched on 2 July 2012 as the Rajiv Gandhi Jeevandayee Arogya Yojana by covering eight districts in Maharashtra on pilot basis and then it was expanded in all districts of Maharashtra from 21 November 2013. This flagship health scheme was initially started for low-income families and then added other categories from time to time.

The Government of India launched Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on 23 September 2018. Earlier the households included were based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.

This scheme was implemented in integration with Mahatma Jyotirao Phule Jan Arogya Yojana during 2018 to 2020. Government of India and Government of Maharashtra have been sharing cost of implementation in the ratio of 60:40.

The MJPJAY scheme even offers coverage for over 34 specialized services, 1300 procedures, and 262 follow-up treatments, with top healthcare providers and health camps to ensure accessibility in remote areas.

What is Covered Under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)?

Maharashtra Health Insurance Scheme provides health insurance coverage for the following treatments:

Surgical and Medical Procedures

It mainly covers 971 surgeries, procedures, and therapies, including general surgery, ENT, gynaecology, cardiac, plastic, pediatric, orthopaedic, ophthalmology surgeries, and radiation surgery.

Renal Transplant

It covers renal transplant surgery up to ₹2.5 Lakh per family per policy year.

Follow-Up Care

It even includes 121 follow-up health packages for continued treatment.

Post-Hospitalization Expenses

This scheme also covers medical expenses and consultations for 10 days after discharge from the hospital. 

MJPJAY: Features and Benefits

The MJPJAY scheme offers several features to make health insurance more accessible and effective for families:

• Universal Health Coverage for all citizens of Maharashtra
• Cashless secondary and tertiary healthcare procedures in network hospitals
• Provides health coverage of Rs.5 lakhs per year on a family floater basis which means that it can be used by one or all members of the family
• Medical services of surgeries/treatments requiring hospitalization under 34 Specialties.
• All pre-existing diseases are covered from day one. It means health services are available right away, with  no waiting period for pre-existing conditions.
• MJPAY Beneficiary can avail cashless treatment in any Govt. or Pvt. Network hospital in State.
• Benefits of PMJAY scheme are portable across the country.
• Patient can avail treatment in emergency through intimation by telephone or email.

Here are the benefits of the MJPJAY yojana:

• The scheme mainly covers 971 surgical and therapeutic procedures while offering treatment for many health conditions.
• Beneficiaries receive continuous care with numerous follow-up health packages for ongoing medical requirements.
• Critical treatments, such as renal transplants, are covered up to ₹2.5 Lakh while providing specialized care for individuals and families.

Eligibility Criteria for the MJPJAY Scheme

The following are the eligibility criteria for the Mahatma Jyotirao Phule Jan Arogya Yojana:

• This scheme is available to families in districts identified as distressed by the Maharashtra government.
• Beneficiaries need an orange, white, or yellow ration card or an Annapurna/Antyodaya card.
• Farmers from districts like Amaravati, Aurangabad, Akola, etc., are eligible.
• Farmers need a white ration card and a 7/12 extract or certificate from the Patwari with the beneficiary's name.
• The scheme even provides health insurance for vulnerable families while ensuring financial protection and access to quality healthcare. 

Diseases and Treatments Covered under MJPJAY

MJPJAY yojana covers a wide variety of medical procedures, including:

General Surgery

Under general surgery, this scheme covers:

• ENT (Ear, Nose, Throat) surgery
• Ophthalmology (eye surgery)
• Gastroenterology (digestive system)
• Orthopedics (bone and joint surgery)
• Gynecology and Obstetrics (women's health and childbirth)
• Pediatric surgery (children's surgery)
• Surgical oncology (cancer surgery)
• Cardiac and cardiothoracic surgery (heart surgeries)
• Prosthetics (artificial limbs)
• Plastic surgery
• Neurosurgery (brain and nervous system surgery)

Advanced Medical Procedures

The scheme also covers treatments for:

• Endocrinology (hormonal issues)
• Medical oncology (cancer treatment)
• Polytrauma (multiple injuries)
• Critical care
• Genitourinary system (urinary and reproductive system)
• Nephrology (kidney care)
• Cardiology (heart conditions)
• Neurology (nervous system)
• Infectious diseases

Specialized Care Treatments

The MJPJAY card covers specialized care treatments such as:

• Radiation oncology (cancer treatment)
• Burns management
• Gastroenterology (digestive system)
• Dermatology (skin conditions)
• Rheumatology (joint and autoimmune diseases)
• Interventional radiology
• Pulmonology (lung diseases)

Note: General medicine treatments are also included in the scheme. 

How to Register for MJPJAY?

A person should follow these steps for MJPJAY registration online:

1. Visit the official website of MJPJAY and find the MJPJAY registration option online. 
2. Fill out a short form to create an account and use the credentials to MJPJAY login later.
3. Check if they qualify for the scheme by evaluating different factors such as family size and income.
4. If eligible, fill out the registration form with their personal and family details, including income.
5. Upload scanned copies of the required documents before submitting the form.
6. Review the application to ensure everything is correct, and click submit. 

Applicants will receive a confirmation email once their registration is complete. 

Documents Required for MJPJAY Application

Along with the ration card, an individual will require the following documents for verification:

●  PAN card/Voter ID/Aadhaar card/nationalized bank passbook with a photo
●  Driving license/school or college ID/passport
●  Handicap certificate (if applicable)
●  Tehsildar's stamp on the photograph
●  Any government-issued photo ID (from India or Maharashtra)
●  Government-issued senior citizen card
●  Freedom Fighter ID card

Note: If there is no photo of the newborn, parents can submit their photo with the child's birth certificate and their ration card.

How to File a Claim under the MJPJAY?

The process of filing a claim under the Mahatma Jyotirao Phule Jan Arogya Yojana is outlined below:

1. Visit the nearest general, district, women's, or network hospital and meet with an Aarogyamitra (health advisor) to start the application.
2. Receive a health referral card to present at the hospital for the recommended treatment.
3. The applicant can provide an orange/yellow card or an Annapurna card if they don't have a ration card.
4. After document verification, they will be admitted to the hospital for treatment.
5. The insurance company will send an e-authorization request, which MJPJAY will review.
6. After authorization, the individual will receive cashless treatment.
7. The hospital will then submit the original bills and documents to the insurer for claim processing. Once approved, the payment will be made to the hospital.
8. After discharge, the person can access free diagnostic services and consultations for up to 10 days at the network hospital.

The Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a significant step by the Maharashtra government to ensure healthcare access for low-income families. This scheme provides much-needed financial relief to vulnerable sections of society by offering cashless medical treatments for a wide variety of illnesses, including surgeries and critical care.

So, in case you or anyone you know is eligible for the MJPJAY Yojana benefits, this guide can help them take the right steps to gain health insurance coverage.