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MJPJAY: Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility, Benefits, Coverage

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The Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a transformative healthcare initiative introduced by the Government of Maharashtra. With a resolute aim of providing free and quality healthcare to the economically disadvantaged sections of society, this scheme has emerged as a lifeline for a significant number of people, particularly those who previously lacked access to essential medical services. By ensuring financial protection against high healthcare expenses, the MJPJAY offers a glimmer of hope and relief to vulnerable households in India. Let's delve into the Mahatma Jyotiba Phule scheme eligibility, process of application, coverage, exclusions, the scheme's notable features, and the hospital list.

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

The Government of Maharashtra launched the MJPJAY to make healthcare accessible to the poor and underprivileged sections of society. All expenses relating to surgical procedures, hospitalisation and consultations are covered up to the sum insured of Rs 1.5 lakh per annum. Beneficiaries can avail of cashless treatments up to the sum insured.

What is Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?

The scheme covers the following:

• As many as 971 surgical procedures/therapies and 121 follow-up procedures in 30 specialised packages

• About 132 procedures are reserved by the government to be performed only by empanelled government medical colleges or hospitals

• Up to Rs 2.5 lakh can be availed for a renal transplant operation

• After discharge, the beneficiary can claim expenses of consultations and medicines for up to 10 days from the date of being discharged

What is Not Covered?

• The MJPJAY scheme covers all healthcare expenses except the 131 planned procedures such as hernia, cholecystectomy, vaginal or abdominal hysterectomy, discectomy, and appendectomy. These procedures must be performed at empanelled government medical colleges and hospitals.

Features of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Here's a look at some features of Mahatma Jyotiba Phule Jan Arogya Yojana.

• The health insurance scheme offers a sum insured of up to Rs.1.5 lakh per year for each family.

• The treatment is completely cashless. The beneficiaries need not deposit anything during hospitalisation.

• The State Government of Maharashtra pays the premium of MJPJAY.

• This scheme can be taken as individual or family health insurance covering the entire family.

• There is no waiting period for pre-existing medical conditions.

• The beneficiaries can attend health camps conducted at government-empanelled hospitals.

Benefits of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY):

Several benefits are offered under the scheme:

• The health scheme provides financial coverage for 971 surgical and therapeutic procedures.

• Covers 121 types of follow-up procedures in 30 identified categories.

• There are about 132 procedures which have to be performed only at empanelled government medical colleges and hospitals.

• Beneficiaries can avail up to Rs 2.5 lakh for a renal transplant operation.

List of Diseases and Treatments Covered Under MJPJAY

Here are some procedures covered under the Mahatma Jyotiba Phule Jan Arogya Yojana disease list:

• Surgeries, such as General, ENT, Ophthalmology, Gastroenterology, Orthopaedic, Gynaecology and obstetrics, Paediatric, Surgical Oncology, Cardiac and Cardiothoracic, Prostheses, Plastic Surgery, and Neurosurgery

• Other procedures relating to Endocrinology, Medical Oncology. Polytrauma, Critical Care, Genitourinary System, Nephrology, Cardiology, Neurology, Infectious Diseases, Radiation Oncology, Burns, Gastroenterology, Dermatology, Rheumatology, Interventional Radiology, and Pulmonology

• General Medicine

Eligibility for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

The Mahatma Jyotiba Phule scheme eligibility criteria:

• Families must belong to the distressed districts identified by Maharashtra

• The beneficiary should have a white/orange/yellow ration card, Annapurna Card or Antyodaya Anna Yojana Card (AAY)

• Farmers from agriculturally distressed districts such as Amaravati, Akola, Aurangabad, Buldhana, Beed, Hingoli, Jalna, Nanded, Latur, Osmanabad, Parbhani, Wardha, Washim, and Yavatmal

• Farmers of the agriculturally distressed districts must have a white ration card, 7/12 extract, beneficiary name/family head or certificate from the respective Talathi or Patwari

How to Enrol in Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Scheme?

Here's a step-by-step guide on how to enrol in MJPJAY:

1. The beneficiary needs to approach the nearest district/network/women/general hospital and meet Arogyamitra to initiate the enrolment process or application.

2. If the beneficiary goes to a government healthcare facility, he/she will be given a referral card which can be shown to the network hospital for treatment. The preliminary diagnosis by the government doctors also has to be submitted.

3. The referral card can also be obtained by attending health camps organised by the network hospital.

4. The beneficiary, then, has to provide the referral card along with the orange/yellow ration card. If there's no ration card, the Antyodaya or Annapurna Card will also help.

5. After all the details are provided, the diagnosis and check-ups will start. On the basis of diagnosis, the beneficiary will be admitted to the network hospital.

6. An E-authorisation request will be mailed to the health insurance company. The MJPJAY will also review the request.

7. After the authorisation request is approved by the insurance company and MJPJAY (which is done within 24 hours), the beneficiary can avail of cashless treatment. In an emergency, the authorisation will be done immediately and marked as "EM".

8. All the documents, like original bills, test reports, discharge summary, etc., will be sent directly to the insurance provider for settlement of the claim.

9. Once the insurer approves the claim request, it will settle the bills directly with the hospital.

10. After discharge from the hospital, the beneficiary can avail of free consultations, medicines and lab tests for up to 10 days from the date of discharge.

Documents Required to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Apart from the ration card, the MJPJAY beneficiary needs to submit any one of the below KYC documents:

• Aadhaar Card

• PAN Card

• Driving License

• Voter ID card

• Passport

• Handicap Certificate

• Senior Citizen Card

• Bank passbook with photograph

• Marine Fishers ID card

• Défense ex-service card

• College or school ID

• Freedom Fighter ID card

• Any other photo ID proof issued by the Government of India/Government of Maharashtra.

To enrol a newborn for the scheme, if the child's name and photo are not available on the health card or ration card, the beneficiary can submit the baby's photo with either parent along with the ration card and birth certificate.

How to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana Card Online?

Here are the steps to apply for an MJPJAY card online:

1. Visit the official website of MJPJAY.

2. Click on New Registration on the homepage.

3. Fill in all the relevant details, attach scanned copies of the required documents and click on Submit.

4. Once you have been successfully registered, you can raise a claim whenever required.

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Application Form

To enrol on the MJPJAY scheme, the beneficiary needs to approach the nearby district/women/general/network hospital to initiate the application process. The health scheme has been launched to provide free access to health care to the poor and vulnerable sections of society, particularly those belonging to the APL and BPL families.

Claim Procedures of Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Here's the procedure to file claims under MJPJAY, which is quite simple:

1. The beneficiary has to get himself/herself diagnosed and admitted at a network hospital.

2. The network hospital will send a pre-authorisation request to the insurance provider.

3. As soon as the insurer approves the pre-authorisation request, treatment will begin. In case of emergencies, the hospital starts the treatment immediately.

4. After treatment, the network hospital will send the required documents like medical reports, bills and discharge summary to the insurer.

5. After the documents are verified and approved, the claims will be settled.

6. If the diagnosis is made in a non-network hospital, Arogyamitra will issue a referral card. This referral card must be shown at the network hospital to start the treatment.

Mahatma Jyotiba Phule Jan Arogya Yojana Hospital List

Here is the Mahatma Jyotiba Phule Jan Arogya Yojana hospital list:

Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) Toll-Free Number and Address

The toll-free helpline number and address of MJPJAY are:

Toll-Free Number: 1800-233-2200 / 155 388

Address:

Mahatma Jyotiba Phule Jan Arogya Yojana,
State Health Assurance Society,
ESIS Hospital Compound,
Ganpat Jadhav Marg,
Worli, Mumbai - 400018

Conclusion

The rising healthcare costs have necessitated the need to buy the best health insurance in India. To make sure low-income families are not left behind, the Government of Maharashtra launched Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) to enable them to access quality healthcare. Based on the eligibility, you can enrol yourself and your family and avail of the benefits. The scheme can be purchased by an individual or as family health insurance.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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