Mahatma Jyotiba Phule Jan Arogya Yojana

Mahatma Jyotiba Phule Jan Arogya Yojana

Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Jyotiba Phule Jan Arogya Yojana is a scheme backed by the Maharashtra State Government. It was launched with the aim to offer health insurance benefits to individuals and families in households that are below and close to the poverty line. Earlier named as the Rajiv Gandhi Jeevandayee Arogya Yojana, it provides free medical access and care to economically challenged people in the State of Maharashtra through various government hospitals for numerous surgeries, diseases and therapies. This article talks about the Mahatma Jyotiba Phule Jan Arogya Yojana and the multiple aspects of the same.

Overview

The State Government of Maharashtra inaugurated the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in order to improve the access to healthcare for individuals and families belonging to Below Poverty Line (BPL) and Above Poverty Line (APL) households. On the 1st of April, 2017, the Scheme was effectively renamed to the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). This health insurance plan is fitting for families with an annual income below the threshold of INR 1 Lakh. The Maharashtra State Government pays INR 333 as premium for an insurance cover of up to INR 1.5 Lakhs. An individual or an entire family may avail the total insurance coverage on a floater basis.

Insured members are offered the facility of cashless hospitalisation at any of the hospitals under the Scheme’s network. There is no waiting period applicable for pre-existing covers. Renal Transplant procedures are covered up to INR 2.5 Lakhs as the immunosuppressive therapy is to be carried on for a year or so. This Scheme may be availed by individuals who have either of the two cards:

  • Orange Ration Card for individuals and families Above Poverty Line
  • Yellow Ration Card for individuals and Below Poverty Line

Mahatma Jyotiba Phule Jan Arogya Yojana provides for over 972 surgeries and treatments along with 121 follow-up packages in 30 various specialised categories such as cardiology, neurology, ENT surgery and more. For 10 days after the date of discharge, The network hospitals will offer free follow-up consultations, medicines, and diagnostics post 10 days from the date of discharge as indicated by the Scheme. The insurance company providing this health cover shall ensure that a minimum of one free medical camp is organised each week by each network hospital.

Eligibility

The following are the eligibility as per their role in the Mahatma Jyotiba Phule Jan Arogya Yojana.

For Individuals and Family

Every family or individuals from families who are below the poverty line or merely above the poverty line are eligible to avail this Scheme. Therefore, individuals/ families who have either of the Orange Ration Card or the Yellow Ration Card may be a part of this scheme.

For Agencies

  • An agency must be registered under the Companies Act of 1956.
  • An agency must have a valid Other Service Providers License to offer services at the said location.
  • An agency must have an average annual turnover that crosses the threshold of INR 15 Crores in the previous 4 financial years.
  • An agency must have a positive net worth.

For Hospitals

  • A hospital of the Scheme’s network is required to have a minimum of 50 inpatient beds with appropriate space and enough staff.
  • A hospital is required to have individual general wards for males and females.

Documents Required

In order to avail the benefits of the Mahatma Jyotiba Phule Jan Arogya Yojana, the most crucial document that has to be produced is the Yellow or Orange Ration Card along with relevant Aadhaar Card. If the individual does not possess an Aadhaar Card or Aadhaar Number, the individual may produce either of the following photo identities provided by the Government of India as proof.

  • Voter’s Identity Card
  • Driving License
  • School Identity Card
  • PAN Card
  • Other identity cards issued by an authorized officer.

Benefits and Features

There are several benefits that come with the Scheme in the form of 971 procedures. Out of these many procedures, 131 of them are performed solely in government hospitals. However, illnesses that can be treated in ordinary hospitals or primary level health centres will not be covered as a part of this Scheme. The following are the many features of the Mahatma Jyotiba Phule Jan Arogya Yojana.

  • Members of this scheme will be able to avail the benefits on a floater basis. This means that a particular individual may avail insurance of INR 1.5 Lakhs in the family or by the entire family.
  • Hospitals that are a part of the Scheme’s network will be required to offer cashless services. Moreover, deposits are not required to be paid by the insured.
  • There will be no exclusions or pre-existing disease waiting period that will be applicable in this Scheme.
  • Medical service will also be provided at individual private hospitals that are listed in the network of the Scheme.
  • Network hospitals are also required to offer follow-up consultation sessions free of cost.
  • Individuals with the relevant health card will be offered kidney transplants free of cost.
  • A minimum of one free medical camp at each hospital under the Scheme’s network will be conducted every month.

Coverage

The total number of procedures that are included in the Mahatma Jyotiba Phule Jan Arogya Yojana can be segregated into 30 categories. A few are as follows:

  • General Surgery
  • Plastic Surgery
  • ENT Surgery
  • Ophthalmology Surgery
  • Paediatric Surgery
  • Neurosurgery
  • Radiation Surgery
  • Burns
  • Critical Care
  • General Medicine
  • Infectious Diseases
  • Cardiology
  • Neurology
CoveredNot Covered
Lobar Pneumonia, Aspiration Pneumonia, Bronchopneumonia, Pneumothorax, Pneumoconiosis, Pneumonectomy. PneumoniaPneumonia
Numerous medical and surgical gastroenterology related proceduresDiarrhoea
Diabetic retinopathy, Uncontrolled diabetes with infectious emergencies, Diabetic ketoacidosisDiabetes
Snakebite with ventilation supportSnakebite without ventilation support
Diaphragmatic Hernia, Appendicular PerforationHernia and Appendicitis (unless it is an emergency).

Registration Process

The following is the enrolment process for the Mahatma Jyotiba Phule Jan Arogya Yojana.

  • Families and individuals may approach a hospital in the Scheme’s network that is nearest to their area. If a customer visits a facility that is not within the Scheme’s network, then a referral card after initial diagnosis by the doctor should be submitted to the network hospital. The patient’s medical information relevant to the visit will be captured in the Scheme’s database.
  • Customers will then required to provide the referral card along with their yellow or orange ration card. An Antyodaya or Annapurna Card may also be produced instead of the ration card as such. Post submitting their documents, their diagnosis and check-ups will be conducted. Such medical information will be recorded in the relevant database.
  • The patient will then be admitted, based on the diagnosis, in the network hospital. A digital pre-authorisation request will be forwarded to the insurance company. The Rajiv Gandhi Arogya Yojana Society will even review the same.
  • Specialists and expert doctors of the Mahatma Jyotiba Phule Jan Arogya Yojana along with the insurance company, will review and examine the request. If the necessary conditions are met, the case will be approved. In cases of emergency, this will be executed immediately and will have the validity of a week.
  • Cashless treatment and surgery will be offered, and relevant information and details will be documented.
  • All the essential bills, reports concerning the procedures will be forwarded to the insurer. This is done to claim settlement post procuring all the required signatures. Discharge and follow-up information of the patient will be available on the Mahatma Jyotiba Phule Jan Arogya Yojana portal.
  • Every network hospital is required to offer free follow-up consultations, medicines and diagnostics as indicated by the Scheme that lasts for 10 days from the date of discharging the relevant patient.

Online Claim Settlements

The Mahatma Jyotiba Phule Jan Arogya Yojana scheme works through the effective use of IT-based solutions in order to widen the reach to more beneficiaries. The insurance company is required to settle the claims made by network hospitals within 15 working days after receiving the duly-filled claim form and other supporting documentation. Additional documents may include medical reports, diagnosis report, discharge summary, prescriptions, doctor’s written opinion, and more.

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