Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Phule medical scheme was launched by the Maharashtra State Government with the objective of offering free and quality healthcare for low-income families. This scheme was initially launched under the moniker “Rajiv Gandhi Jeevandayee Arogya Yojana” in July 2012.

Under the MJPJAY, which is essentially a medical insurance plan, individuals who have been socioeconomically marginalised can access free medical care. This includes speciality services that require hospitalisation, surgeries, as well as therapies via an identified network of medical professionals.

The MJPJAY’s health insurance provides coverage to take care of all healthcare expenses during the beneficiary’s hospitalisation with a sum assured of ₹1,50,000 per annum for the family.

An important benefit of this medical insurance plan is that it enables cashless hospitalisation, and the ₹1,50,000 annual coverage can be availed of by the family or an individual member.

The MJPJAY coverage is fairly inclusive and secures the policyholder against 971 surgeries, procedures, and therapies. In addition to this, the plan comprises 121 follow-up packages in 30 specialised categories, including:

Cardiac and cardiothoracic surgery, ophthalmology surgery, orthopaedic surgery and procedures, gynaecology and obstetrics surgery, paediatric surgery, ENT surgery, radiation surgery, general surgery, etc.

As many as 132 procedures have been reserved by the government to be performed by either government medical colleges or empanelled government hospitals.

For complex medical requirements such as renal transplants, the upper limit has been set at ₹2,50,000.

The post-hospitalisation care, particularly with regard to consultations and medicines, is covered for up to 10 days from the date of discharge.

Government-Funded Health Insurance: The coverage for the medical insurance plan as well as the premium amount are both taken care of by the government on behalf of the policyholder.

Annual Coverage Limit: The amount of sum assured per family is ₹1,50,000.

Flexible Usage Options: The policy can be availed of by an individual member as well as the family on a floater basis.

Comprehensive Medical Coverage: The plan offers wholesome protection with coverage for surgeries, diagnostics, medications, follow-up consultations, and treatment.

Inclusive Coverage for Pre-Existing Conditions: All pre-existing health conditions are secured from the first day of the coverage.

Wide Hospital Network: In addition to an extensive list of government-empanelled hospitals, the scheme also includes access to several private hospitals.

Community Health Services: Policyholders also have free access to health camps conducted at government-empanelled hospitals.

Broad Coverage of Surgeries/Therapies/Procedures: The policy secures the insured member against a sweeping 971 types of surgeries/therapies/procedures and 121 types of follow-up procedures in as many as 30 specialised categories.

Government Reserved Procedures: The government-reserved procedures will exclusively be conducted by empanelled government hospitals and medical colleges.

Renal Transplant Upper Ceiling: The maximum coverage limit is set at ₹2,50,000 for renal transplants.

Considering the benefits, it is evident that the policy will be highly advantageous for the underprivileged and vulnerable sections of society to access quality healthcare. It enables them to prioritise their healthcare needs without worrying about incurring debt to take care of the hospitalisation bills.

Having adequately analysed the features and benefits of the MJPJAY, let’s now take a look at the Mahatma Jyotiba Phule Jan Arogya Yojana disease list to better understand the scope of the coverage.

For every health insurance coverage, an individual must be aware of both the policy exclusions as well as the inclusions so they are not unpleasantly surprised at trying times. Here are some of the illnesses and treatments that are covered under the MJPJAY plan:

Surgical Procedures:

General Surgery

Ophthalmology

ENT

Gastroenterology

Gynaecology and obstetrics

Orthopaedic

Paediatric

Cardiac and cardiothoracic

Surgical oncology

Prostheses

Neurosurgery

Plastic surgery

Other Procedures Involving the Following:

Endocrinology

Medical oncology

Polytrauma

Critical care

Genitourinary system

Nephrology

Cardiology

Neurology

Infectious disease

Radiation oncology

Burns

Gastroenterology

Dermatology

Rheumatology

Interventional radiology

Pulmonology

General Medicine Expenses

In addition to the aforementioned, the policy takes care of all pre-existing health ailments of the policyholders so they can get treatment for their existing health conditions under the MJPJAY scheme.

The MJPJAY policy offers coverage for all acceptable medicare aside from the planned 131 procedures. These include hernia, vaginal or abdominal hysterectomy, discectomy, appendectomy, cholecystectomy, etc. All these shall exclusively be performed at either government medical colleges or government-empanelled hospitals.

Category A

The Mahatma Jyotiba Phule Jan Arogya Yojana card is provided to families holding a Yellow ration card (offered to families falling under the below poverty line category), Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange ration card (annual income up to ₹1 lakh).

These cards are issued by the Civil Supplies Department of the Government of Maharashtra for 36 districts in the state.

Category B

Families holding the White ration card hailing from any of the 14 agriculturally distressed districts of Maharashtra. These are Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Wardha, Osmanabad, Amravati, Buldhana, Washim, Yavatmal, and Akola.

Category C

There are three sets of individuals who can benefit from the MJPJAY scheme in category C. These are:

Children from government orphanages, students from the Government Ashram Shala, female residents of Government Mahila Ashram, and senior citizens from government old age homes.

Journalists and their dependent family members approved by the Directorate General of Information and Public Relations (DGIPR.)

Construction labourers and their families who are registered members of the Maharashtra Building and Other Construction Worker Welfare Board.

Members belonging to any of the aforementioned categories are eligible for the Mahatma Jyotiba Phule Jan Arogya Yojana card. Let us now discover the application process to avail of the MJPJAY scheme.

The application process for the MJPJAY scheme is seamless, as the primary goal of the policy is to make good healthcare accessible to the economically disadvantaged section of society. For the Mahatma Jyotiba Phule Jan Arogya Yojana registration, individuals can simply approach nearby General, Women, District or Network hospitals and enrol themselves to avail of the policy.

For the Mahatma Jyotiba Phule Jan Arogya Yojana online application, a representative of the healthcare policy or the “Arogyamitra” can assist with the procurement of the card.

Aside from the Yellow/White/Orange ration card, the following documents need to be shared for KYC for the MJPJAY policy:

Pan Card

Voter Id

Driving Licence

School/College Id

Passport

Freedom Fighter ID card

Health Card of RGJAY / MJPJAY

Handicap Certificate

Nationalised Bank Passbook with Photo

Senior citizen card issued by the Central Government or State Government

Defence ex-servicemen card issued by Sainik Board

Marine Fishery Identity card (Issued by Ministry of Agriculture / Fisheries Department Government of Maharashtra).

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

For instances involving a newborn baby, where the name and photograph of the child have not yet been mentioned on a valid Yellow or Orange ration card, a photograph of the child with either one of the parents needs to be submitted. Along with this, the parents will also have to submit their White/Orange/Yellow ration card and the birth certificate of their child.

Access to quality healthcare services is a fundamental human right and the cornerstone of a just society. With schemes such as the MJPJAY, the government is taking conscious steps to ensure medical facilities trickle down to every member of society regardless of their economic status.

While the MJPJAY scheme extends medical facilities to the weaker section of society, you can avail of a health insurance plan for your family and yourself if you are not covered under the scheme.

With Tata AIG, you can choose between various individual and family medical insurance plans and avail of multiple benefits of health insurance, like cashless hospitalisation, tax benefits, and pre and post-hospitalisation coverage.