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Mahatma Jyotiba Phule Jan Arogya Yojana

  • Author :
  • TATA AIG Team
  • Published on :
  • 18/07/2022

Providing quality healthcare to the citizens should be a priority for any government. Many state and central governments have launched healthcare schemes to meet the goal of affordable healthcare for all. Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) is a medical insurance scheme launched by the Maharashtra government. The Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), was launched in 2012 on a pilot basis in eight districts of Maharashtra. The scheme was later introduced in every district.

More About Mahatma Jyotiba Phule Jan Arogya Yojana

The MJPJAY scheme is the Maharashtra Government’s health insurance policy aimed at providing free of cost and quality healthcare access to the underprivileged sections of society. Individuals below the poverty line or marginally above the poverty line can access the benefits. The features of the Mahatma Jyotiba Phule scheme are as follows:

  • With an identified network of hospitals, the scheme provides free-of-cost healthcare facilities up to the sum of Rs.1.5 lakhs per family annually. The scheme acts as individual health insurance and a family floater plan.

  • The policy limit is increased to Rs. 2.5 lakhs per family per year in case of renal transplant.

  • There is no need to pay cash at the network hospitals as the claims are settled by the insurance company. This makes the scheme cashless and hassle-free.

  • The health insurance coverage and premium costs are borne by the state government of Maharashtra.

  • The scheme involves zero waiting period in case of pre-existing illnesses like diabetes, hypertension, etc.

  • Along with government hospitals, the cashless network includes several private hospitals.

  • The website of the scheme has a list of network hospitals. The eligible individuals can join the scheme by applying to a nearby network healthcare provider.

  • The Mahatma Phule Yojana includes several healthcare facilities such as surgeries, diagnostics, treatment, medicines and consultations.

  • Individuals can also access one free medical camp in a year at government-empanelled hospitals.

Eligibility Criteria

The medical insurance scheme has the following eligibility criteria:

  • The applicant must be a resident of Maharashtra.

  • The scheme provides health insurance coverage to individuals having an income less than Rs. 1 lakh per annum.

  • The beneficiary should hold a yellow, orange, or white ration card. The beneficiaries of Antyodaya Anna Yojana and Annapurna Yojana are also eligible under the scheme.

  • The families who belong to identified distressed districts of Maharashtra.

  • Farmers who belong to identified distressed districts of Maharashtra.

  • The immediate family of the policyholder is covered under the scheme.

  • There is no age criterion to enrol in the scheme.

Mahatma Jyotiba Phule Jan Arogya Yojana Registration

The procedure to register for MJPJAY is as follows:

  • Visit the official website of the scheme.

  • Click “New Registration”, and you will be redirected to the MJPJAY application form.

  • You need to fill out the form with the correct details.

  • You need to attach the scanned copies of the required documents and click “submit”.

  • After submitting the application form, you will be registered under the scheme, after which you can raise a claim in need of a medical emergency.

  • In case of offline registration, you need to visit the nearest network hospital where the Arogya Mitra will initiate the registration.

Raising a Claim Under the Scheme

The beneficiary has to go through the following process to raise a claim in a network hospital:

  • Visit the nearest network hospital for health check-ups and diagnosis.

  • If you are not diagnosed at the network hospital, a referral card is provided by the government facility along with a diagnosis. You can show these at the network hospital.

  • You can also get the referral card at the health camps conducted by the network hospitals.

  • An e-authorisation request is then sent to the insurance company. If it is approved, cashless healthcare can be availed at the hospital. The e-authorisation request is delayed in case of emergency treatments.

  • Once you get the treatment, the bills and other documents are forwarded to the insurance company for claim settlement.

  • After reviewing the documents, the insurance provider settles all claims.

  • Moreover, you can get free medicines, consultations, and diagnostics up to 10 days after discharge.

Documents to Apply for the Mahatma Jyotiba Phule Yojana Scheme

Apart from the ration cards, any of the below-mentioned KYC documents should be submitted for identification:

  • Aadhar card

  • Pan card

  • Voter identity card

  • Driving licence

  • Nationalised bank passbook with photo ID

  • Handicap certificate

  • School or college ID

  • Passport

  • Freedom fighter ID card

  • Health card of RGJAY or MJPJAY

  • Senior citizen cards issued by the central or the state government

  • Defence ex-service card by Sainik board

  • Any photo identity proof issued by the state or the central government

  • Marine fishers’ identity card

  • In the case of an urban area, the government local body or tahsildar’s stamp and signature on the applicant’s photo

  • In the case of rural areas, the applicant’s photograph with the tahsildar’s stamp and signature

  • In the case of a newborn, photo of the child with either parent and the child’s birth certificate

Coverage Offered Under MJPJAY

Surgical procedures Other medical procedures
General Endocrinology
Gastroenterology Cardiology
Gastroenterology Cardiology
Orthopaedic Neurology
ENT Critical care
Ophthalmology Nephrology
Paediatric Burns
Cardiac and cardiothoracic Radation Oncology
Plastic Surgery Medical Oncology
Neurosurgery Dermatology
Prostheses Rheumatology
Surgical Oncology Interventional Radiology
Gynaecology and obstetrics Pulmonology
Infectious diseases
Genitourinary system
Polytrauma

Exclusions Under the Scheme

The MJPJAY covers most of the medical procedures except 131 procedures. Some of the excluded procedures are vaginal or abdominal hysterectomy, discectomy, hernia, etc. which are to be performed only at government hospitals or medical colleges.

Conclusion

Quality healthcare is the basic right of all. However, buying a health insurance plan is not affordable for everyone. The Mahatma Phule Jan Arogya Yojana is a perfect scheme for the underprivileged sections. Now that you know the eligibility criteria, enrolment procedure and claim process of the scheme, you should register yourself if you are eligible. If not eligible for government schemes, then you should consider buying a health insurance plan for yourself at the earliest.

Tata AIG gives you a range of health insurance plans that take care of your health costs in times of need. To make the optimum choice, you can compare health insurance plans and choose the one that suits you best. With rising health costs, health insurance has become essential in recent times. So, buy a health insurance policy now!

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