Mahatma Jyotirao Phule Jan Arogya Yojana
(MJPJAY)
Did you know? The second edition of the health index released by NITI Aayog revealed that Maharashtra is the third-best state in India in terms
of overall health performance! The state has considerably improved its healthcare facilities, considering its past ranks.
There are several initiatives behind this achievement, one of the most crucial of which is the Mahatma Jyotirao Phule Jan Arogya Yojana
(MJPJAY). This scheme is specially designed to assist people with low income with cashless health treatments and timely medical care. In fact,
this initiative covers 2.2 million families in Maharashtra.
If you do not know much about it, stay tuned till the end. This article will cover everything there is to know about MJPJAY in detail.
What is Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY)?
Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a health insurance initiative implemented by the government of Maharashtra. It was started on 2nd July 2012 with eight districts on a trial basis; then, it was further expanded to all over Maharashtra from 21st November 2013.
Under this scheme, beneficiaries, particularly economically weaker sections, can get cashless treatment for a wide range of diseases. MJPJAY is also an integrated programme covered under the Ayushman Bharat Yojana, aimed at expanding universal health coverage across India. It provides coverage of ₹ 1.5 lakh for families per year for medical expenses.
Objectives of Mahatma Jyotirao Phule Jan Arogya Yojana
The objective of this Ayushman Bharat scheme is to ensure healthcare for the most
vulnerable people. Key objectives include:
Key Features of MJPJAY
MJPJAY comes with various healthcare insurance benefits for people who belong to low-income
groups. Some of these benefits include:
1
Cashless Treatment
Under the scheme, beneficiaries can avail of cashless treatment for a wide range of diseases at impanelled hospitals. It covers pre-hospitalisation, hospitalisation, and post-hospitalisation costs for the treatments.
2
Wide Coverage
The initiative covers a wide range of diseases and treatments, including cancer, kidney failure, and cardiac treatments. It gives coverage of ₹ 1.5 lakhs per annum per family. Additionally, MJPJAY beneficiaries can avail treatment in private or government hospitals across the state. However, the other schemes, such as PMJAY, provide coverage of ₹ 5 lakh per annum per family.
3
Comprehensive Benefits
It covers 971 medical and surgical procedures for both rural and urban areas. The comprehensive benefits also include treatment for all the pre-existing conditions from day one. This also makes it similar to other medical insurance for senior citizens in India.
4
Dedicated Grievances Redressal
MJPJAY scheme is completely paperless and runs on dedicated portals. In fact, under this scheme, you also receive a helpline and grievance portals for assistance regarding queries.
Eligibility Criteria for MJPJAY
To enrol for the MJPJAY scheme, families must meet the following eligibility criteria:
Coverage Offered Under MJPJAY
The Mahatma Jyotirao Phule Jan Arogya Yojana provides coverage for Abha card benefits and the following:
Diseases and Treatments Covered by MJPJAY
MJPJAY covers a wide range of diseases and treatments. Some of them are:
Conditions Not Covered Under MJPJAY
You can check the official documents for conditions not covered under the initiative. However, some common conditions and treatments excluded from the MJPJAY scheme are:
Benefits of Enrolling in MJPJAY
There are several benefits of enrolling in MJPJAY. Some of them are:
1
Financial Security
The initiative provides you with financial security for your emergency and normal medical expenses. It offers you cashless healthcare services covering 971 surgery and treatment procedures.
Improved Access to Healthcare There is a long list of empanelled hospitals that are part of the initiative. This provides you with access to improved and specialised treatment options. You can avail yourself of advanced care from medical professionals across Maharashtra at high-quality hospitals.
2
Health Equity
The main focus of the MJPJAY initiative is to bridge the gap between the accessibility of quality healthcare services for rural and urban areas. The scheme caters to weaker sections which are below the poverty line and empowers them with better healthcare access. This makes it similar to other government initiatives, such as PMJAY insurance.
3
Cashless Medical Experience
Under this initiative, you do not have to pay any fees upfront for the treatment. You receive cashless treatment, and the hospital handles all the financial transactions with the insurance company. This also makes it similar to other schemes that provide health insurance for elderly in India .
How to Apply for MJPJAY
Do you meet all the eligibility criteria for MJPJAY but do not know how to apply for it? Just
follow the steps given below to register online:
Step 1
To initiate the process, you will need to meet the Aarogyamitra or health friend (representative of the scheme) at the nearest general/district/woman/network hospital or health camp.
Step 2
Following these, you will be given a health referral card that you will need to show at the network hospital for getting the recommended treatment.
Step 3
You will need a yellow or orange ration card with this health referral card. If a ration card is not available, you can also show an Abha card.
Step 4
Hospital admission and treatment will start post-verification.
Step 5
After this, you will get an e-authorisation request from the insurance company for review by the MJPJAY.
Step 6
Once the authorisation is done and the review is approved, the cashless treatment procedure will start.
Step 7
The hospital will share original hospital bills and documents with the insurance company for claim settlement. The payment will be made automatically to the hospital once the documents are reviewed and the claim is approved.
Step 8
You can also avail yourself of diagnostic services and free consultations 10 days after your discharge from the network hospital.
Documents Required for MJPJAY
Apart from the ration card, you might also need the following documents for KYC verification
for MJPJAY:
Empanelled Hospitals Under MJPJAY
There is a long list of empanelled hospitals that come under the MJPJAY initiative. You can
check the complete list here. Some of them are:
| Hospital Name | Location |
|---|---|
| Sahyadri Super Speciality Hospital | Latur |
| District Hospital Pune | Pune |
| Noble Hospital | Pune |
| Yashwantrao Chavan Memorial Hospital | Pune |
| Ch. Shivaji Maharaj Sarvopachar Rugnalaya Solapur | Solapur |
| Mahalaxmi Hrudayalaya Pvt. Ltd. (Shri Sai Cardiac Center) | Kolhapur |
| Super Speciality Hospital Nashik | Nashik |
| Institute of Urology | Dhule |
| Rashtriya Sant Tukdoji Maharaj Cancer Hospital & Research Centre | Nagpur |
| Prakash Kidney Care Clinic and Dialysis Centre | Thane |
How to Find an Empanelled Hospital
To locate an empanelled hospital for treatment near you, follow the following steps:
Step 1
Visit the official MJPJAY website.
Step 2
Use the search function by entering the district and speciality required.
Step 3
As an alternative approach, you can contact the toll-free helpline.
Claim Process for MJPJAY
The MJPJAY is a completely paperless process. This is what the normal claim process will look like for beneficiaries:
Pre-authorisation
It starts with you submitting your health card and documents like your Abha card, ID proof, and other necessary documents to the hospital.
Treatment Approval
The hospital will verify the case with the insurance company and send documents to MJPJAY for review.
Cashless Treatment
Once the review is approved, you can start receiving the cashless treatment and services.
Steps to File a Claim
If you want to file a claim for MJPJAY, simply follow the steps given below:
Step 1
If the diagnosis of a medical condition begins at the empanelled hospital, the insurance company sends the pre-authorisation form to start your treatment.
Step 2
If the medical condition is diagnosed at a non-empanelled hospital, then the arogyamitra will provide you with a health card to start the treatment at an empanelled hospital.
Step 3
You will need a yellow or orange ration card with this health referral card. If a ration card is not available, you can also show an Abha card.
Step 4
Upon completion of treatment/surgery, the hospital will send original bills, documents, medical reports, diagnostic reports, and discharge summaries to the insurer.
Step 5
The claim will be approved, and you can also avail of post-hospitalisation services after 10 days of your discharge.
Step 6
The insurance company will settle the claim within around 15 working days of receiving all the necessary claim documents from the network hospital.
Conclusion
The Mahatma Jyotirao Phule Jan Argoya Yojana (MJPJAY) is an initiative that brings hope to millions of people in Maharashtra for getting better medical facilities. It not only provides people access to quality healthcare but also gives them financial security for their unseen medical needs. If you are someone from Maharashtra and have not yet applied for the MJPJAY scheme, take the first step today and apply to ensure better healthcare for you and your loved ones.
