MJPJAY | Mahatma Jyotirao Phule Jan Arogya Yojana

Table of Contents

“Mahatma Jyotirao Phule Jan Arogya Yojana” (MJPJAY) is a health insurance scheme implemented by the government of Maharashtra, India. The scheme was formally also known as Rajiv Gandhi Jeevandayee Arogya Yojana.

The main objective of this scheme is to provide financial assistance and quality healthcare to the economically vulnerable sections of society in Maharashtra. It aims to cover the medical expenses of eligible families for certain specified treatments and procedures.

Key features of the Mahatma Jyotirao Phule Jan Arogya Yojana(MJPJAY) include:

Coverage: The scheme covers various medical and surgical treatments for beneficiaries at empanelled hospitals.
Eligibility: Eligibility is primarily based on socioeconomic criteria. Families falling under specific income categories are eligible for the scheme.
Cashless Transactions: Under this scheme, beneficiaries can avail of cashless treatment at network hospitals.
Empanelled Hospitals: A network of government and private hospitals are empanelled to provide services to beneficiaries.
Identification: Beneficiary families are issued a “Rashtriya Swasthya Bima Yojana” (RSBY) card or an “MJPJAY” card to avail of the benefits.

The objective of this is to provide cashless quality medical care to beneficiaries under the scheme for catastrophic illnesses requiring hospitalisation for surgeries and therapies under identified speciality services through a network of healthcare providers.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched by the Government of India on 23rd September 2018. AB-PMJAY was launched in Maharashtra in integration with Mahatma Jyotirao Phule Jan Arogya Yojna and was implemented in mixed Insurance and Assurance Mode.

The Integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) were launched in the state on 1st April 2020. United India Insurance Company Limited (a Public sector Undertaking Company) is providing health insurance coverage to beneficiaries under the insurance mode and the State Health Assurance Society provides coverage in assurance mode.

Mahatma Jyotirao Phule Jan Arogya Yojana is fully funded by the Government of Maharashtra. Pradhan Mantri Jan Arogya Yojana is jointly funded by the Government of India and the Government of Maharashtra in a ratio of 60:40.

What is Covered Under the MJPJAY?

MJPJAY beneficiary gets the benefit of 996 Medical and Surgical procedures with 121 follow-up procedures.

Surgeries: The scheme covers the cost of various surgeries, including cardiac surgeries, neurosurgeries, cancer surgeries, organ transplants, etc.
Medical Treatments: It includes coverage for medical treatments such as chemotherapy, radiotherapy, dialysis, etc.
Maternity Services: MJPJAY provides coverage for maternity services, including normal delivery and C-sections.
Neonatal Care: The scheme extends coverage for neonatal intensive care and related treatments.
Pre-Existing Diseases: In certain cases, pre-existing diseases may also be covered, subject to scheme guidelines.
Hospitalisation Expenses: The expenses related to hospitalisation, room charges, and other medical facilities during the treatment period are typically covered.
Follow-up Care: The scheme may cover post-operative follow-up care and treatments.

Sr.No.	Specialised Category
1	Burns
2	Cardiology
3	Cardiovascular and Thoracic surgery
4	Critical Care
5	Dermatology
6	Endocrinology
7	ENT surgery
8	General Medicine
9	General Surgery
10	Haematology
11	Infectious diseases
12	Interventional Radiology
13	Medical Gastroenterology
14	Medical Oncology
15	Neonatal and Paediatric Medical Management
16	Nephrology
17	Neurology
18	Neurosurgery
19	Obstetrics and Gynaecology
20	Ophthalmology
21	Orthopaedics
22	Paediatric Surgery
23	Paediatric Cancer
24	Plastic Surgery
25	Polytrauma
26	Prosthesis and Orthosis
27	Pulmonology
28	Radiation Oncology
29	Rheumatology
30	Surgical Gastroenterology
31	Surgical Oncology
32	Urology (Genitourinary Surgery)
33	Mental disorders
34	Oral and Maxillofacial Surgery

It’s important to emphasise that the coverage and benefits can vary, and there might be specific limitations, exclusions, and conditions under the MJPJAY. The eligible treatments and procedures are generally listed in the official scheme documents or on the official website of the Maharashtra government’s health department.

Features and Benefits

Here are some of the key features and benefits of the scheme:

Health Insurance Coverage: MJPJAY provides 1.5 lakh health insurance coverage every year for the entire family. The scheme aims to reduce the financial burden of medical expenses for eligible beneficiaries.
Cashless Treatment: Under the MJPJAY, beneficiaries can avail of cashless treatment at empanelled hospitals. They do not need to pay upfront for the covered treatments; the expenses are directly settled between the hospital and the scheme authorities.
Extensive Network of Hospitals: The scheme has a network of government and private hospitals empanelled to provide medical services to beneficiaries. These hospitals are equipped to provide quality healthcare services.
Comprehensive Treatment Coverage: The MJPJAY covers a wide range of medical treatments, including consultations, diagnostics, treatment, surgeries & medications. It aims to cover various critical illnesses and procedures.
No Age Limit: Unlike some other health insurance schemes, the MJPJAY does not have an upper age limit for beneficiaries. It covers individuals of all age groups who meet the eligibility criteria.
Family Coverage: The scheme covers the entire family, including the primary beneficiary, spouse, and dependent children. The coverage extends to all eligible family members under the same policy.
Pre-Existing Diseases: In certain cases, the MJPJAY may cover pre-existing diseases, subject to scheme guidelines. This provides a significant benefit to individuals with existing health conditions.
Easy Access to Healthcare: By providing financial support and free check-ups, the MJPJAY ensures that eligible beneficiaries have easy access to healthcare facilities when needed.

Eligibility Criteria

The eligibility criteria for the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) or the Maharashtra Health Scheme can vary based on specific categories of beneficiaries. The scheme primarily targets economically vulnerable families in Maharashtra and aims to provide them with access to quality healthcare.

Here are the general eligibility criteria for MJPJAY:

Residence: The primary requirement is that the beneficiary must be a resident of the state of Maharashtra. The scheme applies only to the residents of Maharashtra. Families that fall in the classified identified distressed districts of Maharashtra.
Socioeconomic Criteria: The eligibility is determined based on socioeconomic categories. Families falling under specific income categories are eligible for the scheme. The income criteria may vary from time to time, and different categories may have different income ceilings.
Occupation-Based Eligibility: The scheme also extends coverage to certain occupational categories, such as farmers, unorganised workers, construction workers, etc., regardless of their income.

Families with a yellow, orange and white ration card from the following districts are eligible-

Washim, Yavatmal, Parbhani, Wardha, Osmanabad, Nanded, Latur, Jalna, Beed, Hingoli, Buldhana, Akola, Aurangabad & Amravati.

Categories	Description of Beneficiaries
Category A	All eligible families shall be identified with valid Yellow, Orange, Antyodaya, and Annapurna ration cards (irrespective of the date of issue of the Ration Card or the inclusion of the beneficiary’s name therein) coupled with any Photo ID proof (as finalised by the Society).
Category B	Eligibility for farmers from 14 agriculturally distressed districts of Maharashtra will be decided based on a white ration card with 7/12 extract bearing the name of the beneficiary/head of the family or certificate from the nearest Revenue Officer stating that the beneficiary is a farmer or a family member of a farmer with valid photo ID proof of the beneficiary.
Category C	The eligibility of beneficiaries shall be decided based on any identity card/health card or any other identification mechanism as decided by the State Health Assurance Society (SHAS).

How To Apply For Mjpjay

For Mjpjay Registration or to get the Mahatma Jyotirao Phule Jan Arogya Yojana card, the applicant needs to approach the nearby General, Women/District/Network hospital. Arogyamitra, who is the representative of the scheme, shall facilitate getting the health card.

For Mjpjay Online Application these steps need to be followed-

Step 1: Visit the official website of Mahatma Jyotirao Phule Jan Arogya Yojana at www.jeevandayee.gov.in.

Step 2: On the homepage, click on the “New Registration” option.

Step 3: It will be directed to the application form page. Fill out the form with all the relevant details, and scan and upload the required certificates.

Step 4: Provide the necessary information, including the applicant’s name, father/husband’s name, date of birth, gender, and other relevant details. Upload the required documents as instructed.

Step 5: Once the form has been completed and the documents are uploaded, click on the “Submit” button to finalise the application and complete the enrollment process.

Documents Required

Under PMJAY, members from families registered under the Social, Economic and Caste Census, 2011 (SECC) are eligible for getting benefits in all empanelled hospitals by showing computerised e-cards and photo identity cards. Beneficiaries of PMJAY from any state having an e-card and photo identity proof can avail of treatment at any empanelled hospital of any other state.

The applicants need to submit the following documents along with the list of valid Photo Id proof-

1. Aadhaar Card / Aadhaar Registration Slip with a photo of the beneficiary. Aadhaar Card would be insisted upon as an identification document and in the absence of an Aadhaar card/number; any document which is accepted for issuance of an Aadhaar card will also be accepted.
2. Pan Card
3. Voter Id
4. Driving License
5. School/College Id
6. Passport
7. Freedom Fighter ID Card
8. Health Card of RGJAY / MJPJAY
9. Handicap Certificate
10. Nationalised Bank Passbook with Photo
11. Senior citizen card issued by Central Government or State Government
12. Defense ex-servicemen card issued by Sainik Board
13. Marine Fishery Identity card (Issued by Ministry of Agriculture / Fisheries Department Government of Maharashtra).
14. Any photo ID proof issued by the Government of Maharashtra/ Government of India

Claim Procedures

The claim procedures for the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) or the Maharashtra Health Scheme generally involve the following steps:

Hospitalisation: If the applicant or a family member covered under MJPJAY requires hospitalisation for a covered treatment or procedure, they should visit an empanelled hospital authorised under the MJPJAY scheme.
Verification of Eligibility: At the hospital, the patient’s eligibility for MJPJAY will be verified using the MJPJAY card or unique identification number issued during enrollment. The hospital will also verify that the treatment or procedure is covered under the scheme.
Pre-Authorisation: For certain high-cost treatments or procedures, the hospital may need to obtain pre-authorisation from the MJPJAY authorities before proceeding with the treatment. The hospital will submit the necessary medical documents and treatment details to seek pre-authorisation.
Post-Treatment Formalities: After the completion of the treatment, the hospital will prepare and submit the necessary claim documents and bills to the MJPJAY authorities for claim reimbursement.
Claim Processing: The MJPJAY authorities will review the submitted claim documents and verify the treatment details. They will assess the claim’s validity and check whether it complies with the scheme’s guidelines.
Claim Settlement: Upon approval, the eligible amount will be reimbursed to the empanelled hospital for the covered treatment or procedure. The reimbursement will be made by the MJPJAY authorities.

Hospital List

The Mjpjay Hospital List is divided by district and can be found on the official website.

The empanelled Hospitals under the Scheme include both Government and Private hospitals. Government Hospitals include Hospitals from Public Health Department, Medical Education and research department, Hospitals from Municipal Corporations and Municipality. The maximum number of Government and Private Hospitals will be 1000.

Government and Private Hospitals, both multi-speciality and single-speciality, can be empanelled as per the requirement and directions of the Coordination Empanelment and Disciplinary Committee chaired by the Chief Executive Officer of the State Health Assurance Society. For multi-speciality Private hospitals, there are criteria of a minimum of 30 beds with ICU (with certain relaxations), while for single-speciality hospitals 10 beds and other criteria shall be applicable.

MJPJAY Toll-Free Number and Address

Mjpjay Contact Number and address are below –

The ESIC Hospital, Third Floor
Ganpat Jadhav Marg, Near Worli Naka
Worli, Mumbai 400018
Toll-Free: 18002332200

Conclusion

In conclusion, the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a significant healthcare initiative implemented by the government of Maharashtra, India. The scheme aims to provide financial assistance and quality healthcare to economically vulnerable families across the state. By offering cashless treatment for various medical procedures and treatments, MJPJAY helps alleviate the burden of medical expenses on beneficiaries, especially during critical illnesses and emergencies.

The MJPJAY’s key features, such as an extensive network of empanelled hospitals, coverage for a wide range of treatments, no upper age limit for beneficiaries, and family coverage, make it a comprehensive and inclusive healthcare scheme. The enrollment process allows eligible individuals to avail themselves of the benefits by meeting specific socioeconomic criteria and submitting necessary documents.

Moreover, MJPJAY’s claim procedures streamline the reimbursement process, ensuring that beneficiaries receive the financial support required for their medical treatments promptly.

Ketto Crowdfunding

Ketto is a crowdfunding platform that aims to bring donors together through a common portal which is easy to access. The goal is to collect funds for those in need of medical assistance. Ketto acts as a medium that assists in raising money for healthcare across India.

To do so one should begin by creating an account on their website. Once logged in, click on “Start a Fundraiser” and provide details about the medical emergency, including the patient’s name, condition, required treatment, and other relevant information. Set a realistic fundraising goal that covers the expenses, and upload compelling images and videos related to the situation. Share the campaign through social media, email, and personal networks to reach a wider audience. Regularly update the campaign page with progress reports and milestones. Keep supporters informed about the patient’s progress and express gratitude for their contributions.