Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility Coverage and More

MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana)

Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a flagship health insurance scheme launched by the Government of Maharashtra to offer free, quality, critical cashless healthcare to low-income families.

The MJPJAY scheme is named after Jyotirao Phule, a Maharashtrian writer and social reformer who lived in the 19th century and who worked for the equality of all people, especially women and poor labourers.

What is MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana)

The MJPJAY is a health insurance scheme aimed at the poorer sections of society, run-on lines similar to the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) run by the Government of India.

The PJMJAY offers end-to-end cashless healthcare services for designated diseases through a service provider network comprising hospitals run by both the public and private sectors.

While the AB-PMJAY is a scheme of the Government of India, it was implemented in the state of Maharashtra by integrating it with the PJMJAY on mixed Insurance and Assurance Mode from 1 April 2020.

While the State Health Assurance Society provides coverage in assurance mode, it also pays the PSU United India Insurance Company an insurance premium of Rs. 797 per family per year in quarterly instalments on behalf of eligible beneficiary families.

The Government of Maharashtra fully funds the MJPJAY, while the PMJAY is funded jointly by the Government of India and Maharashtra in a 60:40 ratio.

Features of MJPJAY

The MJPJAY scheme contains features that help low-income families secure healthcare services for their ailments, including the following:

• The Government of Maharashtra pays the health insurance premium for the coverage under the scheme.
• Each family gets coverage of Rs. 1.5 lakh per year. However, the coverage is raised to Rs. 2.5 lakh for renal transplants.
• The State Government of Maharashtra bears the health insurance coverage and premium charges.
• The scheme applies to family members under a family floater policy.
• Diagnostics, medications, surgeries, treatments and follow-up consultations are covered under the policy.
• The policy covers pre-existing diseases from day one.
• Government hospitals are empanelled, alongside some private hospitals.
• Government-empanelled hospitals run health camps at which policyholders are eligible to participate.

The PMJAY or Ayushman Bharat from the Government of India offers coverage up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation in any of the country's empanelled hospitals.

Benefits of MJPJAY

The Mahatma Jyotirao Phule Jan Arogya Yojana Benefits that are available to members of the scheme comprise the following:

• The policy covers hospitalisation for 996 medical and surgical interventions and 34 designated diseases through cashless facilities.
• The policy also covers 121 follow-up procedures.
• Under PMJAY, the policyholders benefit from 1,209 plus 213 medical and surgical procedures, with 183 follow-up procedures.
• Policyholders also benefit from 131 government-reserved procedures out of 996 MJPJAY procedures and 37 government-reserved procedures out of 1,209 procedures.

Eligibility for MJPJAY

The following categories of people would come under the Mahatma Jyotirao Phule Jan Arogya Yojana Eligibility criteria to avail benefits under the MJPJAY:

• Category A: Families holding valid Yellow, Orange, Antyodaya, and Annapurna ration card alongside any photo ID proof.
• Category B: Farmers holding white ration card with 7/12 extracts bearing the name of the beneficiary/head of the family or certificate from the nearest Revenue Officer stating that the cardholder is a farmer or a family member of a farmer with valid photo ID proof from 14 agriculturally distressed districts of Maharashtra.
• Category C:The State Health Assurance Society (SHAS) can enlist members based on an identification mechanism decided by the SHAS, which could be, for instance, any health/identity card.
• Under PMJAY, members of families registered under the Socio-Economic and Caste Census, 2011 (SECC) holding computerised e-cards and photo identity cards can avail themselves of the scheme's benefits.
• Members under PMJAY from any state who have e-cards and photo identity proof can receive treatment at any empanelled hospital in any other state.
• Typically, an Aadhaar card is the identification document, failing which several other identity documents, as per guidelines issued from time to time, could be presented.
• Poor sections of the population living in urban areas under various occupation categories are also included as per the list generated under the PMJAY.
• Poor sections of the population living in rural areas under classifications D1 to D7 are also included as per the list generated under PMJAY.
• Under the PMJAY, 83.72 lakh households belonging to the Socio-Economic Caste Census 2011 (SECC 2011) are automatically included under the classification of deprivation and occupational criteria for rural and urban areas, respectively. This data is frozen, but new household members can be added.

What is Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?

A variety of diseases, procedures, surgeries, treatments, and follow-up packages across a number of categories are covered under the Mahatma Jyotirao Phule Jan Arogya Yojana Disease List.

Hospitalisation, diagnostics, medications, therapies, consultations, post-hospitalisation treatments, and follow-ups are also covered.

The government-empanelled hospitals and medical colleges render almost all healthcare services. Around 131 government-reserved procedures out of 996 MJPJAY procedures and an additional 37 government-reserved procedures under 1,209 PMJAY procedures are in the domain of the government hospitals and medical colleges.

What is Not Covered Under the Mahatma Jyotiba Phule Jan Arogya Yojana?

All diseases and procedures are generally covered by empanelled government hospitals. However, empanelled private hospitals will not cover the list of 131 government-reserved procedures out of 996 MJPJAY procedures and an additional 37 government-reserved procedures out of 1,209 PMJAY procedures, as per the list available with the concerned authorities.

List of Diseases and Treatments Covered Under MJPJAY:

The Mahatma Jyotirao Phule Jan Arogya Yojana Disease List and Procedures covered under the MJPJAY scheme are the following:

• Burns
• Cardiology
• Cardiovascular surgery
• Thoracic surgery
• Critical care
• Dermatology
• Endocrinology
• ENT surgery
• General medicine
• General surgery
• Haematology
• Infectious diseases
• Interventional radiology
• Medical gastroenterology
• Medical oncology
• Neonatal medical management
• Paediatric medical management
• Nephrology
• Neurology
• Neurosurgery
• Obstetrics
• Gynaecology
• Ophthalmology
• Orthopaedics
• Paediatric surgery
• Paediatric cancer
• Plastic surgery
• Polytrauma
• Prosthesis
• Orthosis
• Pulmonology
• Radiation oncology
• Rheumatology
• Surgical gastroenterology
• Surgical oncology
• Genitourinary surgery
• Mental disorders
• Oral surgery
• Maxillofacial surgery

The following are also included in the package of benefits under the schemes:

• Charges for beds in the general ward
• Nursing charges
• Boarding charges
• Charges for surgeons and anaesthetists
• Fees for medical practitioners and consultants
• Oxygen, O.T., and ICU charges
• Surgical appliances costs
• Cost of drugs, disposables, consumables, implants, and prosthetic devices
• Blood transfusion costs
• Cost of X-rays and diagnostic tests
• Food costs for patients
• Costs of travel by government transport
• Cost of carrying dead body in the unlikely event of death

The complete list of procedures, treatments, diagnostics, and other free services under MJPJAY and PMJAY is available from the concerned authorities.

How to Enrol in the MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana) Scheme?

To ensure the MJPJAY scheme is implemented properly for the beneficiaries, the scheme has employed Arogyamitras, who are friends of the health service and play the role of facilitators.

The intended beneficiary is required to contact the Arogyamitra to enrol in the scheme. These Arogyamitras would be available at PHCs/RHs/GHs/SDHs/WHs/DHs/general/district/women/network hospitals.

For Arogyamitras in network hospitals, beneficiaries could contact them using this URL:

https://www.jeevandayee.gov.in/MJPJAY/FrontServlet?requestType=PublicViewsRH&actionVal=AarogyaMitraView#

They will guide the beneficiary to complete the MJPJAY Registration Online to enrol in the concerned healthcare centre. They will also help the beneficiary secure the health referral card that will be required to be shown to the relevant hospital.

The beneficiaries are required to furnish the relevant documents to enrol.

The enrolment will be verified by the concerned hospital, after which an e-authorisation process will take place. The insurance company will generate and send an e-authorisation for it to be reviewed by MJPJAY.

The generation of an e-authorisation means the cashless treatment is approved, and the medical process will begin. The hospital will admit the beneficiary, and treatment will commence.

Once the treatment is completed and the patient is cured, the hospital will submit the required documents to the insurer for the settlement of the claim and collect the payment from the insurer.

Documents Required to Apply for MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana)

The documents required to apply for the MJPJAY scheme are the following, depending on the category of the applicant:

• Yellow, Orange, Antyodaya, and Annapurna ration cards
• White ration cards of farmers from 14 agriculturally distressed districts of Maharashtra
• Any documents decided by the SHAS like an identity/health card
• Computerised e-cards and photo identity cards

An appropriate identity proof document like Aadhaar card, driving licence, voter ID, PAN card, school/college ID, passport, freedom fighter ID card, MJPJAY/PMJAY health card, handicap certificate, nationalised bank’s photo ID passbook, central government’s senior citizen card, Sainik Board’s ex-serviceman ID, Government of Maharashtra’s Ministry of Agriculture and Fisheries Department’s ID card and Government of Maharashtra and Government of India issued photo-ID document.

How to Apply for MJPJAY Online?

The Arogyamitras help the beneficiary to apply for MJPJAY registration online. The beneficiary is required to furnish the relevant documents to be uploaded on the website to enable MJPJAY registration online.

Claim Procedures for MJPJAY

Beneficiaries may follow the procedure as outlined below:

• If the diagnosis of the illness takes place outside of a network or empanelled hospital, the beneficiary needs to visit the nearest Arogyamitra and collect a health card from the facilitator.
• If the diagnosis is at an empanelled hospital, the insurer will generate a pre-authorisation form to commence the process of initiating treatment.
• On receiving the approval from the insurer, the treatment will commence.
• Post-treatment, the hospital submits the necessary documents to the insurer to claim the hospital charges.
• The insurer reviews the claim from the hospital and settles it.
• Beneficiaries can avail post-hospitalisation services for a period of ten days under the MJPJAY scheme

List of Hospitals under the Mahatma Jyotiba Phule Jan Arogya Yojana

The MJPJAY hospital list includes empanelled hospitals run by governments, government departments, charitable organisations, and private entities. The scheme allows for the empanelment of up to 1,000 hospitals.

The policy covers the following:

• Empanelled hospitals under the public health department, municipal corporation, municipality, and the medical education and research department.
• Empanelled hospitals run by the private sector, covering single specialities and multiple specialities.
• The CEO of the SHAS heads the Coordination Empanelment and Disciplinary Committee, which determines the requirement of hospitals under the health insurance scheme.
• Currently, the minimum requirement for multi-speciality hospitals in the private sector is pegged at 30 beds with ICU facilities, and for single-speciality hospitals, it is pegged at ten beds alongside such other criteria as decided by the committee.

The complete MJPJAY hospital list of empanelled hospitals can be accessed through the URL:

https://www.jeevandayee.gov.in/MJPJAY/FrontServlet?requestType=PublicViewsRH&actionVal=AarogyasriView&page=Network%20Hospitals&Network%20Hospitals&mainMenu=Hospitals&subMenu=Network%20Hospitals

MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana) Toll-Free Number and Address

The MJPJAY scheme can be accessed through various means, including phones, email, a website, and Arogyamitras.

The toll-free numbers to contact the MJPJAY authorities are:

• Toll-free phone: 1800 233 2200
• Toll-free phone: 155 388

Various officials of the MJPJAY organisation can be contacted by visiting the URL:

https://www.jeevandayee.gov.in/MJPJAY/ContactUs.html

Email ID: ad@jeevandayee.gov.in

The role of Arogyamitras can be found by visiting the URL:

https://www.jeevandayee.gov.in/MJPJAY/FrontServlet?requestType=CommonRH&actionVal=RightFrame&page=undefined%3E%3E%3Cb%3EAbout%20Aarogyamitra%3C/b%3E&pageName=About_Aarogyamitra&mainMenu=About%20%20--%3E%20%20Aarogyamithra&subMenu=About%20Aarogyamithra

The MJPJAY address is as follows:

• MJPJAY, Project Office, ESIC Hospital, Third Floor, Ganpat Jadhav Marg, Near Worli Naka, Worli, Mumbai 400018

Frequently Asked Questions:

Does the ration card need to be presented in place of another document when registering for MJPJAY?

While a health card is sufficient, it is better to keep the valid Yellow, Orange, Antyodaya, and Annapurna ration card alongside the required photo ID proof to ensure that registration goes smoothly.

Which health conditions are not covered under the MJPJAY scheme?

The following health conditions are not covered under the MJPJAY:

• Adult cataracts
• Adult hernias
• Appendicitis
• Pneumonia
• Diarrhoea
• Diabetes
• Snakebite

However, in some cases, emergency treatments can be considered when the beneficiary is undergoing treatment for some other approved conditions. Further, under the scheme, 131 government-reserved procedures out of 996 MJPJAY procedures and an additional 37 government-reserved procedures out of 1,209 PMJAY procedures are available only in government hospitals. These would not be available in the empanelled private hospitals.

Are ambulance charges included in the scheme?

No, ambulance charges have to be borne by the beneficiary.

Should I have to spend any further money on my treatment?

Yes, if the cost of treatment is more than the costs approved under the MJPJAY. If not, there is no need to spend further money.

What is the maximum insurance covered under the scheme MJPJAY?

The maximum cover is Rs 1.5 lakh per year. However, for renal transplants, the cover is raised to Rs 2.5 lakh.

Does Mahatma Jyotiba Phule Jan Arogya Yojana scheme cover COVID-19 (Coronavirus) treatment?

Yes, the MJPJAY covers the COVID-19 (coronavirus) treatment.