Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

Over the years, the Indian Government has come up with multiple initiatives to facilitate a better livelihood for the poor. One of them is the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). It is one of the many schemes aiming to make healthcare easily accessible to the economically backward mass.

Not sure if this scheme can benefit you?

Well, here is a detailed discourse on the “what, how, and for whom” of this government initiative. Read on for a detailed understanding!

The Mahatma Jyotiba Phule Jan Arogya Yojana is a healthcare coverage scheme launched by Maharashtra’s State Government. It was initially introduced as the Rajiv Gandhi Jeevandayee Arogya Yojana. The scheme aims to provide affordable and quality medical care to individuals below or marginally above the poverty line.

This healthcare scheme also covers surgical procedures and related consultation and hospitalisation expenses.

The MJPJAY scheme was first launched in July 2012. It was valid only in 8 districts of Maharashtra. Later, the scheme became functional in all 35 districts from November 2015. Since then, any individual holding a valid document could avail of free healthcare services from network hospitals.

Here is a list of features of the Mahatma Jyotiba Phule Jan Arogya Yojana. Have a look!

• This health insurance scheme offers financial coverage up to Rs.1.5 lakhs per year against medical treatments.
• Policyholders do not need to deposit any sum while undergoing treatment, so it is a cashless process.
• The State Government of Maharashtra bears the premium charges required for Mahatma Jyotiba Phule Jan Arogya Yojana.
• This scheme allows an individual beneficiary to benefit from it. Alternatively, an entire family can also enjoy insurance benefits with a floater policy.
• The Mahatma Jyotiba Phule Jan Arogya Yojana scheme does not specify any waiting period for pre-existing ailments.
• Policyholders can also attend 1 medical camp per year free of cost.

If you want to check the accessibility of such healthcare benefits near you, look up the list of network hospitals. It is available on the official website of the State Health Assurance Society. You can find a number of private as well as government-enrolled hospitals in this list. All of these can offer you the benefits of Mahatma Phule Arogya Yojana.

The primary benefits of MJPJAY are noticeable from the extensive treatment coverage it offers. This includes diagnosis, medication, surgeries, follow-up treatment, and expert consultation.

Following is a detailed list of benefits that policyholders can avail from this scheme:

• MJPJAY benefits include financial coverage against approximately 971 surgical and therapeutic procedures.
• This scheme covers 30 identified categories, including around 121 types of follow-up procedures.
• There are 132 government-reserved procedures under MJPJAY coverage. Policyholders can avail of these treatment benefits only from enlisted government medical colleges and hospitals.

In addition to the above-mentioned Mahatma Jyotiba Phule Jan Arogya Yojana benefits are the extended upper ceiling for renal transplant. In this case, beneficiaries can avail a maximum of Rs.2.5 lakhs for operation.

Want to know what other medical procedures you can avail of for free under the MJPJAY scheme?

Keep reading!

Let us check the list of medical procedures covered under the Mahatma Jyotiba Phule Jan Arogya Yojana.

1. Surgical procedures:

• General
• Ophthalmology
• ENT
• Gastroenterology
• Gynaecology and obstetrics
• Orthopaedic
• Paediatric
• Cardiac and cardiothoracic
• Surgical oncology
• Prostheses
• Neurosurgery
• Plastic surgery

2. Other procedures involving:

• Endocrinology
• Medical oncology
• Polytrauma
• Critical care
• Genitourinary system
• Nephrology
• Cardiology
• Neurology
• Infectious disease
• Radiation oncology
• Burns
• Gastroenterology
• Dermatology
• Rheumatology
• Interventional radiology
• Pulmonology

3. General medicine

Generally, most insurance plans come with specific exclusions. However, no such Mahatma Jyotiba Phule Jan Arogya Yojana disease list is available for this scheme, explicitly mentioning procedures not covered under the scheme. Instead, there are specific conditions mentioned under which certain medical treatments are provided.

If you belong to an APL or BPL family, you can get all the above treatments covered under MJPJAY by registering for the scheme. However, you need to consider the eligibility requirements before moving on with the process.

The Mahatma Jyotiba Phule Jan Arogya Yojana eligibility requirements demand individuals meet the following parameters to qualify as beneficiaries:

• Individual applicants must have an annual income of less than Rs.1 lakh.
• Family members of the primary applicant can enjoy Mahatma Jyotiba Phule Jan Arogya Yojana coverage benefits as well.
• Registering families must belong to the identified distressed districts of Maharashtra.
• Farmers belonging to agriculturally distressed districts of Maharashtra can also sign up for this insurance policy.

Once you meet the above eligibility requirements, you will need to submit specific documents to support your claims.

Here is a list of all mandatory documents that you need to submit to qualify for the MJPJAY scheme.

Any of the following KYC photo IDs:

• Aadhaar card
• PAN card
• Passport
• Driving license
• Voter ID
• Senior citizen card 
• Handicap certificate
• Bank passbook with photograph
• Marine fishers ID card
• Defense ex-service card 
• College or school ID
• Freedom fighter ID card
• Any other photo identity proof issued by the Maharashtra State Government or Central Government of India. You can also provide a valid yellow, orange, or white ration card

To register a child born after issuing a health card, his/her authorised birth certificate, photo with either parent, and the parent’s yellow, orange, or white ration card must be issued.

Once you have checked your eligibility and gathered all Mahatma Jyotiba Phule Jan Arogya Yojana documents, proceed with the registration process.

In case you do not have a clue as to how to avail of Mahatma Jyotiba Phule Jan Arogya Yojana online registration, here is a step-by-step guide.

• Step 1: Go to the official website of MJPJAY.

• Step 2: On the home page, click on “New Registration.”
• Step 3: Next, the next page will redirect you to the Mahatma Jyotiba Phule Jan Arogya Yojana online application form. 
• Step 4: Fill in all the mandatory fields with accurate details. 
• Step 5: Attach scanned copies of the mandatory documents previously mentioned.
• Step 6: Click on “Submit.”

Upon completing the above procedure, you will be successfully registered under this insurance scheme.

After that, you can raise a claim anytime you need to avail of medical treatment.

Following is a step-by-step overview of the claim procedure for the Mahatma Jyotiba Phule Jan Arogya Yojana scheme.

• Step 1: Visit your nearest network hospital to get your medical condition diagnosed. 
• Step 2: The hospital authorities will send a digital pre-authorisation request to the insurance company.
• Step 3: Upon approval, the treatment procedure will commence. In case of emergencies, this procedure is instant and is not delayed by e-authorisation requirements.
• Step 4: If the diagnosis does not take place in a network hospital, then the Arogyamitra will issue a referral card. You need to produce this card at an empanelled hospital to avail of cashless treatment.

After completing the medical procedure, the network hospital will share all essential details like diagnostic reports, treatment summary, and final bill with the insurer. The latter will verify all submitted documents to initiate claim settlement.

Now that you are well acquainted with the detailed registration and claim procedure, delay no more. Check your eligibility and enroll yourself and your family under the MJPJAY scheme at the earliest to avail of optimum benefits!