Affordable Healthcare: Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY)

What is MJPJAY?

The health insurance scheme called Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), now known as Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY), was introduced by the Maharashtra State Government. Its main objective was to provide free hospitalisation and medical services to families falling under the Below Poverty Line (BPL) category.

The Government declared that the Mahatma Jyotirao Phule Arogya Yojana (MJPJAY) scheme, previously limited to individuals below the poverty line, has now been extended to include all citizens of Maharashtra. Dr Mansukh Mandaviya, the Union Minister for Health and Family Welfare and Chemicals & Fertilisers, made this announcement. Additionally, the MJPJAY scheme is merged with the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana. Furthermore, the coverage under the MJPJAY scheme has already been raised from Rs 1.5 lakh to Rs 5 lakh per family per year. The program provides complimentary medical services, particularly specialised treatments that necessitate hospitalisation, consultations, surgeries, and therapies; all facilitated through a designated network of healthcare providers.

MJPJAY was officially launched on July 2, 2012, and has already provided coverage to 54 lakh patients, incurring an expenditure of Rs 10,550 crore so far. Health experts have highlighted that this marks the first instance of healthcare universalisation in Maharashtra. Concurrently, the state government is planning to establish 50 Criticare Unit beds in rural and tribal areas equipped with all necessary medical facilities.

Dr Mandaviya expressed that the primary goal is to enhance the accessibility and affordability of healthcare services. By amalgamating the two schemes, a total of 60 crore people across India will benefit, and within Maharashtra, the joint scheme aims to cover 12 crore people. Deputy CM Devendra Fadnavis announced that 1 crore citizens will receive co-branded cards by August, and an additional 10 crore citizens will be issued these cards within the following six months.

The Mahatma Jyotirao Phule Jan Arogya Yojana is entirely financed by the Government of Maharashtra. On the other hand, the 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 the objective of the scheme?

As per the official website of the MJPJAY (www.jeevandayee.gov.in/MJPJAY), the objective of the scheme 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 health care providers.

Who is covered under the scheme?

Beneficiaries under Mahatma Jyotirao Phule Jan Arogya Yojana:

What is covered under the scheme?

The Mahatma Jyotirao Phule Jan Arogya Yojana offers health coverage, i.e. sum insured of Rs 5 lakh per family per annum for hospitalisation.

The MJPJAY scheme provides an extensive range of medical services, encompassing approximately 971 therapies, surgeries, and procedures, along with 121 follow-up packages that fall under 30 specialised categories. These categories include orthopaedic surgery and procedures, general surgery, ENT surgery, gynaecology and obstetrics surgery, cardiac and cardiothoracic surgery, ophthalmology surgery, paediatric surgery, radiation surgery, plastic surgery, and others.

Out of these procedures, the Government has reserved 132 for performance exclusively by empanelled government hospitals or government medical colleges.

Additionally, the scheme covers consultation fees and medication costs for up to 10 days after hospitalisation, starting from the discharge date.

Which diseases and treatments are covered under the scheme?

All pre-existing diseases are covered from day one under the scheme. Below is the list of diseases and treatments covered under the MJPJAY:

• General Surgery

• Ophthalmology Surgery

• ENT Surgery

• Gynaecology and Obstetrics Surgery

• Surgical Gastroenterology

• Orthopaedic Surgery and Procedures

• Cardiac and Cardiothoracic Surgery

• Genitourinary System

• Paediatric Surgery

• Surgical Oncology

• Neurosurgery

• Medical Oncology

• Plastic Surgery

• Radiation Oncology

• Burns

• Prostheses

• Polytrauma

• Critical Care

• Infectious Disease

• General Medicine

• Paediatrics Medical Management

• Nephrology

• Cardiology

• Neurology

• Dermatology

• Pulmonology

• Rheumatology

• Gastroenterology

• Endocrinology

• Interventional Radiology

What is not covered under the scheme?

The scheme offers comprehensive medical care, except for 131 planned procedures, including vaginal or abdominal hysterectomy, hernia repair, cholecystectomy, appendectomy, discectomy, and others. These specific procedures will only be carried out at government-empanelled hospitals or government medical colleges.

What are the network hospitals/service providers of the scheme?

The hospitals included in the scheme are a mix of both government and private hospitals. Government hospitals comprise institutions from the Public Health Department, Medical Education and Research Department, as well as hospitals under Municipal Corporations and Municipalities. The total number of empanelled hospitals, whether government or private, will not exceed 1,000.

Both multi-speciality and single-speciality hospitals, whether government or private, can be empanelled based on the requirements and guidelines set by the Coordination Empanelment and Disciplinary Committee, which is chaired by the Chief Executive Officer of the State Health Assurance Society. Multi-speciality private hospitals must meet certain criteria, such as having a minimum of 30 beds with an ICU (with some relaxations), while single-speciality hospitals must have a minimum of 10 beds and meet other relevant criteria.

Click here to check the complete list of network hospitals.

How can you enrol for the MJPJAY and raise a claim?

Here is the step-by-step enrolment process for the MJPJAY scheme in Maharashtra:

Step 1: To initiate the application for the scheme, individuals or families should approach a nearby Network/District/Women/General hospital and meet with an Arogyamitra.

Step 2: If you visit a Government Health Facility, they will provide you with a referral card that can be presented to the Network Hospital along with the preliminary diagnosis conducted by the doctors at the Government Health Facility. Alternatively, you can attend Health Camps organised by the Network Hospital to obtain the referral card.

Step 3: Present the referral card along with your Yellow or Orange Card during the enrolment process. You can also use your Antyodaya or Annapurna Card instead of a ration card.

Step 4: Once the above details are provided, diagnosis and check-ups will be initiated.

Step 5: You will be admitted to the Network Hospital based on the diagnosis.

Step 6: An E-authorisation request will be sent to the insurance company, and the same will also be reviewed by MJPJAY.

Step 7: Medical Specialists from both the insurance company and MJPJAY will review the authorisation request. If all conditions are met, the request will be approved. Authorisation will be done within 24 hours, and in case of an emergency, it will be immediate with the authorisation marked as "EM".

Step 8: With the authorisation approved, you will receive cashless treatment or hospitalisation.

Step 9: The hospital will submit all the original bills, diagnostic reports, a discharge summary, and other relevant documentation to the insurance company for claim settlement.

Step 10: The insurance company will review the documents, approve the claim, and proceed to clear the payment to the hospital.

Step 11: The network hospital will provide free consultations, medicines, and diagnostics under the scheme for up to 10 days from the date of discharge.

How to get the Mahatma Jyotirao Jan Arogya Yojana Card online?

To get the Mahatma Jyotirao Jan Arogya Yojana Card, you should visit the nearby General, Women/District/Network hospital. There, the Arogyamitra, who acts as the scheme's representative, will assist you in acquiring the health card.

If you choose to visit a Government Health Facility, they will provide you with a referral card to the Network hospital for the initial diagnosis by the doctors. Alternatively, you can also participate in Health Camps organised by the Network hospitals to get a health card.

What are the documents required to avail of the benefit of the scheme?

For identification, in addition to the ration card (Orange/Yellow/White), you must provide any of the following KYC documents:

• Pan Card

• Driving License

• Aadhar Card

• Voter ID

• Handicap Certificate

• Nationalised Bank Passbook with Photograph

• School/College ID

• For urban areas, Government Local bodies/Tahsildar's stamps and signatures on the applicant's photograph.

• For rural areas, Tahsildar's stamp and signature on the applicant's photograph.

• Passport

• Freedom Fighter ID Card

• Senior citizen card issued by the central and State Government of India

• Defence ex-service card issued by Sainik Board

• Any photo ID proof issued by Govt. of Maharashtra/Govt. of India.

• Marine Fishers Identity card.

In the case of a newborn child, wherein the name and photo are not available on the valid ration card, you should submit the photograph of the child along with either of the parents, along with the ration card and the child's birth certificate.

Does it make sense to rely only on MJPJAY for your health insurance needs?

Relying solely on MJPJAY for your health insurance needs may not be the most comprehensive approach. While MJPJAY offers valuable coverage for certain medical services and treatments, it is essential to consider its limitations and exclusions.

MJPJAY has a specific coverage limit of Rs 5 lakhs per family per annum for secondary and tertiary care hospitalisation. This may not be sufficient for some major medical procedures or chronic illnesses that require long-term treatment. Although MJPJAY includes both government and private hospitals, the number of empanelled hospitals is currently limited, especially in rural areas. Besides, the scheme may not cover certain medical conditions or treatments, and there may be limitations on specific procedures or therapies. Note that MJPJAY is specific to the state of Maharashtra, meaning if you need medical treatment outside of the state, the scheme's coverage may not apply.

To ensure comprehensive coverage for your health insurance needs, it is advisable to consider supplementing MJPJAY with additional health insurance plans through private insurance providers. Assess your family's specific healthcare requirements, budget, and geographic mobility to make an informed decision about the best approach to health insurance coverage.

To conclude:

Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) has emerged as a significant healthcare initiative in Maharashtra, offering quality medical services to economically backward families. With its extensive coverage, including various therapies, surgeries, and treatments, the scheme has positively impacted millions of lives. However, while MJPJAY plays a crucial role in enhancing healthcare accessibility, it may not fully address all health insurance needs due to certain limitations and eligibility criteria. To ensure comprehensive coverage, individuals should consider complementing MJPJAY with additional health insurance plans tailored to their specific requirements. Overall, MJPJAY stands as a remarkable stride towards promoting universal healthcare and uplifting the health and well-being of the people of Maharashtra.

KETKI JADHAV is a Content Writer at PersonalFN since August 2021. She is an MBA (Finance) and has over seven years of experience in Retail Banking. Ketki specialises in covering articles around banking, insurance, personal finance, and mutual funds and has been doing it for over three years now.

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