MJPJAY also covers the beneficiaries for COVID-19 treatment. The maximum health insurance coverage offered is Rs 1,50,000 for the beneficiary family.
The Integrated Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) was launched in the state on April 01, 2020.
Highlights of MJPJAY
Name of the Yojana
Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)
Maharashtra Health Ministry
Objective of the Scheme
Providing healthcare services to the needy
Eligibility Criteria for Mahatma Jyotiba Phule Jan Arogya Yojana
The eligibility criterion for MJPJAY is given below:
- The scheme offers health cover to the families who are a part of any of the destitute districts of Maharashtra
- The beneficiary should have an Annapurna Card, white/yellow/orange Ration Card, and Antyodaya Anna Yojana Card (AAY)
- Farmers belonging to the agriculturally distressed districts are also covered
Features of Mahatma Jyotiba Phule Jan Arogya Yojana
The salient features of Mahatma Jyotiba Phule Jan Arogya Yojana are as follows:
- Sum insured of Rs. 1.5 lakh per annum for a family
- The scheme covers the cost of the medications, surgeries, treatment, diagnostics, and consultations
- The health insurance coverage under the scheme is provided on a family floater and individual basis
- The State Government bears the cost of thehealth insurance premium and treatment charges
- The best part is that claim is permissible for pre-existing illnesses from Day 1
- In this scheme access is also provided to healthcare camps that are conducted at the government hospitals
- The beneficiaries can avail of medical treatment under government and private empanelled hospitals
What is covered under Mahatma Jyotiba Phule Jan Arogya Yojana?
MJPJAY offers health insurance coverage to the insured for the following medical expenses:
- The scheme covers 971 medical surgeries/therapies/procedures and 121 follow-up packages
- It includes General surgery, ENT surgery, Obstetrics surgery, Gynecology, Cardiac and Cardiothoracic surgery, Orthopedic surgery, Plastic surgery, Pediatric surgery, Ophthalmology surgery, Radiation surgery, etc.
- Renal transplant operation up to a maximum limit of Rs 2.5 lakh
- Post-hospitalization expenses for medical consultations/medicines are covered for 10 days after getting discharged from the hospital
How to Enroll under the MJPJAY?
Mahatma Jyotiba Phule Jan Arogya Yojana enrollment process is given below:
- The beneficiary needs to meet the Aarogyamitra at the nearest general/district/women/network hospital to initiate the application.
- A health referral card will be given that can be shown to the network hospital for the treatment recommended.
- Along with this card orange/yellow card or Annapurna Card needs to be furnished in case a ration card is not available.
- The treatment will follow and hospital admission will begin post verification.
- An e-authorization request will be sent by the insurance company and will be reviewed by MJPJAY.
- Cashless treatment will start once the authorization is done and the request is approved.
- The hospital will share the original bills, documents with the insurer for claim settlement. Once the documents are reviewed and the claim is approved the payment will be made to the hospital.
- Post-10-days of getting discharged you can avail of diagnostic services, free consultations, at the network hospital
How can You Apply for MJPJAY Card?
When applying for the MJPJAY card, you can visit the nearby government health facility and take the help of the Aarogyamitra who is the representative of this scheme, and he/she will help you in getting you the MJPJAY health card.
Documents Required for Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)
In addition to the ration card, the following KYC documents would be required for the beneficiary’s verification:
- PAN card/ Voter ID/Aadhaar card/Nationalized bank passbook with photograph
- Driving license/ School/college ID
- Handicap certificate
- Tehsildar’s stamps on the applicant’s photograph
- Any photo ID proof issued by the Government of India/Government of Maharashtra
- Senior citizen card issued by the Central/State Government of India
- Freedom fighter ID card
Note that if the photo of a newborn child is not available, then parents can submit their photo with the child with the birth certificate and the ration card.
How to File a Claim for MJPJAY?
The process is simple and is given below:
- A medical condition is diagnosed in an empanelled hospital and the insurance company sends a pre-authorization from to begin your treatment
- If the disease was diagnosed at a non-empanelled hospital, then the Aarogyamitra at the hospital will provide you a referral card to start the treatment at the network hospital
- Once the hospital receive the approval from the insurer, the hospital will start the treatment
- On completion of the surgery/treatment, the hospital will provide all the required documents to the insurer. These include medical reports, bills, diagnostic reports, discharge summary, etc.
- The claim will be approved and you can avail post-hospitalization services till 10 days
Ans: Yes, Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) covers the treatment of COVID-19 or the Novel coronavirus.
Ans: No, the beneficiary does not require paying any money to the hospital for healthcare services that are included in the packages.
Ans: To check the list of network or empanelled hospitals under the Mahatma Jyotiba Phule Jan Arogya Yojana scheme you can go their official website.
Ans: No, the scheme only covers the cost of treatment incurred on the appendicular perforation.
Ans: No, the ambulance charges under this scheme need to be borne by the beneficiary itself.
Ans: The TAT for pre-authorization under MJPJAY is 12 hours.
Ans: The toll-free helpline number for MJPJAY is 1800-233-2200/155 388.
Written By: PolicyBazaar