MJPJAY: Mahatma Jyotiba Phule Jan Arogya Yojana, Features, Benefits & Application Process

Mahatma Jyotiba Phule Jan Arogya Yojana is a popular health scheme, introduced by the Maharashtra government to provide advanced healthcare facilities to people, who belong to low-income strata and can’t afford superior medical services. Earlier known as Rajiv Gandhi Jeevandayee Arogya Yojana, this scheme is a significant step of the Maharashtra government to offer healthcare assistance to people who are in a social and economic disadvantageous position. Initially, Mahatma Phule Yojana was initiated in 8 districts of Maharashtra, and later on 21st November 2013, increased horizons to all districts of Maharashtra.

Want to know more about Mahatma Phule Yojana and associated healthcare benefits, go through this blog to get comprehensive information about the scheme, including features, benefits, application procedure, required documents, etc. 

Mahatma Jyotiba Phule Jan Arogya Yojana: Healthcare Support to Maharashtra People

Launched on 2nd July 2012, Mahatma Jyotibha Phule Jan Arogya Yojana provides cashless healthcare services to people for the treatment of fatal diseases. Ensuring easy access to superior healthcare facilities, it offers maximum health insurance coverage of up to Rs 1,50,000.  In this insurance benefit, hospitalization for minor and critical illnesses, surgeries, and therapies are covered. This scheme aims to promote healthcare in rural areas by organizing health camps, spreading awareness, and assisting in diagnosis and treatment.  As it is a cashless health insurance, thus it gets easy for beneficiaries to claim and avail of scheme benefits. 

Features of Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Phule yojana is equipped with various features, that ensure seamlessly accessible quality healthcare assistance for families.

•  Extensive coverage: Under this scheme, health insurance of up to Rs. 1.5 lakhs is provided to each family on a floating basis for the treatment of various ailments included under specialized categories of the scheme. 

•  Cashless support: Through this scheme, beneficiaries get cashless support, thus they don’t need to pay any money during their treatment and hospitalization.

•  Premium amount: The whole premium amount will be bear by the Maharashtra government. 

•  Health Camps: Under this scheme, many health camps will be organized by the government hospitals for early diagnosis of diseases. 

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Benefits offered under Mahatma Phule Yojana

There are various healthcare benefits provided by Mahatma Jyotibha Phule Jan Arogya Yojana, which are mentioned below:

• Insurance coverage: Beneficiary gets insurance coverage up to Rs. 1,50,000/- for hospital expenses. 
• Enhanced Limit: In the case of Rental Transplants, the insurance coverage limit can be expanded up to Rs. 2,50,000/- for each family per policy year. 
• Floater plan: This scheme is based on a floater basis, thus allowing either one individual or all family members to access the scheme i.e., the total coverage of ₹ 1,50,000/- or ₹ 2,50,000/- depending upon the case. 
• Benefits Coverage: Scheme insurance coverage includes hospitalization for Medical and Surgical procedures in the identified 34 specialties. Thus beneficiaries can utilize up to 996 Medical and Surgical procedures along with 121 follow-up procedures. Among 996 MPJAY procedures, around 131 procedures are government-reserved. 

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Mahatma Jyotiba Phule Jan Arogya Yojana Eligibility

To be eligible to apply for the Mahatma Phule Yojana, applicants need to meet the Mahatma Jyotiba Phule Jan Arogya Yojana eligibility conditions that are listed below: 

• The yearly income of the applicant should be less than Rs.1 lakh.
• Applicant must have a White/Orange/Yellow Ration Card, Annapurna Card, or Antyodaya Anna Yojana Card (AAY).
• Candidates who are registering must hail from districts of Maharashtra and identified as distressed. 
• Farmers who belong to Maharashtra and are agriculturally distressed are also eligible to apply for this scheme.
• Farmers who hail from Agriculturally distressed districts must have a white ration card. Additionally, they should gain a 7/12 extract or a certificate from the Patwari. Documents and certificates should have the name of the beneficiary or family head. 

Simple procedure to Apply for Mahatma Jyotiba Phule Jan Arogya Yojana

To apply for Mahatma Jyotiba Phule Jan Arogya Yojana, people need to follow the step-by-step procedure that is listed below: 

• First, the Beneficiary is required to visit the nearby Network Hospital and reach out to Arogyamitras present in each network hospital. Beneficiaries can also join the Health Camps organized by the Hospital nearby and receive a referral letter depending upon their diagnosis. 
• The Arogyamitra checks the valid ration cards and Photo IDs and helps the patient register and enroll in the scheme. All details and admission and test-related data will be recorded in the database by the respective authority based on the scheme’s requirements. 
• If the procedure comes under 996 procedures and 1209 procedures, the e-preauthorization request will be sent by the hospital along with the attachment of mandatory documents.
• The preauthorization requests will be checked by the Medical Specialists of the insurer, to determine if all the conditions are satisfied. 
• In case of rejection of the preauthorization request, it will be sent to the technical committee including the CMO of TPA and the CMC of SHAS. If their opinions clash, the matter will be shared with the ADHS- SHAS whose decision of preauthorization approval or rejection will be final. 
• After the approval of the preauthorization request, the process will be completed within 30 days by a Private Hospital and within 60 days in the case of a public Hospital. 
• Following this, the beneficiary will get cashless Medical or Surgical treatment benefits from the network hospital. The Post-operative / daily treatment notes-related data will be updated regularly on the portal by the respective authority of the network hospital. 

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The Process to Raise a Claim for MJPJAY Health Scheme

Here is the procedure you are required to go through to raise a claim for the MJPJAY health scheme. 

• Go to your nearest network hospital for the treatment. 
• An online pre-authorization request will be sent by the hospital to the insurance company.
• As the request gets approved, the treatment procedure gets started. If there is an emergency, treatment may begin immediately by the hospital authorities. 
• After completion of the treatment, the empaneled hospital will share all the required documents like medical reports, bills, and discharge summaries with the insurer.
• As the verification process of documents is complete, the settlement of the claims gets done.

Required Documents for Mahatma Jyotiba Phule Jan Arogya Yojana

While registering for the Mahatma Phule yojana, applicants are required to submit some documents for the KYC process. The list related to these documents are listed below: 

• Aadhaar Card or Aadhaar Registration Slip with your photo
• Pan Card
• Voter ID
• Driving License
• School/College Id
• Passport
• Freedom Fighter ID card
• Health Card of RGJAY / MJPJAY
• Handicap Certificate
• Nationalized Bank Passbook with Photo
• Senior citizen card issued by the Central Government or State Government
• Defense ex-servicemen card issued by Sainik Board
• Marine Fishery Identity card (Issued by Ministry of Agriculture / Fisheries Department, Maharashtra Government).
• Any photo ID proof issued by the Maharashtra Government/ Indian Government

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Specialized Categories Covered Under Mahatma Jyotiba Phule Jan Arogya Yojana

Mahatma Phule yojana includes various categories that are identified for beneficiaries to get access to associated medical and surgical procedures. 

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. Hematology
11. Infectious diseases
12. Interventional Radiology
13. Medical Gastroenterology
14. MEDICAL ONCOLOGY
15. Neonatal and Pediatric Medical Management
16. Nephrology
17. Neurology
18. Neurosurgery
19. Obstetrics and Gynecology
20. Ophthalmology
21. Orthopedics
22. Pediatric Surgery
23. Pediatric 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

Hospitals Under Mahatma Jyotiba Phule Jan Arogya Yojana

There are over 700 hospitals in Maharashtra linked with the Mahatma Jyotiba Phule Jan Arogya Yojana. The package costs for different medical treatments and procedures are fixed under the scheme through negotiation with the hospitals. This is done to make healthcare facilities affordable for people. Here is the list of all the hospitals that are empaneled with the scheme:

FAQs for MJPJAY Scheme

Q.1. What is the MJPJAY scheme?

A.1. MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana) is a healthcare scheme introduced by the Maharashtra government to provide health coverage of up to Rs.1.5 Lakh per year, covering medical services of surgeries/treatments related to 34 special categories. 

Q.2. What are the benefits of Mahatma Jyotiba Phule Jan Arogya Yojana?

A.2. Under Mahatma Jyotiba Phule Jan Arogya Yojana, Rs. 1.5 lakh or Rs. 2.5 lakh based on the case is provided to the beneficiary during the policy year. It includes 996 medical and surgical procedures with 121 follow-up procedures.

Q.3. What documents are required for Mahatma Phule Jan Arogya Yojana?

A.3. The documents required during Mahatma Phule Jan Arogya Yojana are Aadhaar Card, PAN card, Voter ID, Driving License, School/College ID, Freedom Fighter ID card, Health Card of RGJAY / MJPJAY, Handicap Certificate, Nationalized Bank Passbook with Photo, etc. 

Q.4. How can I register for the Mahatma Jyotiba Phule Scheme?

A.4. To register for the MJPJAY Scheme, an individual needs to visit the nearby Network Hospital and meet Arogyamitras available in the hospital.  Arogyamitra will assist you in registering and getting enrolled in the scheme. You can also go to the Health Camps organized by the network Hospital in nearby areas to get a referral letter. 

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