- Details
- Benefits
- Eligibility
- Application Process
- Documents Required
- Frequently Asked Questions
- Sources And References
- Feedback
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Maharashtra
Mahatma Jyotirao Phule Jan Arogya Yojana
Details
Benefits
- The scheme provides coverage for meeting all expenses relating to the hospitalization of beneficiaries up to ₹ 1,50,000/- per family per policy year. For Renal Transplants, this limit has been enhanced up to ₹ 2,50,000/- per family per policy year.
- The benefit is available to every member of the family on a floater basis, i.e., the total coverage of ₹ 1,50,000/- or ₹ 2,50,000/- as the case may be, can be availed by one individual or collectively by all members of the family in the policy year.
- Burns
- Cardiology
- Cardiovascular and Thoracic surgery
- Critical Care
- Dermatology
- Endocrinology
- ENT surgery
- General Medicine
- General Surgery
- Haematology
- Infectious diseases
- Interventional Radiology
- Medical Gastroenterology
- MEDICAL ONCOLOGY
- Neonatal and Pediatric Medical Management
- Nephrology
- Neurology
- Neurosurgery
- Obstretrics and Gynecology
- Ophthalmology
- Orthopedics
- Pediatric Surgery
- Pediatric Cancer
- Plastic Surgery
- Polytrauma
- Prosthesis and Orthosis
- Pulmonology
- Radiation Oncology
- Rheumatology
- Surgical Gastroenterology
- Surgical Oncology
- Urology (Genitourinary Surgery)
- Mental disorders
- Oral and Maxillofacial Surgery
Note: 1209 packages include bed charges in General ward, Nursing and boarding charges, Surgeons and Anesthetists charges, Medical Practitioner and Consultants fees, Oxygen, O.T. & ICU Charges, Cost of Surgical Appliances, Cost of Drugs, disposables, consumables, implants, Cost of Prosthetic Devices, Cost of Blood Transfusion (Blood to be provided as per policy of State Government), X-Ray and Diagnostic Tests, food to inpatient, one time transport cost by State Transport or second class rail fare (from Hospital to residence of patient only). The package covers the entire cost of treatment of patient from date of reporting to his discharge from hospital including complications if any, making the transaction truly cashless to the patient. In instance of death, the carriage of dead body from network hospital to the village/ township would also be part of package.
Eligibility
| Category | Description of Beneficiaries | ||
| Category A | Families holding Yellow ration card, Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange ration card (annual income up to ₹ 1,00,000) issued by Civil Supplies Department, Government of Maharashtra for 36 districts of Maharashtra. | ||
| Category B | White ration card holder farmer families from 14 agriculturally distressed districts of Maharashtra (Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal, and Wardha). | ||
| Category C | 1. Children of Government Orphanages, Students of Government Ashram Shala, Female Inmates of Government Mahila Ashram, and Senior Citizens of Government Old Age Homes. | 2. Journalists & their dependent family members approved by DGIPR | 3. Construction workers and their families have live registration with the Maharashtra Building & Other Construction Worker Welfare Board. |
| Category | Description of Beneficiaries |
| Category A | All eligible families shall be identified with valid Yellow, Orange, Antyodaya, and Annapurna ration cards (irrespective of the date of issue of the Ration Card or the inclusion of the beneficiary's name therein) coupled with any Photo ID proof (as finalized by the Society). |
| Category B | Eligibility for farmers from 14 agriculturally distressed districts of Maharashtra will be decided based on a white ration card with 7/12 extract bearing the name of the beneficiary/head of the family or certificate from the nearest Revenue Officer stating that the beneficiary is a farmer or a family member of a farmer with valid photo ID proof of the beneficiary. |
| Category C | The eligibility of beneficiaries shall be decided based on any identity card/health card or any other identification mechanism as decided by the State Health Assurance Society (SHAS). |
Application Process
Note 1: The claim settlement module along with electronic clearance and the payment gateway will be part of the workflow in the State Health Assurance Society (SHAS) portal and will be operated by the Insurer.
Note 2: The reports will be available for scrutiny on the State Health Assurance Society (SHAS) login.
Documents Required
Frequently Asked Questions
What is the full form of MJPJAY?
MJPJAY's full form is Mahatma Jyotiba Phule Jan Arogya Yojana.
When was MJPJAY started?
MJPJAY was launched in 28 districts of Maharashtra on April 1st, 2020.
What is the objective of MJPJAY?
MJPJAY aims to provide cashless, quality medical care to the beneficiaries under the scheme for catastrophic illnesses requiring hospitalization for surgery and treatment under identified specialized services through a network of health care providers.
How much assistance is available under MJPJAY Yojana?
MJPJAY Yojana 2024 provides coverage up to ₹ 1,50,000/- per policy year per family to meet all expenses related to hospitalization of the beneficiary. For renal transplants, this limit has been increased to ₹ 2,50,000/- per family per policy year.
Who is eligible for receiving Maintenance Haemodialysis treatment under MJPJAY?
A patient suffering from chronic kidney disease requiring maintenance HD and who has a health card is eligible. If the patient does not have a health card, he or she should have an orange or yellow ration card or an Antyodaya or Annapurna card along with valid ID proof.
Which services are provided under package of Maintenance Haemodialysis under MJPJAY for the patient?
The package includes pre- and post-treatment diagnostics,consultation, hospital charges, consumables, and medicines. The detailed package is as follows: >> Investigations Creatinine tests (Monthly) Complete blood count (CBC, Monthly) HIV/Hep.A/Hep.C tests (once every three months) Serum electrolytes (as per advise) Blood glucose, if required >> Consultion Clinical examination by Nephrologist/Medical Cordinator. >> Consumable -Dialyser (It will be used upto optimal capacity and replaced if needed free of charge under scheme), -Tubing (It will be used upto optimal capacity and replaced if needed free of charge under scheme), - Fistula Needle (It will be used upto optimal capacity and replaced if needed free of charge under scheme). - IV fluids, - Haemodialysis Part A/B and o Heparin. >> Medicines Inj. Erythropoetin, as per the advice of Nephrologist
What should be frequency of dialysis cycles under MJPJAY for each approved preauth?
The frequency of dialysis should be a minimum of 8 cycles and a maximum of 12 cycles, as recommended by the nephrologist or medical coordinator based on his or her serum creatinine level.
Does patient have to pay any extra money for treatment?
No. The patient should not pay any extra money to the hospital or center for services that are covered under the approved package.
Will Balance Sum Insured used for dialysis patient limit other household members to avail services under MJPJAY?
The maximum sum assured under MJPJAY is ₹ 1,50,000/- per family, on a family-floater basis. If the dialysis patient has utilized a particular amount from the sum assured, other family members can still avail services under MJPJAY till the total amount of ₹ 1,50,000/- gets exhausted. This amount of Sum Insured cannot get extended under any circumstances (except if patient requires a renal transplant, where BSI will be considered as ₹ 2,50,000/-)
Can HIV or HCV positive cases avail Maintenance Haemodialysis service under MJPJAY ?
Yes. If a patient is a beneficiary of MJPJAY and is HIV or HCV positive, then he or she can still avail services under MJPJAY. Empanelled hospitals and stand-alone dialysis centers must have dedicated machines for HIV or HCV-positive patients. Under no circumstances shall these units be used for other patients.
If patient requires blood transfusion, is cost of blood transfusion covered under package?
No. Maintenance Haemodialysis package does not cover the cost of a blood transfusion.
In case of a query or to register a complaint what should I do ?
In case of a query, you can contact Arogyamitra or call the toll-free number. Arogyamitra is available round the clock in the hospital or center and will facilitate and guide you if any problem arises. But if you are not satisfied, then call our toll-free numbers, 155388 or 18002332200, to register a complaint.
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Maharashtra
Mahatma Jyotirao Phule Jan Arogya Yojana
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