Mahatma Jyotiba Phule Jan Arogya Yojana: 6 Important Things to know

Mahatma Jyotiba Phule Jan Arogya Yojana was launched in July 2012 as the Rajiv Gandhi Jeevanand Arogya Yojana by the Maharashtra state government. On April 1, 2017, the scheme was renamed to what it is currently known. This scheme aims at providing free and proper healthcare to the vulnerable and underprivileged sections of society [1].  

Under the Mahatma Phule Jan Arogya Yojana scheme, beneficiaries can avail of coverage for consultations, medications, treatment, surgeries, and diagnostics services. If you are eligible for the Mahatma Phule Yojana scheme, you can avail yourself of a sum of Rs.1.5 lakh per year for your family’s healthcare expenses. The maximum sum insured is Rs.2.5 lakh in case of a renal transplant. Either you or your entire family can avail of annual coverage as per the scheme through cashless hospitalization. Read on to understand more about the Mahatma Phule Jan Arogya Yojana.

Eligibility criteria for the Mahatma Jyotiba Phule Arogya Yojana

Here is how you can qualify for the Mahatma Phule Yojana. 

• The policyholder should have a yellow, orange or white ration card, Annapurna Card, or Antyodaya Anna Yojana Card 
• The policyholder can be from a family living in the identified destitute districts of Maharashtra 
• The policyholder can be a farmer belonging to agriculturally distressed districts of the state

To apply for the Maharaja Jyotiba Phule Jan Arogya Yojana scheme, you can approach the nearest network, general, women, or district hospital.

Coverage under the Mahatma Jyotiba Phule Jan Arogya Yojana

The Mahatma Phule Yojana includes 971 therapies, procedures, and surgeries and 121 follow-up packages in 34 specialized categories. These include the following:

• Procedures to be performed by an empaneled government hospital or medical college
• General surgery, orthopedic surgeries and procedures, ENT surgeries, obstetrics and gynecology surgery, cardiac surgery, ophthalmology surgery, plastic surgery, radiation surgery, and pediatric surgery, among a few
• Medication and consultation post-hospitalization (can be covered for up to 10 days from the date of discharge)

Things not covered under the Mahatma Jyotiba Phule Jan Arogya Yojana 

Under this scheme, all the acceptable medical care will be provided to you, except in the cases of 131 planned procedures like hernia, cholecystectomy, abdominal or vaginal hysterectomy, and more. 

Mahatma Jyotiba Phule Jan Arogya Yojana disease list and treatments

While this is not a comprehensive list, it includes the major diseases and treatments you can avail of under the Mahatma Phule Yojana.

• Ophthalmology surgery 
• General surgery
• Surgical oncology
• Gynecology and Obstetrics Surgery
• ENT surgery
• Pediatric surgery
• Neurosurgery 
• Orthopedic Surgery and Related Procedures
• Genitourinary System
• Plastic surgery
• Cardiac and Cardiothoracic Surgery
• Burns 
• Medical oncology
• Prostheses 
• Nephrology 
• Infectious disease 
• Critical care 
• Dermatology
• General care 
• Cardiology 
• Pediatrics medical management 
• Pulmonology
• Polytrauma 
• Radiation oncology
• Rheumatology
• Endocrinology 
• Gastroenterology
• Interventional radiology 

Features of Mahatma Jyotiba Phule Jan Arogya Yojana

Here are the key highlights of the Mahatma Phule Jan Arogya Yojana.

• It comes with a sum insured of Rs.1.5 lakh and provides coverage of up to Rs. 2.5 lakh in case a renal operation is needed 
• All charges and coverage claims are paid by the state government with this health insurance. 
• The coverage is available on either individual or family floater basis.
• This scheme covers diagnostics, surgeries, and medications with follow-up consultations and treatment.
• Apart from government empaneled hospitals, you can avail of treatment at major private hospitals under this scheme.
• Pre-existing diseases are covered from the first day of coverage.
• It provides access to all the health camps conducted at government hospitals.

Steps to avail benefits under Mahatma Jyotiba Phule Jan Arogya Yojana

Here are the usual steps to get healthcare benefits under this scheme. 

• You need to visit the Aarogyamitra at the nearest network, women, general or district hospital to get started with your application.
• You will get a health card that you can show to a network hospital while availing of treatment.
• Along with this card, make sure you furnish a yellow or orange ration card or the Annapurna Card.
• Post verification, the treatment and hospital admission will get initiated.
• Your insurance company sends an e-authorization request, which is reviewed by MJPJAY.
• Once the request is approved after review, cashless treatment will begin.
• The hospital needs to share all the medical documents, and bills with the insurer for a timely settlement of the claim
• You can avail of free consultations and diagnostic services at the network hospital up to 10 days post discharge

For comprehensive coverage, you can apply for the Mahatma Jyotiba Phule Jan Arogya Yojana on the official government website. If you are not eligible, opt for health insurance from private insurers like Bajaj Finserv Health. Find a variety of plans under Aarogya Care and choose a suitable one according to your needs. With them, you can enjoy multiple healthcare benefits like preventive health check-ups, online consultation, network discounts, pre- and post-hospitalization coverage, and more. Get started now!