MJPJAY

Mahatma Jyotirao Phule Jan Arogya Yojana

The Mahatma Jyotirao Phule Jan Arogya Yojana, launched by the Government of Maharashtra, offers cashless treatment for identified diseases through a network of government and private healthcare providers.

राज्य नकद

राज्य / केंद्र शासित प्रदेश: महाराष्ट्र

नोडल विभाग: Public Health and Family Welfare Department

योजना किसके लिए: Family

योजना प्रोफ़ाइल

डीबीटी (प्रत्यक्ष लाभ अंतरण): नहीं

श्रेणियाँ: स्वास्थ्य और कल्याण

उप-श्रेणियाँ: Disease and conditions, Health care providers and access, Medicine and health products, वित्तीय सहायता, Medical insurance, Health Insurance

लक्षित लाभार्थी: व्यक्तिगत

टैग: Hospital, Health Insurance, Cashless Service, Diseases, Hospital

विवरण

The Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY), launched by the Government of Maharashtra under Public Health and Family Welfare Department,The scheme provides cashless medical services for secondary and tertiary treatments through empaneled hospitals. Initially targeted at low-income families, the scheme now covers all families in the state, offering up to ₹1.5 lakh under MJPJAY and ₹5 lakh under Ayushman Bharat annually. From 1st July 2024, it ensures comprehensive, cashless healthcare for the entire population of Maharashtra.

लाभ

- Health Coverage for Categories A to E (Excluding D): ₹5lakhs per family per year on a floater basis under both schemes.- Health Coverage for Category D: ₹1lakh per person per year. Medical Benefits • For categories A to E (Excluding D) - 1356 Health Benefits Packages under 34 specialities. • For category D – 184 Health Benefits Packages for Road accident patients. Follow-up treatment 262 Health Benefits Packages for both schemes (for categories A to E) Treatment Reserved for Govt. Hospitals 119 Health Benefits Packages for both the schemes (for categories A to E) Benefits under Health Packages The health packages provide comprehensive coverage, ensuring a cashless treatment experience for patients. The benefits include: Hospitalization Costs
Bed charges in general wards
Nursing and boarding charges
Surgeons, anaesthetists, medical practitioners, and consultants& 39; fees. Medical Expenses
Charges for oxygen, O.T., and ICU facilities
Cost of surgical appliances, drugs, disposables, consumables, implants, and prosthetic devices
Expenses for blood transfusion (as per State Government policy). Diagnostics and Support Services
X-rays and diagnostic tests
Food for inpatients during hospitalization. Transportation Costs
One-time transport cost by State Transport or second-class rail fare from the hospital to the patient’s residence

Health Coverage for Categories A to E (Excluding D): ₹5 lakhs per family per year on a floater basis under both schemes.- Health Coverage for Category D: ₹1 lakh per person per year.

Medical Benefits
• For categories A to E (Excluding D) - 1356 Health Benefits Packages under 34 specialities.
• For category D – 184 Health Benefits Packages for Road accident patients.
Follow-up treatment

262 Health Benefits Packages for both schemes (for categories A to E)

Treatment Reserved for Govt. Hospitals

119 Health Benefits Packages for both the schemes (for categories A to E)

Benefits under Health Packages
The health packages provide comprehensive coverage, ensuring a cashless treatment experience for patients. The benefits include:
Hospitalization Costs

Bed charges in general wards.
Nursing and boarding charges.
Surgeons, anaesthetists, medical practitioners, and consultants' fees.

Medical Expenses

Charges for oxygen, O.T., and ICU facilities.
Cost of surgical appliances, drugs, disposables, consumables, implants, and prosthetic devices.
Expenses for blood transfusion (as per State Government policy).

Diagnostics and Support Services

X-rays and diagnostic tests.
Food for inpatients during hospitalization.

Transportation Costs

One-time transport cost by State Transport or second-class rail fare from the hospital to the patient’s residence.
In the unfortunate event of a patient's death, the cost of transporting the deceased's body from the network hospital to their village or township.
The package covers all costs from the date of reporting to discharge, including treatment complications, ensuring a truly cashless experience for patients.

Scheme on Assurance Mode
The Integrated Scheme is being implemented on an Assurance Basis. This means that the claims of the network hospitals for the expenses of the patients undergoing treatment under the scheme are being paid directly by the State Health Assurance Societies to the respective network hospitals. Accordingly, the State Health Assurance Society is paying claims up to ₹5 lakh per family per year of groups A, B, C and E and ₹1 lakh per person per year for road accident victims of group D.

पात्रता

Category A: Families holding Yellow, Antyodaya Anna Yojana (AAY), Annapurna Yojna and Orange Ration Card.
Category B
• White ration card holder families (including Govt./Semi Gov employees).
• A family without having any kind of ration card but having domicile certificate of Maharashtra
Category C
• Students in Govt. and Govt. recognized Ashram School
• Children in Govt. and Govt. recognized Orphanages
• Women in Govt. and Govt. recognized Women's Ashram
• Sr. citizens in Govt. and Govt. recognized old age homes
• Journalists and their dependent family members as per criteria of Directorate General of Information and Public Relations Office.
• Construction workers and their families (who are resident of outside of Maharashtra) registered with Maharashtra Building and Other Construction Workers Board.
Category D

Road traffic accident victims from outside Maharashtra and outside India who met with an accident on roads in Maharashtra

Category E
Families holding below mentioned ration cards from 865 villages of Belgaon, Karwar, Kalburgi and Bidar Districts of Maharashtra- Karnataka border

Antyodaya Anna Yojana (AAY)
Priority House Holder (PHH)
Annapurna Yojna

अपवर्जन

आवेदन प्रक्रिया

Offline

Step 1: The interested applicant should visit the any Govt./Pvt. network hospital in State, and request the hard copy of the prescribed format of the application form from the concerned authority.
Step 2: In the application form, fill in all the mandatory fields, paste the passport-sized photograph (signed across, if required), and attach copies of all the mandatory documents (self-attest, if required).
Step 3: Submit the duly filled and signed application form along with the documents, within the prescribed period (if any), to the authority.
Step 4: Request a receipt or acknowledgement from the concerned authority to whom the application has been submitted. Ensure that the receipt contains essential details such as the date and time of submission, and a unique identification number (if applicable).
NOTE: Ensure that the application is submitted within the prescribed period, if any.
> 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.

स्पष्टीकरण

myScheme पर प्रकाशित योजना सूचना से अतिरिक्त बिंदु (कानूनी सलाह नहीं)।

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.

आधिकारिक लिंक

संदर्भ

आवेदन करें

अभी आवेदन करें

Hospital Health Insurance Cashless Service Diseases Hospital

आधिकारिक आवेदन या कार्यक्रम पोर्टल नए टैब में खुलता है। संदेह हो तो मंत्रालय की साइट पर विवरण सत्यापित करें।

Documents Required for Government Schemes

Most government schemes require basic documents for verification. While the exact requirements vary, common documents include:

Aadhaar Card
Income Certificate
Caste Certificate (if applicable)
Residence Proof
Bank Account Details
Educational Certificates (for student schemes)

How to Apply for Government Schemes?

The application process for government schemes may be online or offline depending on the scheme. In most cases, you can follow these steps:

Check eligibility criteria
Collect required documents
Fill the application form
Submit the application online or at the relevant office
Track application status

यह पृष्ठ सार्वजनिक व आधिकारिक स्रोतों से योजना सूचना का सार प्रस्तुत करता है। यह कानूनी, वित्तीय या व्यावसायिक सलाह नहीं है; अधूरी या पुरानी हो सकती है; तथा सरकारी अधिसूचनाओं का स्थान नहीं लेती। आवेदन या निर्भरता से पहले पात्रता, लाभ व आवेदन चरण आधिकारिक पोर्टल या परिपत्र पर अवश्य सत्यापित करें।

हिन्दी चुनने पर साइट पर मेनू, बटन, फ़िल्टर और जहाँ उपलब्ध हो श्रेणी नाम हिन्दी में दिखाए जाते हैं। योजना का मुख्य पाठ (शीर्षक, विवरण, पात्रता, दस्तावेज़ आदि) स्रोत की भाषा में रहता है—अक्सर अंग्रेज़ी—जब तक आधिकारिक द्विभाषी या हिन्दी संस्करण उपलब्ध न हो।