Mahatma Jyotirao Phule Jan Arogya Yojana

Description
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.

Exclusions
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Benefits
• 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.

Eligibility Criteria
1. **Category A:** Families holding Yellow, Antyodaya Anna Yojana (AAY), Annapurna Yojna and Orange Ration Card.
2. **Category B**
3. • White ration card holder families (including Govt./Semi Gov employees).
4. • A family without having any kind of ration card but having domicile certificate of Maharashtra
5. **Category C**
6. • Students in Govt. and Govt. recognized Ashram School
7. • Children in Govt. and Govt. recognized Orphanages
8. • Women in Govt. and Govt. recognized Women&#39;s Ashram
9. • Sr. citizens in Govt. and Govt. recognized old age homes
10. • Journalists and their dependent family members as per criteria of Directorate General of Information and Public Relations Office.
11. • Construction workers and their families (who are resident of outside of Maharashtra) registered with Maharashtra Building and Other Construction Workers Board.
12. **Category D**
13. - Road traffic accident victims from outside Maharashtra and outside India who met with an accident on roads in Maharashtra
14. **Category E**
15. Families holding below mentioned ration cards from 865 villages of Belgaon, Karwar, Kalburgi and Bidar Districts of Maharashtra- Karnataka border
16. 1) Antyodaya Anna Yojana (AAY)
17. 2) Priority House Holder (PHH)
18. 3) Annapurna Yojna

Required Documents
• **List of valid photo ID proofs to be accepted along with document of eligible criteria:**
• Aadhaar Card or Aadhaar Registration Slip with a photo of the beneficiary. An Aadhaar Card would be insisted upon as an identification document and in the absence of an Aadhaar card/number; any document that is accepted for issuance of an Aadhaar card will also be accepted.
• 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 Government of Maharashtra).
• Any photo ID proof issued by the Government of Maharashtra/ Government of India

Frequently Asked Questions
Q: What is the full form of MJPJAY?
A: MJPJAY's full form is Mahatma Jyotiba Phule Jan Arogya Yojana.

Q: When was MJPJAY started?
A: MJPJAY was launched in 28 districts of Maharashtra on April 1st, 2020.

Q: What is the objective of MJPJAY?
A: 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.

Q: How much assistance is available under MJPJAY Yojana?
A: 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.

Q: Who is eligible for receiving Maintenance Haemodialysis treatment under MJPJAY?
A: 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.

Q: Which services are provided under package of Maintenance Haemodialysis under MJPJAY for the patient?
A: 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

Q: What should be frequency of dialysis cycles under MJPJAY for each approved preauth?
A: 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.

Q: Does patient have to pay any extra money for treatment?
A: No. The patient should not pay any extra money to the hospital or center for services that are covered under the approved package.

Q: Will Balance Sum Insured used for dialysis patient limit other household members to avail services under MJPJAY?
A: 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/-)

Q: Can HIV or HCV positive cases avail Maintenance Haemodialysis service under MJPJAY ?
A: 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.

Q: If patient requires blood transfusion, is cost of blood transfusion covered under package?
A: No. Maintenance Haemodialysis package does not cover the cost of a blood transfusion.

Q: In case of a query or to register a complaint what should I do ?
A: 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.