Mahatma Phule Jan Arogya Yojana in Maharashtra 2020 (Health Insurance Scheme)

Mahatma Phule Jan Arogya Yojana in Maharashtra 2020 (Health Insurance Scheme) (Hospital List, Card, Check Status, Cashless, treatment disease list, Eligibility, Application form online portal, FAQ at @ jeevandayee.gov.in)

Apart from ensuring financial and food securities, it is the responsibility of the government to see that the common people have access to modern treatment facilities. Both central and state governments develop health and welfare schemes, which guarantee proper treatment at reasonable cost. However, people belonging to the weak socio-economic strata lack the financial resources to pay for sophisticated treatment procedures. Here, the state sponsored health insurance and cashless treatment schemes come to their rescue. The government of Maharashtra had launched the Mahatma Phule Jan Arogya Yojana to provide cashless treatment to the needy people. If you want to gather more information about the application process, eligibility, necessary documents and other details, then read this article.

Mahatma Phule Jan Arogya  Maharashtra health insurance scheme

Launch details of the scheme

Name of the scheme

Mahatma Phule Jan Arogya Yojana

Previous name of the scheme

Rajiv Gandhi Jan Arogya Yojana

Launched by

Prithviraj Chavan

Date of announcement

2012

Original date of implementation

2nd July, 2012

Implementation of revised scheme

1st April, 2017

Target beneficiaries

BPL, APL, and special ration card holders

Supervised by

State Health Assurance Society, Government of Maharashtra

Application mode

Offline registration process

Key features of the scheme

  1. Developing the medical sector – The Maharashtra government has always been keen on coming up with projects, which improve the medical infrastructure in the state. The development of this scheme is another successful attempt by the state authority.
  2. Better treatment for poor – The state government implemented this medical welfare scheme to make sure that the financially weak individuals are getting proper treatment, in government or selected private hospitals.
  3. Health insurance scheme – The project falls under the category of cashless medical insurance plan.
  4. Cashless treatment facility – The applicants will be allowed to obtain cashless treatment in the specified hospitals. The treatment expenses will be tackled by the Maharashtra government.
  5. Insurance coverage limit – Primarily, every beneficiary will be able to obtain cashless treatment up to Rs. 1.5 lakhs under this project. In case the beneficiary need complex surgeries or specialized treatment, the state government can increase the coverage sum to Rs. 2.5 lakhs to Rs. 3 lakhs.
  6. Premium amount and payment – The monthly premium of this cashless medical insurance scheme is Rs. 339 for every applicant. The state government will contribute this sum on behalf of the scheme beneficiaries.
  7. Span of insurance validity – It has been mentioned in the official draft of the scheme that the medical insurance coverage will remain active for one year. However, the beneficiary can go to the hospitals and renew the insurance plan without much hassle.
  8. Phase wise implementation – The state government wanted to include as many eligible people under this scheme. So, it was implemented in separate phases.
  9. Number of districts included – During the implementation of the first phase, only 8 districts were brought under the umbrella of this scheme. The number districts increased to 28 during the beginning of the second phase.
  10. Assured cashless treatments – The state medical board has mentioned around 971 diseases, which will come under the cashless treatment scheme. Apart from this, the beneficiaries will be entitled to attain free follow-up treatments of 121 types.
  11. Listed hospitals – The Maharashtra government has already published a list of government and private hospitals, which will be able to offer cashless treatment, under this project. The beneficiaries must go to the empaneled treatment facilities to obtain proper medical attention. The list contains the names of 1000 hospitals in the state.
  12. Easy application and claim procedures – The interested candidates will not have to worry about the application process. The health care agents at the hospitals will take care of the registration and benefit claim procedures on behalf of the applicant.
  13. Treating Coronavirus patients – The current Chief Minister of the state has mentioned that the COVID – 19 patients will be treated under this scheme.
  14. Insurance company – The Maharashtra government has signed a contract with the General Insurance Public Sector Association to pay for the cashless treatment of the beneficiaries.

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Eligibility for applicants

  1. It is mandatory for the applicants to be permanent and legal residents of Maharashtra.
  2. The scheme will allow the participation of such candidates who fall in the BPL and APL categories.
  3. Keeping in view the number of COVID – 19 patients, the Maharashtra Health and Welfare Department has announced that people from other financial backgrounds will also obtain cashless treatment.
  4. If the annual income of a person is less than or equal to Rs. 1 lakh, then he/she can become the beneficiary of this scheme.
  5. The individuals, who possess yellow and orange ration cards, will also be able to obtain the perks of this cashless medical treatment project.
  6. Antyodaya Anna Yojana Card (AAY) and Annapurna Card holders will also get the opportunity to enjoy the free treatment facility.

Documents necessary for registration

  1. It is necessary for the candidate to furnish an official document that highlights that he/she is a permanent and legal inhabitant of Maharashtra.
  2. The submission of the BPL and APL certificates is mandatory during the application process.
  3. The applicant can also produce the annual income certificate, issued by the local administrative officer.
  4. If the applicant has the yellow or orange ration card, then a copy of this pass must be submitted during enrollment.
  5. The beneficiaries of Antyodaya Anna Yojana Card (AAY) and Annapurna Scheme, who have the project registration passes, will also become beneficiaries of this cashless treatment scheme.

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How to enroll for the health insurance scheme?

  1. Offline registration – The Maharashtra government will allow offline enrollment for the convenience of the eligible applicants. However, one can gather scheme related details by logging on the official portal.
  2. Application in hospitals – If an interested and eligible candidate desires to enroll, then he/she must go to the nearest hospital that is in the empanelled list.
  3. Assistance of the agents – The staff of the hospitals have access to the online application form. These agents can fill in the form and complete the enrollment process.
  4. Verification of documents – It is necessary that the applicant carries all the necessary documents to the listed hospital, for the verification process.
  5. Submission and admission – Once the digitized form has been filled in, the hospital staff will submit the document. Once the verification conformation message is generated, the patient will be admitted in the hospital.

How to claim the benefits of the scheme?

  1. It is the responsibility of the hospital medical staff to keep details record of the treatment.
  2. A separate file for every scheme beneficiary must be maintained. Apart from the reports, the file will contain treatment expenditure receipts.
  3. After the treatment, the patient will be discharged from the hospital. A copy of the discharge certificate will be kept in the file.
  4. This file will be sent to the state health department. The officials will check these documents.
  5. After the assessment of these reports, the health department will issue an official order, directed towards the insurance company.
  6. The insurance company will deposit the specified fee in the bank account of the respective hospital’s bank account.

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Treatments covered under the scheme

Here are some of the diseases, which have been included in the scheme:

  1. ENT operations
  2. General surgeries
  3. Gynecological operations
  4. Obstetrics procedures
  5. Ophthalmology operations
  6. Orthopedic treatments
  7. Gastroenterological operations
  8. Cardiac treatment
  9. Cardiothoracic procedures
  10. Neurosurgeries
  11. Special treatment for infants and children
  12. Genitourinary treatments
  13. Medical oncology
  14. Surgical oncology
  15. Radiation therapy for cancer treatment
  16. Treatment for polytrauma
  17. Treating burn victims
  18. Prostheses treatment
  19. Plastic surgeries
  20. Critical care procedures
  21. General medicine
  22. Pediatrics Treatment management
  23. Endocrinology
  24. Medical management for infectious diseases
  25. Nephrological procedures
  26. Gastronomical organ treatment
  27. Interventional radiology

FAQ about the scheme

From where can one obtain more information about the scheme guidelines?

Ans: If a person wants to obtain more information about Mahatma Phule Jan Arogya Yojana, then he/she can log in on the official portal by clicking on the Link.

What is the beneficiary has been diagnosed in a non-listed hospital?

Ans: If the beneficiary of this scheme has been diagnosed in a non-empaneled treatment center, the patient will need a referral card, and must continue treatment in a listed hospital.

What is the helpline number for the scheme?

Ans: The Maharashtra government has launched two separate helpline numbers for the scheme. These are 155 388 and 1800 233 22 00.

Can children get the benefits of this scheme?

Ans: Yes. The children, belonging to the registered beneficiary household will be able to receive cashless treatment.

Will the beneficiary get post-hospitalization expenses?

Ans: Yes. Every beneficiary will obtain financial assistance as a part of post-hospitalization perks for a span of 10 days.

There are various medical welfare projects, which have been launched by the Maharashtra authority. However, official reports highlight that the popularity of the Mahatma Phule Jan Arogya Yojana has surpassed others. The scheme is still active in the state.

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