- Details
- Benefits
- Eligibility
- Application Process
- Documents Required
- Frequently Asked Questions
- Sources And References
- Feedback
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Mahatma Jyotirao Phule Jan Arogya Yojana
Maharashtra
Details
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.
- 262 Health Benefits Packages for both schemes (for categories A to E)
- 119 Health Benefits Packages for both the schemes (for categories A to E)
- Bed charges in general wards.
- Nursing and boarding charges.
- Surgeons, anaesthetists, medical practitioners, and consultants' fees.
- 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).
- X-rays and diagnostic tests.
- Food for inpatients during hospitalization.
- 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.
Eligibility
- Road traffic accident victims from outside Maharashtra and outside India who met with an accident on roads in Maharashtra
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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Check Eligibility
Mahatma Jyotirao Phule Jan Arogya Yojana
Maharashtra
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