Mahatma Jyotiba Phule Jan Arogya Yojana
About the Mahatma Jyotiba Phule Jan Arogya Yojana
There has been a rapid increase in medical inflation thereby making it impossible for one to opt for quality treatment. Every household does not have an emergency fund that will help in case of hospitalization. The number of diseases existing in this world is around 10,000, and there are known cures available for only 500. The odds of falling prey to diseases are very high in the modern world. To protect oneself financially, the topic of insurance came into the picture. A health insurance policy helps you save today for a better future thereby, not making you worry in case of facing a dreadful disease.
After the introduction of insurance, many numbers of companies began coming up with different insurance plans thereby increasing the competition. It has become difficult for one to choose the best alternative now. Even though insurance helps you but it is until one realizes that to opt for the benefit money is paid from your pocket itself. Not every person can afford a full-fledged insurance plan. In India, many people are less aware of this subject thereby do not bother finding it too. To increase awareness and show support, the government of Maharashtra launched a scheme called Mahatma Jyotiba Phule Jan Arogya Yojana Scheme.
Let us understand the scheme in detail.
The scheme was launched in the state of Maharashtra by the State Government in July 2012. The scheme was earlier known as the Rajiv Gandhi Jeevandayee Arogya Yojana. The scheme’s name changed on 01st April 2017 to the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme. The motive of issuing such a plan is to allow individuals to receive the necessary treatment on facing a serious health condition. It helps the beneficiaries to receive hospitalization under the scheme. Apart from normal hospitalization, the scheme also provides covid-19 protection for the beneficiaries. The treatment received under this scheme is cashless.
The beneficiaries will receive a sum insured of up to Rs.150,000 that can be used for availing treatment from the network of government hospitals as well as private players. In 2012, the scheme covered only 8 districts, and later on, in the year 2013, the benefits were extended up to 28 districts of Maharashtra. The sum insured can be used up by either an individual or the entire family in one year. Any costs incurred beyond the sum insured need to be borne by the beneficiary from their pockets.
The scheme has been launched with the motive of providing necessary financial support to underprivileged families. People must have in-depth knowledge about the benefit they can opt for.
- Network of hospitals: The Mahatma Jyotiba Phule Jan Arogya Yojana Scheme consists of a certain network of hospitals that are mainly linked to government health care. It is also called government empanelled hospitals. On the other hand, one can also opt for private hospitalization. This scheme allows you to avail complete cashless services.
- Hospitalization: In case one faces an emergency and needs to be admitted to a hospital, then the expenses incurred for hospitalization are covered under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme. As mentioned, the policy only provides one method of payment that is availing the cashless benefit, and thus the beneficiary does not have an alternative of reimbursement. The maximum sum insured under this scheme is Rs.150,000. If the beneficiary is undergoing a renal transplant, then the maximum sum insured offered is Rs.250,000.
- Pre-existing conditions: In regular health insurance purchased from huge players, the policy provider asks the customer to serve a certain waiting period for getting their pre-existing conditions covered. Diseases like diabetes, thyroid, blood pressure, and any heart disease are complicated situations for which generally a waiting period of 1 to 4 years is served. In this case, the scheme guarantees coverage for the pre-existing conditions since day one. It means no waiting period clause has been reinstated.
- Health camps: Various government hospitals set up health camps from time to time. It helps people understand their health condition and thereby maintain it. Under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme, you can avail the benefit of getting yourself checked.
- Post-hospitalization: After getting oneself treated, a sort of weakness yet is inside you for which regular check-ups are required. For the same reason, after receiving discharge from a hospital post-hospitalization expenses are incurred. The various expenses included in post-hospitalization are doctor’s visits, tests, medicine, and more. Under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme, post-hospitalization expenses are covered for ten days. Any expenses incurred post those ten days are not covered.
- Conditions covered: The Mahatma Jyotiba Phule Jan Arogya Yojana Scheme covers up to 971 surgeries or therapies or procedures as well as another 121 follow-up packages. It is easily noticeable that the coverage offered has a huge scope.
- Ambulance charges: When a person falls sick and has a serious health condition then they need to be admitted to a hospital. While going to the hospital, you need to make it quick although many cases have been reported in the past stating that due to not rushing to a hospital, the person could not be saved. To review this entire situation, the concept of the ambulance was introduced. In emergencies, if one avails the benefits of an ambulance then the costs incurred for the same are not covered under Mahatma Jyotiba Phule Jan Arogya Yojana Scheme.
- Certain procedures: Even though the plan covers around 971 procedures/therapies/surgeries and around 121 follow-up packages certain conditions are not covered under this scheme. Some of the procedures that are excluded are hernia, virginal or abdominal hysterectomy, discectomy, and another 110 planned exclusions.
- Cosmetic surgeries: Any surgery that occurs for self-improvement such as obesity treatment or getting a nose job, is not covered under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme. Plastic surgery or more is covered only in case, any harm is caused due to a specific injury or ailment.
- Self-harm: Any treatment required by an individual on the grounds of causing oneself harm, costs will not be covered under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme.
The service provided by the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme is an additional benefit being provided. The treatments used by the individual or family are granted by the government and so a wide usage of the policy has not been done yet. With calculating the ratings of the reviews provided on insurancedekho.com it is an assumption that an average of 4.6 stars can be granted. With a wider data search, the ratings may differ. Some of the reviews are –
- Provides necessary financial support.
- Empowers people belonging to the underprivileged part of society.
- Better benefits. For example – having pre-existing diseases covered from day one.
- Huge initiative by the state of Maharashtra.
- Helping people face medical conditions without worrying about not being able to afford treatments.
Mahatma Jyotiba Phule Jan Arogya Yojana FAQs
What are the eligibility criteria for enjoying the benefit offered under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme?
A person belonging to any of the below-mentioned points are allowed to apply for or are eligible for the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme –
Families belonging to the extremely poor or lacking part of the state. It can also be an entire district falling under this category.
Farmers belonging to agriculturally distressed districts.
A person having a valid white/yellow/orange ration card along with an Annapurna card and Antyodaya Anna Yojana Card (AAYC).
What are the documents required to enrol oneself?
The documents required for applying for the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme are mainly for a Know Your Customer (KYC) basis. The most crucial document here is a person’s ration card. The beneficiary needs to have a white/yellow/orange ration card. Along with the ration card, another document required is identification proof. From the various mentioned documents below, anyone needs to be provided –
Senior citizen card issued by a bank
And more options are available, but the most basic necessity here is that any photo/proof ID has to be submitted that is issued by the Government of Maharashtra or the Government of India.
What is the claim filing procedure under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme?
Having a hassle-free claim process is a big yes for everyone, and so the claim filing procedure under the Mahatma Jyotiba Phule Jan Arogya Yojana Scheme is very simple. In normal conditions, the disease is diagnosed at a government empanelled hospital (also known as a network hospital). Once the diagnosis is positive, a pre-authorization form is sent by the insurance company to begin the beneficiary’s treatment. In another situation, if the disease is diagnosed at a non-empanelled hospital, then the beneficiary receives a referral code of beginning their treatment at a network hospital.
The treatment of the beneficiary begins only when approval has been received from the insurance provider. The beneficiary can enjoy the benefit of cashless hospital treatment. On completion of the treatment, the hospital hands over all the necessary documents such as hospital bills, medical reports, discharge summary, and more. The beneficiary has to then file a claim, and on approval, he can also avail the benefit of post-hospitalization expenses being covered for 10 days.