- Date : 15/06/2020
- Read: 4 mins
Maharashtra Government’s health insurance scheme for low-income families is making quality health care more accessible than ever.
With health issues constantly on the rise, having access to affordable healthcare has become an important concern for everyone. However, for those who are from the lower socio-economic backgrounds, healthcare support avenues are few and generally expensive. To help change that, the Government of Maharashtra introduced the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) back in 2012.
The scheme's primary goal is to provide free medical care to low-income families. It was renamed in 2017 and is now known as Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). It is supervised by the State Health Assurance Society, Government of Maharashtra.
People eligible under the MJPJAY scheme get a health insurance cover of up to Rs. 1.5 lakh every year. The premium of Rs. 333 is paid by the Government of Maharashtra. The sum insured can be claimed by the individual or by the whole family on a floater basis.
- All families and individuals who are below the poverty line and hold a yellow ration card.
- All families and individuals who are slightly above the poverty line and hold an orange ration card.
This health insurance scheme is for people who earn less than Rs. 1 lakh annually. Their family members can be covered as well, and there is no upper age limit.
In addition to the yellow or orange ration card, the individual also needs to submit their Aadhaar card. In case they do not have an Aadhaar card, they can present any other form of identity proof authorised by the Government of India. This could include the PAN card, voter’s ID card, etc.
As a government scheme designed to help low-income families by providing free, fair and quality healthcare, the MJPJAY has multiple unique features. The primary ones are as follows:
- Diagnosis, surgery, medication and follow-up consultations are all covered.
- There is no waiting period or exclusion for pre-existing diseases.
- While there are some illnesses and procedures like hernia and appendicitis that are excluded, treatment will be provided if it’s an urgency.
- Cashless treatment is available at network hospitals.
- Network hospitals include both government and private hospitals. The State Health Assurance Society’s official website has a list of network hospitals.
- Patients with the relevant health card can get kidney transplants for free.
- All beneficiaries can access a free medical camp on a yearly basis.
- The scheme can be utilized by an individual or the entire household as family floater
- There are about 971 types of surgeries, procedures and therapies covered. All these are segregated under 30 categories. These include general surgery, paediatric surgery, cardiac and cardiothoracic surgery, radiation oncology, plastic surgery, etc.
- 132 types of such procedures are reserved and can only be performed in empanelled government hospitals.
- There are about 121 follow-up procedures in the 30 specialised categories.
- Follow-up consultation and medicines are covered for up to 10 days from discharge date.
- Rs. 2.5 lakhs is the upper limit for a renal transplant operation.
Performance of MJPJAY
When launched in 2012, the Mahatma Jyotiba Phule Jan Arogya Yojana covered only eight districts in Maharashtra. By the end of 2013, the scheme covered all of Maharashtra. Ever since then, MJPJAY has been working on improving its reach and offerings.
As per the Maharashtra Government’s records:
|Year||Surgeries/therapies conducted||Expenditure incurred|
|2019-2020||4.4 lakhh||INR 906.96 crore|
|2018-2019||5.51 lakh||INR 1,089.03 crore|
|2017-2018||4.95 Lakh||INR 1,006.72 crore|
The central government launched Ayushman Bharat, the National Health Protection Mission, in September 2018. This scheme will further help the Government of Maharashtra to offer accessible healthcare to all its residents. Check out these additional government social welfare and health schemes, along with their eligibility criteria here.