Mahatma Phule Jan Arogya Yojana @jeevandayee.gov.in
The insurance based scheme ‘Mahatma Jyotiba Phule Jeevandayeeni Yojana’ was initially introduced in the state of Maharashtra as the, ‘Rajiv Gandhi Jeevandayee Arogya Yojana’. Now, with some introduction of improvements to the scheme, the Maharashtra government has changed the name as ‘Mahatma Jyotiba Phule Jeevandayeeni Yojana’, by naming after the famous social reformer and also who is a writer from the Maharashtra Mahatma Jyotiba Phule, marking his 125th death anniversary this year.
|S.No||Things Need to know||Detailed Infomation|
|1||Scheme Name||Mahatma Phule Jan Arogya Yojana|
|2||State which Implemented this scheme||Maharashtra State Government|
|3||Scheme is the advanced version of the existing scheme||Rajiv Gandhi Jeevandayee Arogya Yojana|
|4||Financial benefits which can be availed by eligible person under this scheme||Rs. 1.5 L to Rs. 2 L|
|5||The Scheme also includes|
|6||Who are eligible||Farmers from 14 distressed districts|
This new scheme is implemented with all the new improvements to the old one, after changing all of its components lapsing in the month of October and the MoUs with insurance providers and third party administrators are till November this year.
The name of the scheme has been changed after it has been modified with the introduction of some new processes to make it more comprehensive to the downtrodden, who are the main target recipients of the scheme.
All the eligible beneficiary families can avail this insurance policy or coverage under this scheme in 34 districts of Maharashtra.
|Districts in which Jyotiba Phule Jeevandayeeni Yojana benefits can be availed||1. Gadchiroli
7. Mumbai & Mumbai Suburban
This scheme is implemented all over Maharashtra to improve the access to healthcare for the sections of below poverty line (BPL) and the above poverty line (APL) families in the society. The scheme is devised in such a way that a good high quality medical care is provided to the below poverty line (BPL) and the above poverty line (APL) (excluding White Card Holders as defined by Civil Supplies Department).
With this new scheme, the scope has been increased to 2.26 crore BLP and ALP families, farmers from 14 suicide prone districts, students in government hostels, working journalists and residents of destitute and old age homes. Moreover, the scheme also covers those deserving victims of road accidents for their hospital treatments at completely free of cost.
Antyodaya Anna Yojana card (AAY)
The NDA government led by Atal Bihari Vajpayee on 2000, launched this Antyodaya Anna Yojana (AAY) in order to provide subsisted quality food to poor people across the nation. Under this scheme families from below poverty line will hold yellow ration card and Antyodaya Anna Yojana card
Families from the BPL and also from the poor state holding yellow ration card or AAY card will be eligible to avail this health care insurance scheme. Except for those who are holding a white ration card are not eligible.
Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards
Rajiv Gandhi Jeevandayee Arogya Yojana run by the Maharashtra state government is a very popular health scheme. It covers health care facilities for people who are having annual income of less than 1 Lakh. Under this scheme, targeted poor families will be identified based on their annual income of the family and provide with rightful beneficiary cards like Annapurna/Yellow/Orange cards. Desired people should provide valid address and photo proof for availing this health cards.
The residents of Maharashtra, who owns medical care cards like Rajiv Gandhi Jeevandayee Arogya, Antyodaya Anna Yojana card (AAY) or by having yellow ration cards, are eligible to avail the benefits of this new health care insurance scheme .
Consequent Validations to Avail Benefits
In the following three situations, the consequent validations may be accepted for availing the scheme benefits:
- If the applicant has no health card or coloured ration card with them, he/she can avail new one by providing valid Aadhaar card. Health care scheme can be availed using Aadhaar card.
- If a child is born after the issue of the health card, and the child name is not included on the health card, then a photograph of the child with both parent and health card or yellow or orange ration card of parent and a birth certificate issued by the authorization office.
- Beneficiary photo identity must match with the provided all proofs along with the digitized list; else beneficiary would not be eligible to avail those health benefits.
When the scheme was initially implemented, its coverage was only limited to 971 ailments, which now, with the introduction of new scheme after name change, has been increased to 1,100 ailments, including the old age issues like sickle cell, hip and knee replacement, anaemia treatment, kidney transplant, orthopaedic implants and ontological, paediatric and geriatric treatments etc.
In addition, the improvements to the scheme also include the increase in the financial benefits from 1.5 lakh to 2 lakh and also from 2.5 lakh to 3 lakh in case of kidney transplantation.
|30 identified specialized categories cover the 1,100 ailments that are entailed in the scheme||1. General Surgery
2. ENT Surgery
3. Ophthalmology Surgery
4. Gynaecology and Obstetrics Surgery
5. Orthopaedic Surgery and procedures
6. Surgical Gastroenterology
7. Cardiac and Cardiothoracic Surgery
8. Paediatric Surgery
9. Genitourinary System
11. Surgical Oncology
12. Medical Oncology
13. Radiation Oncology
14. Plastic Surgery
|16. Poly Trauma
18. Critical Care
19. General Medicine
20. Infectious Diseases
21. Paediatrics Medical Management
30. Interventional Radiology
Procedure to be followed for treatment in network hospitals
- To attain the healthcare under the scheme, the beneficiary families can approach the near General, Women/District Hospital/Network Hospital, where the Arogyamitra will take care of those beneficiaries. Else, if the beneficiary approaches any Government Health Facility instead of the Network Hospital, then they will be handed over a referral card to the Network Hospital along with a preliminary diagnosis by the doctors. Instead, the beneficiaries can also attend any Health Camps conducted in their villages by the Network Hospital and can get that referral card based on the diagnosis. All the outpatient information and the cases referred in the General, Women/DH and in the camps will be gathered from all the Arogyamitra / Hospitals on a daily basis and stored in the dedicated database through a secure call center.
- Antyodaya card and all other identity card will be carefully examined by the officials of network hospital at the time of registration process of the beneficiary.
- After successful registration process, the desire patients would undergo necessary tests and diagnosis as per the governance of medical co coordinator of the network hospital.
- Based on the results of the diagnosis, the Network hospital admits the patient and then sends E-preauthorization request to the insurer.
- After a careful examination of the preauthorization request by the medical specialists of the insurer and the scheme, they approve the preauthorization after confirming that all the conditions are satisfied. This whole process would be completed within a time of 24 working hours and in case it is an emergency case, it would be done immediately.
- Then, the network hospital would provide the cashless treatment and surgery for the patient. These whole postoperative notes will then be updated on the website by the medical coordinator of the network hospital.
- After providing successfully medication to the patients, the concern network hospital would sent the relevant bills, case sheet and all other medical records related to the patients to the insurance company.
- All the above mentioned documents and details will be sent along with the doctor’s acknowledgement and also with satisfaction letter from the insured patients.
- The desired insurance companies will cross check those medical records and offer insurance amount to patients by including the transportation money for patients in order to compensate the money spend by the patient for travelling from home to hospital.
- After scrutinizing the bills, the insurer offers the approval for the sanctioning of the bill and will release the payment within the agreed upon duration according to the agreed upon package rates.
- Finally, the network hospital will provide free follow-up consultation, diagnostics, and medicines under the scheme up to 10 days from the date of discharge.
Offering such free cashless medical treatment for the poor people takes lots of positive credits among the people and also from the social activities. However, proper instructions must be provided to respective members in order to select only people from the Below Poverty Line.