Mahatma Jyotiba Phule Jeevandayeeni Yojana

 

Mahatma Jyotiba Phule Jeevandayeeni Yojana

The insurance based scheme Mahatma Jyotiba Phule Jeevandayeeni Yojanawas 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 Jyotiba Phule Jeevandayeeni 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
7 Official Website www.jeevandayee.gov.in

Mahatma Jyotiba Phule Jeevandayeeni Yojana

Schemes Purpose

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

2. Amravati

3. Nanded

4. Sholapur

5. Dhule

6. Raigad

7. Mumbai & Mumbai Suburban

8. Akola

9. Buldhana

10.  Yavatmal

11. Washim

12. Aurangabad

13. Beed

14. Hingoli

15. Jalna

16. Latur

17. Osmanabad

18. Parbhani

19. Thane

20. Ratnagiri

21. Sindhudurga

22. Bhandara

23. Chandrapur

24. Gondia

25. Nagpur

26. Wardha

27. Ahmednagar

28. Jalgaon

29. Nadurbar

30. Nashik

31. Kolhapur

32. Pune

33. Sangli

34. Satara

Eligible People

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:

  1. 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.
  2. 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.
  3. 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.

Coverage

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

10. Neurosurgery

11. Surgical Oncology

12. Medical Oncology

13. Radiation Oncology

14. Plastic Surgery

15. Burns

16. Poly Trauma

17. Prostheses

18. Critical Care

19. General Medicine

20. Infectious Diseases

21. Paediatrics Medical Management

22. Cardiology

23. Nephrology

24. Neurology

25. Pulmonology

26. Dermatology

27. Rheumatology

28. Endocrinology

29. Gastroenterology

30. Interventional Radiology

Procedure to be followed for treatment in network hospitals

  1. 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.
  2. 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.
  3. 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.
  4. Based on the results of the diagnosis, the Network hospital admits the patient and then sends E-preauthorization request to the insurer.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.

Conclusion:

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.

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