Throughout the state of Maharashtra, a scheme under the name of Rajiv Gandhi Jeevandayee Arogya Yojana was implemented in a phased manner for a total period of 4 years.
The Government determination was issued on the thirteenth of April 2017 with respect to the change of the name of the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) to Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) and the continuation of a similar plan from the first of April 2017.
The protection strategy/scope offered under the MJPJAY can be benefited by qualified recipient families dwelling in every one of the 36 areas of Maharashtra.
Table of Contents
- Objective of the scheme
- The benefits of the scheme
- Surgeries included within the scheme
- Who can avail the scheme?
- Documentation required to avail the scheme
- How does the scheme work?
- Steps to be followed when taking advantage of the scheme
- What does the scheme offer to the eligible families?
Objective of the scheme
- To enhance access to the families Below Poverty Line (BPL) or more Poverty Line (APL) families.
- To offer quality medicinal administer to distinguished forte administrations requiring hospitalization for surgeries and treatments or interviews through a recognized Network of human services suppliers.
The benefits of the scheme
The plan involves around 971 surgeries/treatments/methods alongside 121 follow up bundles in following 30 recognized specific classes have been mentioned below:
Surgeries included within the scheme
|4||GYNAECOLOGY AND OBSTETRICS SURGERY|
|5||ORTHOPEDIC SURGERY AND PROCEDURES|
|6||SURGICAL GASTRO ENTEROLOGY|
|7||CARDIAC AND CARDIOTHORACIC SURGERY|
|21||PEDIATRICS MEDICAL MANAGEMENT|
131 systems are to be performed just in empanelled open healing centre/government medicinal school subject to accessibility of office and technique is arranged.
Who can avail the scheme?
The families having a place with any of the 36 regions of Maharashtra and hold any of the accompanying cards
- Yellow proportion card
- Antyodaya Anna Yojana card (AAY)
- Annapurna card
- Orange proportion card.
Maharashtra 14 distressed districts with farmers
- Washim and
Excluded from the scheme
- Barring White Card Holders as characterized by Civil Supplies Department
Process for ID
The distinguishing proof for the ranchers from the 14 horticulturally upset areas of Maharashtra will be founded on the archives, for example, white apportion card or 7/12 extricate bearing the name of the recipient/leader of the family or declaration from the concerned Talathi/Patwari expressing that the recipient is an agriculturist or a relative of agriculturist with substantial picture ID confirmation of the recipient. Families with white ration cards from any other district would not be considered under the scheme.
Documentation required to avail the scheme
A legitimate proportion card Orange/Yellow/White Ration Card alongside your,
- Pan Card
- Aadhar Card
- Driving License
- Voter Id
- Nationalised Bank Passbook with Photo
- Impair Certificate
- School/College Id
- In country zones Tahsildar/alongside stamp and mark is there on Photo then it is acknowledged
- In Urban territories Tahsildar/Government, Local bodies alongside stamp and mark is there on Photo then it is acknowledged.
- Senior resident card issued by local and state administration Of India
- Freedom Fighter Id Card
- Defense ex-benefit card issued by Sainik board
- Marine Fishers Identity card (Issue by Ministry of Agriculture Government of Maharashtra).
- Photo ID is given by the Government of Maharashtra/India.
How does the scheme work?
- Prior existence of diseases under the plan
All Diseases under the proposed plot should be secured from the very first moment. A man experiencing ailment preceding the commencement of the approach should likewise be secured under affirmed methodology for that sickness.
Steps to be followed when taking advantage of the scheme
- Beneficiary families must approach nearby hospitals. Arogyamitra set in the clinics should encourage the recipient. In the event that recipient visits Government Health Facility other than the Network Hospital, he/she will be given a referral card to the Network Hospital with preparatory determination by the specialists. The Beneficiary may likewise go to the Health Camps being directed by the Network Hospital in the Villages and can understand that referral card in light of the analysis. The data on the outpatient and alluded cases in the General, Women/DH and the camps will be gathered from all Arogyamitra/Hospitals on standard premise and caught in the devoted database through a settled call focus.
- The Arogyamitra at the Network Hospital look at the referral card and well-being card or Yellow/Orange Ration Card, Annapurna or Antyodaya card enlist the patients and encourage the recipient to experience pro conference, preparatory conclusion, fundamental tests and confirmation handle. The data like affirmation notes, test was done will be caught in the committed database by the Medical Coordinator of the Network Hospital according to the prerequisite of the MJPJAY.
- The Network Hospital, in view of the conclusion, concedes the patient and sends E-preauthorization demand to the guarantor, same can be surveyed by MJPJAY.
- Perceived Medical Specialists of the Insurer and MJPJAY inspect the pre authorization ask for and affirm preauthorization, if, every one of the conditions is fulfilled. This will be done inside 24working hours and instantly if there should arise an occurrence of crisis wherein e-preauthorization is set apart as “EM”.
- The Network Hospital stretches out cashless treatment and surgery to the recipient. The Postoperative notes of the Network Hospitals will be refreshed on the site by the medicinal organizer of the Network Hospital.
- System Hospital in the wake of playing out the secured surgery/treatment/methodology advances the Originals charges, Diagnostics reports, Case sheet, and a Satisfaction letter from tolerant, Discharge Summary appropriately marked by the specialist, affirmation of instalments of transportation cost and other pertinent archives to Insurer for settlement of the claim. The Discharge Summary and follow-up points of interest will be a piece of the MJPJAY entrance.
- Safety net provider investigates the bills and gives an endorsement for the authorization of the bill and might make the instalment inside concurred period according to concurred bundle rates. The claim settlement module alongside electronic freedom and instalment entryway will be a piece of the work process in MJPJAY gateway and will be worked by the loaner. The reports will be accessible for investigation on the MJPJAY login.
- The Network Hospital will give free catch up discussion, diagnostics, and drugs under the plan up to 10 days from the date of release.
What does the scheme offer to the eligible families?
- The plan would give scope to all costs identifying with hospitalization to a recipient of up-to INR.1, 50,000/ – per family every year in any of the Empaneled Hospitals.
- The benefit may be availed by each family member on a floater basis.
- In the case of renal transplant surgery the therapy is required to be completed over the course of 1 year, so the amount given would be around 2, 50,000/- per operation.
The scheme would help save lives and give them a second chance to live a healthy and fruitful life along with their loved ones. The scheme would now allow the poor and medium sector people to avail expensive health options offered at the best hospitals in Maharashtra.