Organising Rajeev GAndhi Jeevandayi Yojna..

Dahiphale Hospital is offical centre for  Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

 

Scheme Details :

SCHEME OBJECTIVE:To provide cashless quality medical care to beneficiaries under the scheme for catastrophic illnesses requiring hospitalization for surgeries and therapies under identified specialty services through network of health care providers.

ABOUT SCHEME:

Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY):Mahatma Jyotirao Pule Jan Arogya Yojana is a flagship health insurance scheme of Government of Maharashtra. The scheme provides end to end cashless services for identified diseases through a network of service providers from Government and Private sector. The scheme earlier was known as Rajiv Gandhi Jeevandayee Arogya Yojana which was started from 2nd July,2012 in eight districts and then was expanded to 28 districts of Maharashtra from 21st November, 2013.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched by Government of India from 23rd September, 2018. AB-PMJAY was launched in the Maharashtra in integration with Mahatma Jyotirao Phule Jan Arogya Yojna and was implemented on mixed Insurance and Assurance Mode.

The Integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was launched in the state on 1st April, 2020. United India Insurance Company Limited (Public sector Undertaking Company) is providing health insurance coverage to beneficiaries under the insurance mode and State Health Assurance Society providing coverage on assurance mode. State Health Assurance Society is paying insurance premium of ₹ 797/- per family per year to Insurance Company in quarterly installment on behalf of eligible beneficiary families.

Mahatma Jyotirao Phule Jan Arogya Yojana is fully funded by Government of Maharashtra. Pradhan Mantri Jan Arogya Yojana is jointly funded by Government of India and Government of Maharashtra in the ratio of 60:40.

Insurer - Scheme was run by insurer National Insurance Company a Public Sector Undertaking Company from 02.07.12 to 31.03.20. From 01.04.20 Integrated Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) and Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is run by insurer United India Insurance Company a Public Sector Undertaking Company.

 

 

BENEFICIARIES :

1) Beneficiaries under Mahatma Jyotirao Phule Jan Arogya Yojana:

Categories Description of Beneficiaries
Category A Families holding Yellow ration card, Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange ration card (annual income up to INR 1 lakh) issued by Civil Supplies Department, Government of Maharashtra for 36 districts of Maharashtra.
Category B White ration card holder farmer families from 14 agriculturally distressed districts of Maharashtra (Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal, and Wardha).
Category C 1. Children of Government Orphanages, Students of Government Ashram Shala, female inmates of Government Mahila Ashram & senior citizens of Government old age homes.
2. Journalists & their dependent family members approved by DGIPR
3. Construction workers and their families having live registration with Maharashtra Building & other Construction worker Welfare Board .

2) Beneficiaries under Pradhan Mantri Jan Arogya Yojana: The households included are based on the automatic inclusion, deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. There are 83.72 lakh families in state. This data is frozen hence additional families cannot be added. However new members in existing families can be added.

Area Description of Beneficiaries
Urban For Urban area, 11 occupational criteria are identified as Rag pickers, Beggars, Domestic workers, Street vendors, Cobbler, hawkers, Construction workers, Plumbers, Masons, Painters, Welders, Sweepesrs Sanitation workesr, Mali, Home-based workers, Artisans, Handicrafts workers, Tailors, Transport workers, Drivers, Conductors, Helpers, Rickshaw pullers, Shop workers, Assistants, Peons, Attendants, Waiters, Electricians, Mechanics, Assemblers, Repair workers, Washer-men, Chowkidar.
Rural Rural Criteria for rural area are from D1 to D7 which include families with only one room with kachha wall and kachha roof, No adult member between age 16 to 59, Female headed household s with no adult members between age 16 to 59, Disabled member and no able bodied adult member, SC/ST households, Landless households deriving major part of income from manual casual labour. Automatically Included category includes Households without shelter, Destitute-living on alms, Manual Scavenger Families, Primitive Tribal Groups and Legally released Bonded Labour.

Eligibility and Identification:

1) Beneficiaries under Mahatma Jyotirao Phule Jan Arogya Yojana :

Categories Description of Beneficiaries
Category A All eligible families shall be identified with valid Yellow, Orange, Antyodaya, and Annapurna ration card (irrespective of date of issue of Ration Card or the inclusion of the beneficiary’s name therein) coupled with any Photo ID proof (as finalized by the Society).
Category B Eligibility for farmers from 14 agriculturally distressed districts of Maharashtra will be decided based on white ration card with 7/12 extract bearing the name of the beneficiary / head of the family or certificate from the nearest Revenue Officer stating that the beneficiary is a farmer or a family member of farmer with valid photo ID proof of the beneficiary.
Category C Eligibility of beneficiaries shall be decided on the basis of any identity card / health card or any other identification mechanism as decided by the State Health Assurance Society (SHAS).

Beneficiaries under Pradhan Mantri Jan Arogya Yojana:

Under PMJAY members from families registered under Social, Economic and Caste Census, 2011 (SECC) are eligible for getting benefits in all empaneled hospitals by showing computerized e-cards and photo identity card. Beneficiary of PMJAY from any state having e-card and photo identity proof can avail treatment at any empaneled hospital of any other state.

List of valid Photo Id proofs to be accepted along with document of eligible criteria :

1. Aadhaar Card / Aadhaar Registration Slip with photo of the beneficiary. Aadhaar Card would be insisted upon as identification document and in absence of Aadhaar card / number; any document which is accepted for issuance of Aadhaar card will also be accepted.
2. Pan Card
3. Voter Id
4. Driving License
5. School/College Id
6. Passport
7. Freedom Fighter ID card
8. Health Card of RGJAY / MJPJAY
9. Handicap Certificate
10. Nationalized Bank Passbook with Photo
11. Senior citizen card issued by Central Government or State Government
12. Defense ex-servicemen card issued by Sainik Board
13. Marine Fishery Identity card (Issued by Ministry of Agriculture / Fisheries Department Government of Maharashtra).
14. Any photo ID proof issued by Government of Maharashtra/ Government of India

Sum Insured on Floater basis:

Mahatma Jyotirao Phule Jan Arogya Yojana:

1. The scheme provides coverage for meeting all expenses relating to hospitalization of beneficiary up to ₹ 1,50,000/- per family per policy year. For Renal Transplant this limit has been enhanced up to ₹ 2,50,000 per family per policy year.
2. The benefit is available to each and every member of the family on floater basis i.e. the total coverage of ₹ 1.5 lakh or ₹ 2.5 lakh as the case may be, can be availed by one individual or collectively by all members of the family in the policy year.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY):

1. Ayushman Bharat PM-JAY provides a health cover of Rs. 5 lakhs per family per policy year for secondary and tertiary care hospitalization in any of empaneled hospitals across the country. The benefit is available to each and every member of the family on floater basis.

 

Come to Dahiphale Hospitals for more Details