State governments all over the country have incorporated multiple schemes to protect the livelihoods of poor families. Mahatma Jyotiba Phule Jan Arogya Yojana is one such health insurance cover established by the Government of Maharashtra. This policy was originally introduced as Rajiv Gandhi Jeevandayee Arogya Yojana, and it was renamed by the Government on April 1, 2017. This cover focuses on providing quality medical insurance access at an affordable price to below poverty line (yellow ration card) and marginally above poverty line (orange ration card) policyholders. This is also a surgicare cover that offers protection against various surgical procedures.
The following eligibility criteria applies to people who wish to enroll themselves in Mahatma Jyotiba Phule Jan Arogya Yojana.
Some of the key features of Mahatma Jyotiba Phule Jan Arogya Yojana can be listed as follows:
|Benefits offered||Extent of coverage|
|Surgeries/procedures/therapies covered by this scheme||971 types in 30 identified specialized categories|
|Follow-up procedures covered||121 types in 30 identified specialized categories|
|Follow-up consultation, diagnosis, medicines, etc.||Covered for up to 10 days after discharge from hospital|
|Categories covered for surgeries||Some of the categories covered for surgeries include plastic surgery, ENT surgery, cardiology, neurology, radiation therapy, critical care, burns, infectious diseases, etc.|
|Government reserved procedures||132 types (these procedures are to be performed only in empanelled government hospitals or government medical colleges)|
|Upper limit for renal failure||Rs.2.5 lakh per operation|
There are no outright exclusions provided under this scheme. All reasonable medical conditions can be treated under this policy. There are some conditions set forth for availing treatments of certain kinds. For instance, conditions like hernia and appendicitis will not be covered by this policy unless it is an emergency.
The claim procedure for this policy starts with the diagnosis of the condition. If the diagnosis is made in a network hospital, treatment for the procedure will begin immediately after getting the pre-authorisation. However, if the diagnosis is made in a hospital that is not a network facility, a referral card will be given for commencing the treatment in a nearby network hospital. Network hospitals can now obtain E-preauthorisation from the insurer by filing a request online.
Once the pre-authorisation is obtained from the insurer, the network hospital will begin the treatment. Upon completion of the cashless treatment and surgery, the network hospital will send all the relevant documents including diagnostic reports, medical bills, and discharge summary to the insurer. The insurer will verify all the documents and provide approval for the claim settlement to the network facility. After the surgery, the network hospital will provide follow-up consultation, diagnosis, and medicines free of charge for a period of 10 days.
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