Health Insurance Government Scheme III

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          Health Insurance Government Scheme III

In this  Post Health Insurance Government Scheme III , We will discuss State Government Scheme (Maharashtra and Kerala) which will benefit for the Poor and under privileged section of the society.

  • Mahatma Jyotiba Phule Jan Arogya Yojana
  • Karunya Health Scheme

 

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Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

 

Mahatma Jyotiba Phule Jan Arogya Yojana/Scheme (Health Insurance Government Scheme III) was Introduced in Maharashtra on 2nd July 2012. It was firstly introduced in 8 districts and later expanded its scheme on 28 districts of Maharashtra till 21st Nov 2013.

Previously It was called Rajiv Gandhi Jeevandayee Arogya Yojana. The main objective of this scheme is to provide free medical care to underprivileged /weaker section/poor people in Maharashtra (who cannot afford medical emergencies). It also provides cashless services for certain diseases in empaneled private and government hospitals of Maharashtra.

This Scheme covers all medical care expenses during hospitalization with sum insured of Rs. 1,50,000 per annum. A sum of Rs. 1.50 lac per annum can be availed by the individual/beneficiary or entire family through cashless hospitalization.

 

Diseases & Treatment covered under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY)

This Yojana/Scheme covers the following diseases and treatment. It also covers all Pre-existing diseases from day one. Below is the details of diseases covered

 

ENT Surgery

Gynecology and Obstetrics Surgery

Cardiac and Cardiothoracic Surgery

Medical Oncology

Surgical Oncology

Radiation Oncology

Infectious Diseases

Nephrology

Dermatology

Gastroenterology

General surgery

Surgical Gastroenterology

Genitourinary System

Plastic Surgery

Neurosurgery

Prostheses

General Medicine

Cardiology

Pulmonology

Endocrinology

Ophthalmology surgery

Orthopedic Surgery and Procedures

Pediatric Surgery

Burns

Critical care

Polytrauma

Pediatrics Medical Management

Neurology

Rheumatology

 Interventional Radiology

 

 

 

Diseases not covered under MJPJAY

It covers all acceptable medical care except planned 131 procedures such as cholecystectomy, hernia, discectomy, vaginal or abdominal hysterectomy, appendectomy etc.

This is treated/performed under Government empaneled hospitals or Government Medical Colleges.

 

Salient Features of MJPJAY

Some of the Main/Salient Features of this Scheme are as follows:

  • This Scheme is utilized by an Individual or Family on a Floater basis.
  • The Health Insurance premium and coverage is covered by State Government (Maharashtra).
  • The Sum Insured is Rs. 1,50,000 per annum per family.
  • All Pre-existing diseases are covered since day one.
  • Not only Government hospitals, but also Private hospitals are also empaneled for this Scheme so that so that the program gets massive coverage.
  • The Beneficiaries have access to various health camps conducted by various empaneled hospitals.

 

 Benefits of MJPJAY Scheme

This Scheme offers several benefits to BPL and Above Partial Poverty Line Families. Below is some of the Benefits floated by the State Government            

  • The MJPJAY scheme covers 971 types of surgeries/therapies/procedures in 30 Specialized Categories and also covers 121 types of follow up procedures in 30 specialized categories.
  • There were 132 Government Reserved procedures which were only performed by Government Empaneled Hospitals.
  • The Beneficiary can Transplant Kidney at Rs. 2,50,000/

 

Eligibility to avail this MJPJAY Scheme

The Candidate have to meet certain criteria for being the Beneficiary of this Scheme. Below is the criteria

  • The candidate must hold White/Orange/Yellow Ration Card, Annapurna card or Antyodaya Anna Yojana Card
  • Families (BPL/APL) who are a part of Identified Distressed Districts in Maharashtra.
  • Farmers from agriculturally distressed districts like Akola, Amaravati, Aurangabad, Hingoli, Buldhana, Latur, Jalna, Nanded, Osmanabad, Wardha, Parbhani, Washim and Yavatmal. The identification of farmers from distressed districts is done by seeing their White Ration card of the Beneficiary or the Head of the family or Certificate from the concerned Patwari or Talathi.

 

 Documents Required for Applying in this Scheme

 The candidate must have a Ration card (White/Yellow/Orange) and Apart from this the candidate must have any of the following documents like

  • Aadhar Card
  • Voter ID
  • PAN Card
  • Driving License
  • Passport
  • Handicap Certificate
  • Nationalized Bank Passbook with Photograph
  • Freedom Fighter ID Card
  • Defence ex-service card issued by Sainik board
  • Senior citizen card issued by Government (central or state) Of India
  • Any photo ID proof issued by Govt. of Maharashtra/ Govt. of India.
  • Marine Fishers Identity card.
  • School/College ID
  • For urban areas, The Applicants photograph must have Government Local bodies/Tahsildar’s stamps and signatures on the applicant’s photograph.
  • For rural areas, The Applicants Photograph must have Tahsildar’s stamp and signature on the applicant’s photograph.
  • In case of a new born child, you can submit Child Photo, Birth certificate along with his/her Parents Ration card (White /Yellow/Orange)

 

Karunya Health Scheme

Karunya Healthcare Scheme is launched in 2012 to provide healthcare to the under privileged sections of the society at nominal premium charge (The Beneficiary have to pay nominal premium for availing this health insurance benefit).

This scheme is carried by Kerala Government. This Schemes are funded through the income of Kerala Lottery and the income is sent directly to the empaneled hospital for settlement.

 

 Benefits for Karunya Health Scheme

Some of the Benefits are given below

  • It covers various chronic diseases such as Kidney diseases, Palliative Care, Heart diseases, Hemophilia, Cancer .
  • Person who is getting Kidney Treatment receives Rs. 3 Lakh under this Scheme.
  • Hemophilia Patients are included in the Lifelong Scheme.
  • Patients who are suffering from Critical Diseases like Heart surgery (including the expense of the stent), Brain and liver surgery, Cancer (including chemotherapy, radiation and surgery) are given Rs. 2 Lakh under this Scheme.
  • At least 5 people can take benefits from this single card (A card is given under this scheme for the beneficiary) which is given to the Head of the family

 

 Salient Features of Karunya Health Scheme

Some of the Features of this Scheme is as follows: –

  • All BPL and APL families can apply for this scheme whose annual income is below Rs. 3 Lakh per annum
  • Government Hospital along with Private Hospital is also empaneled so that massive coverage and treatments of the beneficiaries can be done.
  • Apart from Government Hospital, 61 Private hospitals and 28 dialysis centers are involved/empaneled in this health care scheme/’project.
  • The Government allocated Rs.250 crores in the last financial year for better facilities of empaneled hospital.
  • You can go to website for detailed information like Application form, declaration, claims, network  , Empaneled hospital (Government and Private)   http://www.karunya.kerala.gov.in/ .

 

Document Required to avail this Benefit

Candidate must produce certain documents to be beneficiary of this scheme.

  • Original with Photo Copy of the Ration Card
  • Passport size photo of the patient
  • Estimate of expenditure from the concerned hospital
  • Photo of the patient and their family in front of their house. The house should be visible in the photograph.

 

 

 

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