Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) was launched by the Maharashtra government to improve access to healthcare for families belonging to Below Poverty Line and Above Poverty Line households. From 1 April 2017, the scheme has been renamed as Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). It is a good health insurance plan for families with an annual income less than Rs.1 lakh per year. The state government pays Rs.333 premium for an insurance cover of up to Rs.1.5 lakh. The total coverage can be availed by an individual or the entire family on floater basis.
Cashless hospitalization is offered to the insured members at the network hospitals. Network hospitals are those medical facilities that are on the panel of this scheme like Asian Heart and Research Centre, Seven Hills Healthcare, RN Cooper, Tata Memorial Hospital and Research Centre, etc. No waiting for pre-existing cover. Renal Transplant procedure is covered up to Rs.2.5 lakh as the unimpressive therapy is required for a duration of 1 year. Initially, the scheme was introduced in 8 districts in the state. By November, 2013, the scheme was launched in all districts.
RGJAY scheme provides for 972 surgeries or treatments along with 121 follow-up packages in 30 different specialized categories like cardiology, neurology, ENT surgery, etc. For 10 days from the date of discharge, the network hospitals will provide free follow-up consultation, medicines, and diagnostics covered under the scheme. The insurance company providing the health cover shall ensure that one free medical camp is organised per week by each network hospital at a place recommended by the RGJAY society.
Why was Rajiv Gandhi Jeevandayee Arogya Yojana Launched?
Through this scheme, financial protection is provided to below poverty line families for up to Rs. 1.5 lakhs annually. This scheme was launched so as to provide access to quality medical services through a network of health care services that were identified. 975 Medical and Surgical procedures in identified medical centres are covered under this plan. This identified network is needed to implement all schemes sponsored by the Maharashtra government. Certain minimum standards are maintained so as to provide quality medical services.
Benefits and Features of Rajiv Gandhi Jeevandayee Arogya Yojana:
These scheme comes with a number of benefits in the form of 971 procedures from which 131 are performed solely in government hospitals. Under this scheme illnesses that can be treated in certain primary level health centres or ordinary hospitals will not covered under this option.
- The benefit of this scheme will be available to customers on a floater basis which means that the insurance of Rs. 1.5 lakh can be availed by the entire family or one individual in the family.
- Hospitals that are on the panel of this scheme will provide cashless service and deposit need not be provided by the insured. No exclusions or pre-existing disease waiting period is also required.
- Some of the private medical institutions on the panel include Tata Memorial Hospital and Research Centre, RN Cooper, Asian Heart and Research Centre, Seven Hills Healthcare and others.
- Network hospitals also provide a follow up consultation session for free.
- On producing health card, kidney transplants are also provided for free.
- One free medical camp is also provided.
Coverage Details:
The total procedures that are covered can be divided into 30 categories:
These categories include general surgery, plastic surgery, ENT surgery, ophthalmology surgery, paediatric surgery, neurosurgery, radiation surgery, burns, critical care, general medicine, infectious diseases, cardiology and neurology among others. Although knee and hip replacement surgeries were not included originally, these are under consideration.
| Covered | Not Covered |
| Lobar pneumonia, Aspiration pneumonia, Broncho pneumonia, pneumothorax, pneumoconiosis, pneumonectomy. | Pneumonia |
| Numerous medical and surgical gastroenterology related procedures | Diarrhoea |
| Diabetic retinopathy, Uncontrolled diabetes with infectious emergencies, Diabetic ketoacidosis | Diabetes |
| Snakebite with ventilation support | Snakebite without ventilation support |
| Diaphragmatic Hernia, Appendicular Perforation | Hernia and Appendicitis (unless it is an emergency). |
Eligibility Criteria for Rajiv Gandhi Jeevandayee Arogya Yojana:
For Customers –
Only those families who are below poverty line or marginally above poverty line who have either of the two cards – Orange Ration Card (above poverty line) or Yellow Ration Card (below poverty line) can avail this scheme.
For Agency –
- Agency should be registered under Companies Act 1956.
- Agency should have a valid OSP license to provide services at said location.
- In the previous four financial years, agency must have an average yearly turnover higher than Rs. 15 crores.
- Agency must have a positive net worth.
For Hospital –
- Should have a minimum of 50 inpatient beds with enough staff and spacing.
- Should have separate general wards for males and females.
Documents Required for the Scheme:
The important documents required are Yellow or Orange ration card and Aadhaar card. In case Aadhaar number has not been procured, then customers can produce any of the following photo ID proofs provided by the Government of India.
- Voter’s ID
- Driving License
- School ID
- Other IDs issued by an authorized officer.
- PAN Card
Steps to Enrol in Rajiv Gandhi Jeevandayee Arogya Yojana:
- Families/individuals can approach the closest network hospital in their area and in case they visit a facility that is not a part of the network then a referral card will be provided to the network hospital along after an initial diagnosis by the doctor. Information regarding this will be captured in the database.
- Customers will have to then provide the referral card (if provided) along with yellow or orange ration card, Antyodaya or Annapurna card and their diagnosis and check-ups will be undertaken. These details will be noted down in the relevant database.
- The patient will be admitted in the network hospital based on diagnosis and an E-preauthorization request will be sent to the insurance company and will also be reviewed by the Rajiv Gandhi Arogya Yojana Society.
- Recognized doctors and other specialists of the Rajiv Gandhi Jeevandayee Arogya Yojana and the insurance company will examine the request and approve if necessary conditions are met. This will be done immediately in cases of emergency and will be valid for a week.
- Cashless treatment and surgery will be provided and details will be documented.
- All necessary bills, reports, procedures will be forwarded to the insurer for claim settlement after procuring required signatures. Discharge and follow-up details will be available on the Rajiv Gandhi Jeevandayee Arogya Yojana Society portal.
- Network hospital will also provide free follow-up consultations, medicines and diagnostics as part of the scheme for a period of 10 days from discharge date.
Registration Process for Rajiv Gandhi Jeevandayee Arogya Yojana:
Look for hospitals with RGJAY scheme in your district. Visit the chosen hospital with medical reports from your previous physician or surgeon. The volunteers of the scheme called Aarogyamitra will check the furnished report. The patient’s Ration Card and photo ID proof will be scanned and sent to the main centre/RGJAY society where the documents will be verified. A copy of the registration will be sent within an hour.
