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Rajiv Gandhi Jeevandayee Arogya Yojana, Maharashtra

The Rajiv Gandhi Jeevandayee Arogya Yojana, renamed Mahatma Jyotiba Phule Jan Arogya Yojana, is a scheme that is backed by the State Government of Maharashtra. The scheme offers health insurance benefits to people belonging to BPL and APL households.
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Introduction:

The Rajiv Gandhi Jeevandayee Arogya Yojana is a health care policy that has been run by the Maharashtra Government for all economically challenged people in the state. This policy can be availed by those who have one of the two cards - Orange Ration Card (for individuals above poverty line) or Yellow Ration Card (for individuals below poverty line). Initially, this scheme was launched in 8 districts in the state and followed by all 35 districts. This scheme provides free access to medical care in government hospitals for various surgeries, diseases and therapies.

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 hospitalisation 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, SevenHills 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 immunosuppressive 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 specialised 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.

    Rajiv Gandhi Jeevandayee Arogya Yojana
  • 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.

Conclusion:

In a country with the second largest population in the world, it is important for the government to ensure that everyone’s health is accounted for, right from the higher strata of society to the lowest. It is generally those who come from lower financial background who suffer due to lack of facilities and awareness. Most times, they lose out on good treatments due to lack of money. The Rajiv Gandhi Jeevandayee Arogya Yojana provides individuals with a cover of up to Rs 1.5 lakhs. This scheme is highly beneficial due to its various benefits and features as listed above and also because it provides affordable top quality healthcare to those who cannot afford it. The Rajiv Gandhi Jeevandayee Arogya Yojana is a blessing in disguise to all who cannot access or pay for quality healthcare.

Rajiv Gandhi Jeevandayee Arogya Yojana Online Claim Settlement:

RGJAY scheme is implemented through the effective use of information technology-based solutions as a measure to reach out to the beneficiaries. The insurance company will settle the claims made by the network hospitals within 15 working days upon receipt of the duly-filled claim form and supporting documents such as medical reports, discharge summary, diagnosis report, prescription, doctor's written opinion, etc.

Documents Required for Rajiv Gandhi Jeevandayee Arogya Yojana:

Listed below are the documents required for Rajiv Gandhi Jeevandayee Arogya Yojana:

  • Yellow or Orange Ration Card wherein the applicant's name is mentioned.
  • Photo ID proof like Aadhaar card or PAN card.

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.

Upon successful completion of the registration, the patient will be given an appointment for OPD on the same day or depending on the availability of the doctor. After medical checkup, the doctor will submit a written opinion of the diagnosis and required surgery or treatment. Once all the medical reports along with the pre-authorisation request form are sent to the insurance company and RGJAY society, the sanction is given immediately. There are 3 to 4 beds allocated in each network hospital for beneficiaries under the RGJAY scheme.

Rajiv Gandhi Jeevandayee Arogya Yojana for Cancer:

Followed by kidney transplant procedures, cancer surgeries are amidst the major 3.5 lakh operations performed on the patients belonging to the BPL families from 2012 to 2015, about 1.29 lakh cancer surgeries and procedures were performed. 476 hospitals were empanelled for this purpose.

Frequently Asked Questions (FAQs):

  1. What validation or identity proof will be required if a child is born after the health card is issued and name and photo is not available?

    If the above is the case, then parents will have to submit a photo of the child with any one of the parents and also provide the health card or yellow or orange card of the parent along with birth certificate.

  2. What is the ‘run-off’ period available for the scheme?

    After expiry of policy period, a runoff period of one month will be provided. This implies that pre-authorizations will be done till the end of the period of policy and surgeries for these can be performed.

  3. Will Claim Settlements be done online?

    The insurer will settle hospital claims online within a fortnight or 15 working days on receipt of complete document from the network hospital including all diagnostic reports, original bills, satisfaction letter from the individual and others.

  4. Will health camps be conducted?

    Health camps will be conducted in Major Gram Panchayat, Municipalities and Taluka Headquarters. At least one camp will be conducted by one empanelled hospital per week in all eight districts in one policy year. The insurance company will ensure that a minimum of one medical camp will be conducted for free by one network hospital every week at a location that has been suggested by the Rajiv Gandhi Jeevandayee Arogya Yojana Society. These activities will be coordinated by Rajiv Gandhi Jeevandayee Medical Camp Coordinator MCCOs of each hospital.

  5. Will customers with a white ration card be eligible to receive the benefits of this scheme?

    No, only families with a yellow ration card, orange ration card, Antyodaya Anna Yojana Card and Annapurna Card will be eligible to receive the benefits of this scheme.

  6. Will transaction be cashless for this scheme?

    Yes, transaction for covered procedures will be cashless.

  7. What is Rajiv Gandhi Jeevandayee Arogya Yojana health Card?

    Rajiv Gandhi Jeevandayee Arogya Yojana Health Card is an identification card issued to the beneficiary families under the RGJAY Scheme. Beneficiary families include residents of any of the 35 districts of the state with the Yellow Ration Card (BPL families), Annapurna Card, Antyodaya Anna Yojana (AAY) Card, and Orange Ration Card (APL families). Families with White Ration Card with not be covered under the scheme.

  8. What is the toll-free number of Rajiv Gandhi Jeevandayee Arogya Yojana?

    For any queries related to the Rajiv Gandhi Jeevandayee Arogya Yojana scheme, call toll-free number 1800 233 2200.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

Rajiv Gandhi Jeevandayee Arogya Yojana Reviews

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  • United India Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I got group insurance from company, on time I got policy. My father was not good at the time I have used the policy. I got the reimbursement around Rs. 23,000 the total value is Rs. 33,000. I went to shobha hospital they don't have tie up with United India, hence I got the reimbursement.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • Max Bupa Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I have medical cover with Max bupa, they gave me the coverage value of Rs. 5 lakhs its covers for entire family. One time I claimed for my mother for the eye surgery, I got the reimbursed within 30 days with 90% of amount, the total experience was good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 18, 2019
  • New India Health Insurance
    "Yet to experience the policy"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health insurance policy from new India. As per company norms, they have given me a coverage value of Rs. 5 lakhs. My entire family has been covered in this policy. They are offering a cashless treatment facility.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • United India Health Insurance
    "Very Good Service"
    0.5 4.0/5 "Great!"
    I had taken this insurance policy in the year of 2018 and the the premium has been deducting from my salary. The premium amount has not been too high and there has been many hospitals collaborated within my locality. There has also been some cashless treatment available with this policy as well.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 17, 2019
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have my health insurance with Star health insurance, i had claim experience with it, my experience was good, they have good tie up with my hospital and they have mailed me about the location of it, and i am happy with there service, they have charged me premium amount on yearly basis, and the premium amount is nominal for me, and i use to pay through on line mode.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 17, 2019
  • Max Bupa Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Max BUPA , i have not opt there policy yet and i use to pay premium on monthly bases , and it use to get auto debit from my account and while i applied for health insurance customer service had explained me about all procedure , so far the process went smoothly and it good.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 17, 2019
  • Max Bupa Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with Max bupa health insurance, there service is good, they have charged me premium nominal ,and the premium is on yearly basis, and they have tie up with many hospital , and had shared the details via mail, and i pay premium amount through on line mode.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 17, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with HDFC Ergo, they got tie up with many hospitals, and they have shared me location on those hospital in mail, and they have charged me nominal premium amount ,they have charged me up to 17000-18000 as premium, it is on yearly basis, and i use to pay the premium on an on line basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 17, 2019
  • SBI General Health Insurance
    "Bad experience"
    0.5 1.0/5 "Really Bad"
    I got the health insurance with SBI, they got tie up with many hospitals. I Felt the medical cover its less and i am not happy with there support team ,like if i want to call the customer care there number would not be reachable and they use to mail me PDF after paying premium amount,it would not get open, they have charged me premium amount on yearly basis,i have bad experience with this bank.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 16, 2019
  • HDFC Ergo Health Insurance
    "Very good benefits"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance from HDFC ERGO which was purchased by me in the year of 2018 because the benefits are very good. The claim process was simple and they have more number of hospitals for cashless. I have paid 18,800 for one year and took 3 years policy for myself and my wife. The medical coverage is 10L for myself and 5L for wife.
    Was this review helpful? 2
    , bangalore
    Reviewed on Jan 14, 2019
  • HDFC Ergo Health Insurance
    "Good"
    0.5 3.0/5 "Satisfactory"
    I have taken health insurance from HDFC Ergo which was offered along my personal loan. I have received the insurance paper and its been couple of months. It covers critical illness and need to go through the policy benefits. Always the customer is good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 14, 2019
  • Tata AIG Health Insurance
    "Great company"
    0.5 5.0/5 "Blown Away!"
    I have taken health insurance from tata aig. I did take health insurance from tata aig for my parents and The Process was so simple. Customer representative is good. The customer service and response was on time, never had any issues. Now I feel safe for my family Thank you tata aig.
    Was this review helpful? 0
    , solapur
    Reviewed on Jan 12, 2019
  • ICICI Lombard Health Insurance
    "Good Health insurance provider"
    0.5 3.5/5 "Pretty good"
    This policy was part of my employment, I took the medical coverage of Rs. 5 lakhs for the tenure of one year, this medical benefits for my entire. They have good networks of hospital with major disease cover. But I think it doesn't have no claim bonus.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 11, 2019
  • Reliance General Health Insurance
    "On time approval with reliance"
    0.5 4.0/5 "Great!"
    For my spouse operation I used the health policy, I approached them for the claim through hospital. I submitted the form and they send the papers to the Reliance insurance company. I got the cash less treatment, but I paid some amount which was not covered. But they gave me the on time approval.
    Was this review helpful? 0
    , kolkata
    Reviewed on Jan 11, 2019
  • Cigna TTK Health Insurance
    "On time service"
    0.5 5.0/5 "Blown Away!"
    On time Cigna TTK have activated the policy which provided by the company, the policy which I hold it has the coverage of Rs. 4 lakhs its covers for me. They are providing coverage for the pre existing with the tax benefits but there is no claim.
    Was this review helpful? 1
    , dandeli
    Reviewed on Jan 10, 2019
  • Cigna TTK Health Insurance
    "Its Good"
    0.5 5.0/5 "Blown Away!"
    In Cigna TTK, they are providing pre existing disease cover, but they don't have no claim bonus features. The response is good they have good customer care working 24/7 , the medical coverage is good for me and entire family. They have many hospital which they got tie up in Mumbai.
    Was this review helpful? 0
    , mumbai
    Reviewed on Jan 10, 2019
  • Apollo Munich Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I had taken this insurance policy a while back and i had been paying the premium amount on an annual basis. The premium method has been convenient and the premium amount has not been high. There has been many hospitals covered in my locality and their customer support has also been helpful.
    Was this review helpful? 2
    , pune
    Reviewed on Jan 09, 2019
  • ICICI Lombard Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    My organization has provided me a health insurance with ICICI Lombard. I have not claimed anything from this policy. My entire family has been covered in this policy. They have given me a coverage value of Rs. 3 lakhs. This is a cashless policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 09, 2019
  • Star Health Health Insurance
    "Good"
    0.5 4.0/5 "Great!"
    My company has offered a health insurance from Star Health with the coverage of 1L, its for the family, Still I have not used the policy and am gone utilize the policy within 15 days for my family.They covers a major disease. I have called the customer service and the response is good. I am planning to go for reimbursement, they do have minor network of hospitals for cashless. I can recommend after completing my claim.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 09, 2019
  • National Insurance Health Insurance
    "Good"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health policy from National insurance with the coverage of 2L. It is for the family members and no claim. I never contacted the customer service. Every year it was renewed by the company. They have limited networks of hospitals for cashless. It does not cover only eye problems, if we got admitted in hospital for 24hrs then applicable for claim.
    Was this review helpful? 0
    , pondicherry
    Reviewed on Jan 09, 2019
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