Scheme Details :
OBJECTIVE: To improve access of Below Poverty Line (BPL) and Above Poverty Line (APL) families (excluding White Card Holders as defined by Civil Supplies Department) to quality medical care for identified speciality services requiring hospitalization for surgeries and therapies or consultations through an identified Network of health care providers.
SCHEME: Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) has been implemented throughout the state of Maharashtra in phased manner for a period of 3 years. The insurance policy/coverage under the RGJAY can be availed by eligible beneficiary families residing in all the 35 districts of Maharashtra Gadchiroli, Amravati, Nanded, Sholapur, Dhule, Raigad, Mumbai and Mumbai Suburban, Akola, Buldhana, Yavatmal, Washim, Aurangabad, Beed, Hingoli, Jalna, Latur, Osmanabad, Parbhani, Thane, Ratnagiri, Sindhudurga, Bhandara, Chandrapur, Gondia, Nagpur, Wardha, Ahmednagar, Jalgaon, Nadurbar, Nashik, Kolhapur, Pune, Sangli, Satara.
BENEFITS: The scheme entails around 971 surgeries/therapies/procedures along with 121 follow up packages in following 30 identified specialized categories mentioned below:
• GENERAL SURGERY
• ENT SURGERY
• ORTHOPEDIC SURGERY AND PROCEDURES
• SURGICAL GASTRO ENTEROLOGY
• PEDIATRIC SURGERY
• SURGICAL ONCOLOGY
• MEDICAL ONCOLOGY
• PLASTIC SURGERY
• POLY TRAUMA
• CRITICAL CARE
• GENERAL MEDICINE
• INFECTIOUS DISEASES
The 131 procedures are to be performed only in empanelled public hospital / government medical college subject to availability of facility and procedure is planned.
BENEFICIARY FAMILIES: The families belonging to any of the 35 districts of Maharashtra and holding yellow ration card, Antyodaya Anna Yojana card (AAY), Annapurna card and orange ration card. The families with white ration card holding would not be covered under the scheme. The beneficiary families would be identified through the “Rajiv Gandhi Jeevandayee Health Card” issued by the Government of Maharashtra or based on the Yellow and Orange ration card issued by Civil Supplies Department.
HEALTH CARDS: Eligible families in these districts shall be provided with Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards in due course of time. This Health Cards will be used for identification of Beneficiary families under the Scheme. Family Health Cards will be prepared by using data from valid Yellow or orange ration cards coupled with Aadhaar numbers issued by UID authorities. As an interim measure till the issuance of health cards, a valid Orange/Yellow Ration Card with Aadhaar number or in case Aadhaar number not available, any Photo ID card of beneficiary issued by Govt. agencies (Driving License, Election ID,) would be accepted in lieu of health card to correlate the patient name and photograph.
FAMILY: Family means members as listed on the Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards or holding valid Orange/Yellow Ration Card.
IDENTIFICATION: Health card issued by Govt. of Maharashtra/Rajiv Gandhi Jeevandayee Arogya Yojana Society or valid Orange/Yellow Ration Card with Aadhaar number if Health card is not issued would act as a tool for beneficiary identification for availing the health insurance facility. The following actions would be undertaken by Network hospitals in case of the possible exceptional situations:
|Situation||Validations / Check|
|No Health Card with beneficiary, but Valid Yellow or Orange Ration Card with name of beneficiary is available Aadhaar||Aadhaar number and in case Aadhaar number not taken any Photo Health Card issued by Govt. (Driving license, election identity card with photograph, school ID, certificate issued by authorized office.) to correlate the patient name & photograph (In instance of emergency admission, provisional preauthorization may be given subject to confirmation of it against submission of valid photo identity card issued by Govt. before discharge.)|
|Children born after issue of card i.e. name and photo not available on health card or on valid yellow/Orange ration card||Photograph of child with either parent along with Health card/ valid Yellow or Orange ration card of parent and Birth certificate issued by authorized office.|
|Name is there in Yellow or Orange Ration Card
and matches with name in the Photo identity Card.
But the card is invalid as it does not match with the
|Not eligible for benefit of package. (The yellow/orange ration card is cancelled after verification by the department but still the family is holding it)|