MJPJAY Empanelled Hospitals in Mumbai

The Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY) is a flagship health insurance scheme from the Government of Maharashtra, designed to provide essential medical care to vulnerable families across the state. Formerly known as the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), this scheme offers cashless healthcare services for specific secondary and tertiary medical treatments. This means that eligible beneficiaries can receive treatment at a network of empanelled hospitals without having to pay for covered procedures out of their own pockets.

The scheme aims to improve access to quality medical care for Below Poverty Line (BPL) and Above Poverty Line (APL) families holding specific ration cards, as well as farmers from certain distressed districts. It covers a wide range of therapies and surgeries, ensuring that financial constraints do not become a barrier to receiving critical treatment. The services are provided through a network of both government and private hospitals that have been selected and approved by the State Health Assurance Society.

For residents of Mumbai and its surrounding areas, knowing which hospitals are part of the MJPJAY network is crucial for accessing these benefits. This page provides a comprehensive list of empanelled hospitals in the Mumbai region. It also offers guidance on the process of availing treatment, the necessary documentation, and what to do if you encounter any issues at a network hospital.

List of MJPJAY Empanelled Hospitals in Mumbai

This list is for informational purposes. The empanelment status of hospitals can change. Please verify with the official MJPJAY website or helpline before visiting.

• K.B Bhabha Hospital — Kurla (West)
• Grant Medical College And Jj Group Of Hospitals — Mumbai
• Cama And Albless Hospital — Mumbai
• Gokuldas Tejpal Hospital — Mumbai
• Tata Memorial Hospital — Parel
• King Edward Memorial (KEM) Hospital — Parel
• Lokmanya Tilak Municipal General Hospital (Sion Hospital) — Sion
• Rajawadi Hospital — Ghatkopar
• Bhabha Hospital, Bandra — Bandra
• Nair Hospital — Mumbai Central
• Cooper Hospital — Vile Parle
• Sevenhills Healthcare Pvt Ltd — Andheri
• Mallika Hospital — Mumbai Suburban
• Jaffer Suleman Musafirkhana Trust Medical & Dialysis Centre — Mumbai
• Vedant Hospitals — Mumbai
• Fortis Hospitals Ltd. — Mulund
• Apex Hospital — Borivali West

Rates shown are as per the State Health Assurance Society, Government of Maharashtra (2023) and are subject to periodic revision. Always verify the latest approved rates on the official source.

Understanding Your Coverage Under MJPJAY

The MJPJAY scheme provides a significant safety net, but it's important to understand what is covered. The scheme offers coverage up to Rs. 1,50,000 per family per policy year on a floater basis, which can be used by any member of the eligible family. For renal transplants, the coverage limit is increased to Rs. 2,50,000. This coverage includes the costs associated with the hospital stay, diagnostics, medications, and the procedure itself.

However, the scheme is not an all-purpose health card. It specifically covers 971 types of surgeries and therapies, along with 121 follow-up packages. These are typically for serious illnesses that require hospitalization, falling under categories like cardiology, neurology, cancer treatment, and orthopaedics. Routine outpatient consultations (OPD), general check-ups, and treatments for conditions not on the approved list are not covered. Therefore, beneficiaries should confirm if their required procedure is included in the MJPJAY package list before seeking treatment.

How to Avail Cashless Treatment at an Empanelled Hospital

Accessing cashless treatment under MJPJAY involves a straightforward process at any network hospital. The first step for a beneficiary is to visit an empanelled hospital and contact the dedicated 'Arogyamitra'. These are scheme-appointed representatives stationed at each hospital to guide patients through the entire process. They wear a specific uniform and are usually found at a dedicated MJPJAY helpdesk near the hospital's reception.

The Arogyamitra will verify your eligibility using your MJPJAY health card or the appropriate ration card (Yellow, Orange, Antyodaya, or Annapurna). You will also need to provide a valid government-issued photo ID. Once your eligibility is confirmed, the hospital will conduct a diagnosis and, if a covered procedure is required, the Arogyamitra will initiate the pre-authorisation request with the insurance company and the State Health Assurance Society. Upon approval, the hospital will proceed with the cashless treatment.

• Visit a network hospital and locate the MJPJAY helpdesk.
• Present your eligibility card (ration card) and photo ID to the Arogyamitra.
• Undergo medical diagnosis and tests as advised by the doctors.
• The Arogyamitra facilitates the e-preauthorization process on your behalf.
• Receive cashless treatment once the request is approved by the authorities.

Documents Required for MJPJAY Beneficiaries

To ensure a smooth and hassle-free process at the hospital, it is essential to carry the correct documents. The primary document is the one that establishes your eligibility for the scheme. In addition, a valid photo identification is mandatory for verification purposes. Having these documents ready will help the Arogyamitra expedite your registration and pre-authorisation request.

Please ensure you have both the original documents and a few photocopies with you when you visit the hospital. The key documents required are:

• A valid MJPJAY health card or a valid ration card (Yellow, Orange, Antyodaya Anna Yojana, or Annapurna).
• A government-issued photo ID card, such as an Aadhaar card, Voter ID, PAN card, Driving License, or Passport.
• In case of a medical emergency, identification may be produced within a specified timeframe.
• Referral letter from a government hospital, if applicable.

What to Do If an Empanelled Hospital Refuses MJPJAY Benefits

While empanelled hospitals are obligated to provide cashless services to eligible beneficiaries for covered procedures, there might be rare instances of refusal or requests for payment. If you face such a situation, do not pay cash for a covered treatment. Your first point of contact should be the Arogyamitra at the hospital. They are trained to resolve such issues and liaise with the hospital management on your behalf.

If the Arogyamitra is unable to resolve the problem, you should immediately escalate the matter by contacting the MJPJAY authorities. You can call the scheme's 24x7 toll-free helpline to register a complaint. Provide them with details of the hospital, the patient, and the issue you are facing. The scheme has a robust grievance redressal mechanism to address such complaints and ensure that beneficiaries receive their rightful benefits.

Confirming a Hospital's Current Empanelment Status

Hospital networks under health schemes can change over time. New hospitals may be added, or existing ones might be removed from the empanelled list for various reasons. While the list provided on this page is compiled from available data, it is always a good practice to verify the most current status of a hospital before planning a visit.

The most reliable way to check if a hospital is currently empanelled under MJPJAY is by visiting the official scheme website at www.jeevandayee.gov.in. The portal usually maintains an updated list of its network hospitals. Alternatively, you can call the MJPJAY toll-free number and ask the customer service executive to confirm the empanelment status of a specific hospital in your area. This simple verification step can save you time and prevent any last-minute complications.

Frequently Asked Questions

Is MJPJAY applicable for all treatments at an empanelled hospital?

No, the scheme does not cover all medical treatments. MJPJAY provides coverage for a specific list of 971 secondary and tertiary care procedures and 121 follow-up packages. Routine consultations, outpatient care, and treatments not on this pre-defined list are not covered.

Who is eligible for the Mahatma Jyotirao Phule Jan Arogya Yojana?

Eligibility is primarily for families in Maharashtra holding specific ration cards, including Yellow, Orange, Antyodaya Anna Yojana (AAY), and Annapurna cards. Additionally, farmers from 14 agriculturally distressed districts of the state are also eligible, irrespective of their ration card status.

What is the financial coverage provided under the MJPJAY scheme?

The scheme provides a health coverage of up to Rs. 1,50,000 per family per year on a floater basis, meaning the total amount can be used by one or all members of the family. For renal transplant procedures, the coverage limit is enhanced to Rs. 2,50,000.

What does 'cashless treatment' actually mean under MJPJAY?

Cashless treatment means that an eligible patient does not have to pay any money to the empanelled hospital for a covered procedure. The State Health Assurance Society, through an insurance company, settles the bill directly with the hospital. This covers costs for diagnostics, surgery, medicines, food, and hospital stay.

What is the role of an 'Arogyamitra' at the hospital?

An 'Arogyamitra' is a scheme-appointed representative present at a dedicated helpdesk in every network hospital. Their primary role is to guide beneficiaries, check their eligibility, assist with the documentation and pre-authorisation process, and act as a bridge between the patient and the hospital administration.

Can I get treatment at a non-empanelled hospital in an emergency and claim reimbursement later?

No, the MJPJAY scheme is designed to be completely cashless and functions only through its network of empanelled hospitals. There is no provision for reimbursement if a beneficiary seeks treatment at a hospital that is not part of the scheme's approved network.

Related

• MJPJAY in Maharashtra: eligibility and how to enrol
• Government hospital OPD appointment guides in Maharashtra
• Mukhyamantri Swasthya Bima Yojana: which state scheme is it?

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.