Maharashtra government finalises new insurer for cashless health insurance scheme

MJPJAY, a state-run insurance scheme launched in 2012, covers 2.25 crore families and provides a medical cover of Rs 1.5 lakh. In the latest tender, the government has increased hospitals empanelled under the scheme from 492 to 1,000 and total procedures that patients can avail from 971 to 1,096.

Officials said the file has been sent to the state government for final approval.

Four insurance companies had showed interest in the scheme. “But United India Insurance bid the lowest,” said Dr Sudhakar Shinde, CEO of MJPJAY.

Once rolled out, the fresh scheme will include hip and knee replacement surgery, paediatric cancers, mental illnesses like depression, schizophrenia, delusional disorders and mood disorders. For certain procedures, the government has increased the cost — kidney transplant will fetch a hospital Rs 3 lakh instead of Rs 2.5 lakh, dialysis will be for Rs 1,100 instead of Rs 700, and cost for treatment of a few fractures will rise from Rs 15,000 to Rs 20,000.

Between 2012 till 2019, Maharashtra had tied up with National Insurance Company to run the scheme. Under MJPJAY, a beneficiary can avail free treatment, while the hospital gets reimbursed by the insurance company after state government scrutinises patient’s medical documents.

The Centre’s Pradhan Mantri Jan Arogya Yojana (PMJAY) will function along with MJPJAY under a hybrid model. For beneficiaries of PMJAY, which covers treatment cost up to Rs 5 lakh, the state government has created a trust to pay hospitals. Maharashtra has 83 lakh beneficiaries under PMJAY.