The United India Insurance Company has been appointed as the insurer for the flagship Health insurance scheme of the Maharashtra government, known as MJPJAY (Mahatma Jyotiba Phule Jan Arogya Yojana) since 1st April 2020, co-incidentally exactly when the Covid Pandemic started.
As of 31st March 2021, a total of 28,129,80 covid infections were recorded in the Maharashtra state with 54,649 covid deaths. Although Mahatma Jyotiba Phule Jan Arogya Yojana could benefit only 5,071,88 covid patients from 1st April 2020 to 31st March 2021 across Maharashtra as per info obtained from the RTI. Considering the total number of infections and death of patients, 5 lakhs is a very small figure since the scheme covers 22,208,948 families across Maharashtra.
Surprisingly even though Mumbai had 4,23,419 infections and 11,708 deaths on 1st April 2021 only 29,664 claims from Mumbai have been paid whereas 34,867 claims paid in Ahmednagar when total infections were only 95,000 and 1221 deaths. Total 34,574 in Kolhapur and 34,045 in Pune were paid. Mumbai comes in fifth place when it comes to claims paid by the United India Insurance Company.
A total of 1031,0190692 crores have been paid to hospitals across Maharashtra under the scheme, but the insurance company refused to give the total amount of premiums paid by the Maharashtra government to the United India Insurance Company. The big positive is the fact that the rejection rate is only 4.4 % of the total 6,16,927 applications received.
Activist Jeetendra Ghadge of The Young Whistleblowers Foundation said, “Government has declared that all types of ration cards will be eligible under this scheme but many families in Mumbai have paid lakhs of rupees for Covid treatment. Hospitals forced citizens to pay the bills and avoided implementing the scheme, action should be taken against such hospitals besides a third-party audit should be compulsory to check if hospitals have passed on the benefits of the scheme to the citizens.
On the other hand, Private hospitals are reluctant to enroll in the scheme, it should be made legally binding for them to implement the scheme”
Between 2012 till 2019, Maharashtra had tied up with the National Insurance Company to run the scheme unfortunately they refuse to give the same information under RTI.