- Details
- Benefits
- Eligibility
- Exclusions
- Application Process
- Documents Required
- Frequently Asked Questions
- Sources And References
- Feedback
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Andhra Pradesh
Dr. YSR Aarogyasri Health Insurance Scheme
Health
Insurance
Details
The "Dr. YSR Aarogyasri Health Insurance Scheme" was launched in 2007 by the Govt. of Andhra Pradesh to provide financial aid to low-income families in Andhra Pradesh. The scheme is a unique PPP model in the field of Health Insurance, tailor made to the health needs of poor patients and provides end-to-end cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.
The objective of the scheme are:
- To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
- To provide financial security against the catastrophic health expenditures.
- To strengthen the Government Hospitals through demand side financing.
- To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.
Benefits
The Salient Features of the scheme are:
- Hospital Care: When hospitalisation is needed, the system covers in-patient treatment for all of the aforementioned illnesses.
- Out-Patient Care: These treatments are provided as part of the scheme's cashless services by health camps and network hospitals.
- Cashless Services: When registered family members and beneficiaries demand it, an annual coverage of ₹5,00,000 per family is provided.
- Pre-Existing Disease Coverage: This plan has an unusual characteristic in that it covers ailments that the recipient was already suffering from before enrolling in the scheme.
- Follow-Up: The Dr. YSR Aarogyasri program also pays for post-hospitalization operations that can be rather expensive on their own.
- Affordable Family Health Insurance: Family health insurance allows the complete family to use the covered amount without the requirement for separate policies for each family member.
The following services will be provided free of cost after admission in hospital:
- Free Admission.
- Doctor Consultation. (Every Day).
- Nursing Services. (Per Day).
- Necessary Medical Tests.
- Necessary Medicines.
- Surgery (Operation) or Treament.
- Breakfast, Lunch. (Two Meals).
- Medicine for 10 Days after Discharge.
- Necessary Charges for Going Home after Discharge.
Specialities & Treatments Covered:
ENT Surgery; General Surgery; Ophthalmology; Septorhinoplasty; Gynaecology & Obstetrics; Glaucoma surgery; Orthopaedic Surgery & Procedures; Surgical Gastroenterology; Cardiothoracic Surgery; Paediatric Surgeries; Myringoplasty; Genitourinary Surgeries; Neurosurgery; Surgical Oncology; Medical Oncology; Radiation Oncology; Plastic Surgery; Polytrauma; Prostheses; Open Radical Prostatectomy; Critical Care; General Medicine; Infectious Diseases; Paediatrics; Cardiology; Nephrology; Neurology; Pulmonology; Dermatology; Rheumatology; Endocrinology; Gastroenterology; Psychiatry.
Eligibility
1. All Rice Card Holders are eligible.
2. Families which are eligible for YSR Pension Kanuka Card and Jagananna Vidya and Vasathi Deevena Card are also eligible.
For other families, the following criteria are applicable.
Landowners holding:
- Less than 12.00 Acres of wet land
- Less than 35.00 Acres of dry land
- Total less than 35.00 Acres (Wet & Dry)
Annual income of the Households:
- All households whose annual income is less than or upto Rs.5.00 Lakhs (Salary certificate evidence)
- Income Tax Payers: Families who are filing Income Tax Returns for annual income up to Rs.5.00 Lakhs are eligible (Income Tax Return evidence).
Employees:
Any employee, other than permanent Government employee/ pensioner, whose annual income is less than or upto Rs.5.00 Lakhs is eligible. It includes outsourcing, Contract, Part time employees, Sanitary workers, Honorarium based employees working in Government sector and employees of Private sector.
Municipal Property Tax Payers:
All households paying Municipal Property Tax for the area less than 3000 SFT (334 Sq. Yds)
Personal Vehicle:
Families/Households not having more than one personal car.
Source: https://www.ysraarogyasri.ap.gov.in/web/guest/am-i-eligible
Exclusions
The following medical conditions are not covered in this scheme:
- Knee replacement surgeries
- Gamma-knife procedures in neurosurgery
- Medical treatment related to bone marrow
- Leprosy
- Filaria
- Assisted devices for cardiac failures
- Cardiac and liver transplantations
- Malaria
- HIV/AIDS
- Tuberculosis
- Infectious diseases
- Gastroenteritis
- Jaundice
Application Process
Online
There is no separate enrollment, all the BPL families holding valid white ration card are automatically covered from the day of implementation of the scheme.
Step 2: Log into your account with your ID and password
Step 3: Navigate to the online application form, fill in all the mandatory fields, and attach the required documents.
Step 4: Review and submit the completed application form, and keep a printout with you for future reference.
Step 5: You can avail the benefits of the scheme by approaching any PHC / CHC / Area Hospital / District Hospital or any of the government hospitals nearer to you or any health camp being conducted near your village with the White card / Health Card and medical reports if any. You can also approach the any of the network hospital directly in case of Emergency.
A facilitator called ArogyaMithra will be available in all these hospitals to register, facilitate the treatment and guide you for all the services. ArogyaMithras are also available in PHC / CHC / Area Hospital / District Hospital and other government hospitals and in the Health camps to facilitate examination, screening and referral. ArogyaMithras are also placed at network hospital to guide and facilitate cashless treatment in the network hospital.
Documents Required
- Aadhaar Card
- Address Proof
- Income Certificate
- BPL Certificate
Frequently Asked Questions
What Is Dr.YSR Aarogyasri Scheme?
Dr.YSR Aarogyasri Scheme is a unique health scheme being implemented by State Government of Andhra Pradesh through Dr.YSR Aarogyasri Health Care Trust. The scheme provides financial assistance to BPL families to meet the catastrophic health needs.
How Much Of Financial Coverage Is Provided Under The Scheme?
The scheme provides coverage up to 5 lakhs for each family per year.
Who Are The Beneficiaries Under The Scheme?
All the BPL families identified by BPL ration card issued by Civil Supplies Department are eligible. All the people whose photo and name appear on Health Card / BPL (White, Annapurna and Anthyodaya Anna Yojana, RAP and TAP) ration card and suffering from identified diseases are eligible for availing treatment under the scheme.
What Are The Ailments Identified For Which I Can Get Treatment Under Dr.YSR Aarogyasri Scheme?
Serious diseases affecting Heart, Kidney, Cancer, Brain, Burns and accident cases etc., are covered under the scheme. A total of 2434 Surgeries / Therapies in 30 systems are covered under the Dr.YSR Aarogyasri Scheme. The list of these Surgeries / Therapies is available with PHC Doctors and Network Hospitals.
How To Know That I Am Suffering From These Diseases?
The common symptoms are enlisted in the Brochure on Dr.YSR Aarogyasri provided to all the BPL families. You may approach any of the PHC or Government Hospital near to you to know about your disease. You may contact ArogyaMithra at these hospitals for facilitation. You may also approach a Health Camp conducted by the Network Hospital. The 24 hour call centre with toll free number 104 also will guide you in this regard.
What About Coverage For Other Diseases?
The existing Government Medical Infrastructure from PHC, CHC, Area Hospital, District Hospital and Specialty Hospitals can effectively provide free Treatment for other diseases.
What Will Be The Role Of Government Hospitals?
Government Hospitals will continue to play a vital role in delivering free health care in other sectors such as Preventive Medicine, Primary health care, Secondary Health Care and tertiary care for the disease other than those in Dr.YSR Aarogyasri. They can also get empaneled to treat Dr.YSR Aarogyasri Cases wherever facilities are available and can plough back money from the scheme for their development. The PHC's and Area Hospital also act as referral points for the patients.
Who Is Implementing The Programme?
State Government through Dr.YSR Aarogyasri Health Care Trust is implementing the Programme.
Who Is Paying The Premium?
The entire premium is paid by the Government of AP on behalf of the BPL families
Is There Any Enrollment To Be Done To Avail The Benefits?
No. There is no separate enrollment, all the BPL families holding valid white ration card are automatically covered from the day of implementation of the scheme.
Can All The Hospitals In The State Provide Treatment Under The Scheme?
Cashless treatment under the scheme is provided to beneficiary in a Network Hospital. Trust after due verification of Infrastructure will empanel the hospital as a Network Hospital under the scheme. This is done to ensure quality treatment for the patient. The list of network hospitals with the specialties is available with ArogyaMithra. You can also avail this information by calling toll free number 104.
Is There Any Person Who Will Help Me In The Hospitals?
Yes. A facilitator called ArogyaMithra will be available in all these hospitals to register, facilitate the treatment and guide you for all the services. ArogyaMithras are also available in PHC / CHC / Area Hospital / District Hospital and other government hospitals and in the Health camps to facilitate examination, screening and referral. ArogyaMithras are also placed at network hospital to guide and facilitate cashless treatment in the network hospital.
How Can I Recognize ArogyaMithra?
ArogyaMithras are provided with uniform apron for easy identification and placed at Dr.YSR Aarogyasri kiosk, a special help desk situated at reception in the hospital. The ArogyaMithras in PHC / CHC will be available in the PHC / CHC during OP hours.
What Are The Other Services Provided By ArogyaMithra?
He / She receives you in the network hospital, counsels you, verifies your health card, takes the digital photograph of you, facilitates you for consultation with doctor and admission in the hospital. Facilitates the hospital to send proper pre-authorization for your surgery / treatment. He works in coordination with MEDCO for the above services. ArogyaMithra will also counsel and follow-up the patient on the need of follow-up and available package for the same at the time of discharge.
How Can I Avail The Benefits Under The Scheme?
You can avail the benefits of the scheme by approaching any PHC / CHC / Area Hospital / District Hospital or any of the government hospitals nearer to you or any health camp being conducted near your village with the White card / Health Card and medical reports if any. You can also approach the any of the network hospital directly in case of Emergency.
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Check Eligibility
Andhra Pradesh
Dr. YSR Aarogyasri Health Insurance Scheme
Health
Insurance
Details
Benefits
Eligibility
Exclusions
Application Process
Documents Required
Frequently Asked Questions
The "Dr. YSR Aarogyasri Health Insurance Scheme" was launched in 2007 by the Govt. of Andhra Pradesh to provide financial aid to low-income families in Andhra Pradesh. The scheme is a unique PPP model in the field of Health Insurance, tailor made to the health needs of poor patients and provides end-to-end cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.
The objective of the scheme are:
- To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
- To provide financial security against the catastrophic health expenditures.
- To strengthen the Government Hospitals through demand side financing.
- To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.
Was this helpful?
Share
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