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Aarogyasri
Telangana

Dr.Ysr aarogyasri health insurance scheme is unique in its applicability since no other state/ government agency has provided universal health coverage to the poor. The choice of hospital for treatment is with the patient. The entire process from the time of conduct of health camps to the screening, diagnosing , treatment, follow- up and claim payment is made transparent through online web based processing to prevent any misuse and fraud. The scheme is complimentary to facilities available in government hospitals and put together provides universal health coverage to bpl population including prevention, primary care and in-patient care. All the primary health centres (phcs) which are the first contact point, area/district hospitals and network hospitals, are provided with help desks manned by vaidya mithra's to facilitate the illiterate patients. Objective: 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. Geometry of health insurance coverage population coverage (breadth of universal health coverage) the beneficiaries of the scheme are the members of below poverty line (bpl) families as enumerated and photographed in white ration card linked with adhar card and available in civil supplies department database. Financial coverage (height of universal health coverage) the scheme shall provide coverage for the services to the beneficiaries up to Rs.2.50 Lakh per family per annum on floater basis. There shall be no co-payment under this scheme. Benefit coverage (depth of universal health coverage) Out-patient: The scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation. In-patient: The scheme shall provide coverage for the 1044 "listed therapies" for identified diseases in the 29 categories – are listed in website: www.ysraarogyasri.ap.gov.in package includes the following services: end-to-end cashless service offered through a nwh from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a "listed therapy(ies). Free op evaluation of patients for listed therapies who may not undergo treatment for "listed therapies. All the pre-existing cases under listed therapies are covered under the scheme. Food and transportation. The scheme provides coverage for the procedures under following categories 1 general sugery 2 ent surgery 3 ophthamology 4 gynaecology & obstetrics 5 orthopedic surgery and procedures 6 surgical gastroenterology 7 cardiothorasic surgery 8 paediatric surgeries 9 genito urinary surgeries 10 neuro surgery 11 surgical oncology 12 medical oncology 13 radiation oncology 14 plastic surgery 15 polytrauma 16 prostheses 17 critical care 18 general medicine 19 infectious diseases 20 pediatrics 21 cardiology 22 nephrology 23 neurology 24 pulmonology 25 dermatology 26 rheumatology 27 endocrinology 28 gastro enterology 29 psychiatry

Remark

    The scheme provides coverage for treatments related to the heart, liver, kidney, pediatric congenital malformations, lung, pancreas, or burns in the following districts of Telangana: Anantapur, Srikakulam, Mahabubnagar (Phase-I, Fourth Renewal) Medak, Karimnagar, Prakasam, SPS Nellore and YSR District. (Phase-III, Third Renewal) Post-burn contracture surgeries that are conducted for improvement of body functions, cancer treatments, prostheses, and polytrauma are also covered under the scheme. Amount: The scheme is offered on a floater basis to the families i.e. either an individual or the family as a whole can receive a reimbursement of Rs.1.5 lakh. An additional benefit amount equal to Rs.50,000 is provided to manage expenses when the treatment amount crosses Rs.1.5 lakh. Each family is provided with a Rs.2 lakh protection for the treatment of serious illnesses. Financial protection for 938 medical and surgical treatments can be availed. 125 follow-up treatments are also covered under the scheme. The total amount that can be reimbursed for the treatment is Rs.6.5 lakh per case. The coverage amount available for kidney transplantation is Rs.2.5 lakh. The beneficiaries of the scheme can simply walk into a network hospital and avail cashless treatments. Primary Health Centers, Network Hospitals, and Area/District Hospitals have Aarogya Mithras to aid the illiterate members of the scheme. Aarogya Mithras are chosen by Zilla and Mandal Samakhyas who are under Self Help Groups. Eligibility: Families Below Poverty Line as mentioned in the BPL Ration card and found in the Civil Supplies Department database are eligible for this scheme.

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