Rajiv Aarogyasri is a unique community health insurance scheme that is being implemented in the state of Andhra Pradesh. It provides financial protection for individuals who are below the poverty line in the state. 87% of the population in Andhra Pradesh i.e. 233 families out of 266 families benefit from the scheme. The objective of the scheme is to provide good quality medical treatments for specific diseases that require therapy, hospitalization, or surgery from the network hospitals of the healthcare service providers.
Objectives of Rajiv Aarogyasri
- To provide good quality medical treatments to the underprivileged section of the state.
- To provide coverage for major illnesses that could turn out to be expensive for the economically backward.
- To provide finance to government hospitals for improvement of infrastructure.
- To deliver tertiary medical services to the vulnerable families in the urban and rural regions of the state.
- To increase the accessibility of medical services by finding out diseases, through network hospitals, that require hospitalisation.
Eligibility for Rajiv Aarogyasri
Families Below Poverty Line as mentioned in the BPL Ration card and found in the Civil Supplies Department database are eligible for this scheme.
Features of Rajiv Aarogyasri
- 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 scheme provides coverage for treatments related to the heart, liver, kidney, pediatric congenital malformations, lung, pancreas, or burns.
- Post-burn contracture surgeries that are conducted for improvement of body functions, cancer treatments, prostheses, and polytrauma are also covered under the scheme.
- Children below the age of 6 can also avail protection for cochlear implant surgery along with auditory-verbal therapy. 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.
- Pre-existing cases for any of the above-mentioned health conditions are also covered under the policy.
Exclusions of Rajiv Aarogyasri
- Hip and knee replacement
- Bone marrow, liver, and cardiac transplantations
- Gamma knife procedures for neurosurgery
- Assisted devices for heart failures
Methodology of Rajiv Aarogyasri
- The transactions for all the procedures covered under the scheme are cashless.
- Transactions for diagnostic procedures are also cashless.
- 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.
- Health camps are conducted in each district to create awareness as well as to screen individuals who require treatments.
FAQs on Rajiv Aarogyasri by Government of Andhra Pradesh
- Who can avail services under this scheme?
Any person, below the poverty line, who needs tertiary care can use the smart card to get coverage for the hospitalisation and surgical expenses incurred.
- Who will bear the expenses incurred on hospitalisation?
The government of Andhra Pradesh will bear the expenses incurred. Beneficiaries need not worry about the claim process. They can simply submit their smart cards to enjoy cashless hospitalisation benefits.
- Are there any customer care channels?
Yes, there is a round-the-clock customer care service for beneficiaries who have queries about the facilities provided under the scheme and the usage of the smart card.
- I have been suffering from a cardiac disease and the doctor has recommended a cardiac transplantation. Will the expenses incurred be covered under the scheme?
No. Unfortunately, cardiac transplantations are not covered under the scheme.
- Can I avail services from the scheme if I don’t fall in the BPL category?
No. The scheme has been created keeping in mind the health insurance needs of the underprivileged mass of the state. Only about 2 crore people who fall in the BPL category can avail services under this scheme.