Rajiv Aarogyasri Health Insurance Scheme
Rajiv Aarogyasri Community Health Insurance Scheme(Aarogyasri I)
Aarogyasri I is a unique Community Health Insurance Scheme being implemented in Andhra Pradesh from 1st April, 2007. The scheme provides financial protection to families living below poverty line upto Rs. 2 lakhs in a year for the treatment of serious ailments requiring hospitalization and surgery. 330 procedures are covered under the scheme. The scheme is being implemented through Insurance Company, selected through a competitive bidding process. The objective of the scheme is to improve access of BPL families to quality medical care for treatment of identified diseases involving hospitalization, surgeries and therapies through an identified network of health care providers. The scheme provides coverage for the systems like Heart, Lung, Liver, Pancreas, Renal diseases, Neuro-Surgery, Pediatric Congenital Malformations, Burns, Post -Burn Contracture Surgeries for Functional Improvement, Prostheses (Artificial limbs), Cancer treatment (Surgery, Chemo Therapy, Radio Therapy ), Polytrauma ( including cases covered under MV Act) and Cochlear Implant Surgery with Auditory-Verbal Therapy for Children below 6 years (costs reimbursed by the Trust on case to case basis ). All the preexisting cases of the above mentioned diseases are covered under the scheme.
The beneficiaries of the scheme are the members of below poverty line (BPL) families as enumerated and photographed on the Rajiv Aarogyasri Health Card/ BPL Ration Card. The benefit on family is on floater basis i.e. the total reimbursement of Rs.1.50 lakhs can be availed of individually or collectively by members of the family. An additional sum of Rs 50,000 is provided as buffer to take care of expenses if it exceeds the original sum i.e. Rs 1.50 lakhs per Individual/family.Cost for cochlear Implant Surgery with Auditory �Verbal Therapy is reimbursed by the Trust up to a maximum of Rs.6.50 lakhs for each case.
The transaction is cashless for covered procedures. BPL beneficiary can go to hospital and come out without making any payment to the hospital for the procedures covered under the scheme. The same is the case for diagnostics if eventually the patient does not end up in doing the surgery or therapy. Hospitals have to conduct at least one free medical camp in a month, there by taking advanced evaluation to the doorstep of patient. All the Primary Health Centers (PHCs) which are the first contact point, Area/District Hospitals and Network Hospitals, are provided with Help Desks manned by AAROGYA MITHRAs to facilitate the illiterate patients. The Aarogyamithras were selected by the Mandal Samakhyas under Indira Kranti Patham (Self Help Group Movement)