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AAROGYASRI COMMUNITY HEALTH INSURANCE SCHEME

AAROGYASRI COMMUNITY HEALTH INSURANCE SCHEME

           Modern medicine, with its advancement in technology has made rapid strides in diagnosis and treatment of many a complicated disease, hitherto unattended thus reducing the morbidity and mortality enormously and improving quality of life. While advent of non-invasive diagnostic tools like CT Scan, MRI, Ultra Sound and radio isotope studies made diagnosis of disease more specific, the latest gadgets such as video endoscopes, laproscope etc. made treatment and surgical procedures less cumbersome and simple.
           Hence there is a felt need in the State to provide medical assistance to families living below poverty line for the treatment of serious ailments such as cancer, kidney failure, heart and neurosurgical diseases etc., requiring hospitalization and surgery. Available network of government hospitals do not have the requisite equipment or the facility or the specialist pool of doctors to meet the state wide requirement for the treatment of such diseases. Large proportions of people, especially below poverty line borrow money or sell assets to pay for hospitalization. Presently many people suffering from such diseases are approaching the Government to provide financial assistance to meet hospitalization expenses for surgical procedures.During the period from 14.05.2004 to 26.06.2007, financial assistance to a tune of Rs. 168.52crores has been provided from CM's Relief Fund in 55361 cases to meet hospitalization expenses for such people. From the experience gained, it is now felt that the assistance could be institutionalized so that its benefit can be accessed by poor people across the State easily and in a trouble free manner. Health Insurance could be a way of removing the financial barriers and improving access of poor to quality medical care; of providing financial protection against high medical expenses; and negotiating with the providers for better quality care.
          In order to operate the scheme professionally in a cost effective manner, public private partnership will be promoted between the Insurance Company / TPA, the private sector hospitals and the State agencies. "Aarogyasri Health Care Trust" recently setup by the State Government for the implementation of the Scheme will assist the insurance company / TPA / Beneficiaries and coordinate with Medical and Health Deptt., District Collectors, Civil Supplies Department etc.
THE SCHEME
Name: RAJIV AAROGYASRI COMMUNITY HEALTH INSURANCE SCHEME
Objective:
To improve access of BPL families to quality medical care for treatment of diseases involving hospitalization and surgery through an identified network of health care providers. In the initial phase, the scheme would provide coverage for the following system.

Click here for the complete list of surgeries and other aid covered under this scheme.

For further details please visit :   www.aarogyasri.org


Bringing modern surgeries and medical services to the door step of poor RAJIV AAROGYASRI Community Health Insurance Scheme

Salient features of the Scheme:

  • Health Insurance cover up to Rs. 1.5 Lakhs for each Below Poverty Line (BPL) family.
  • Beneficiaries identified through Health Card/White Ration Card.
  • Cashless treatment for patients in all Network Hospitals.
  • Coverage for major surgeries relating to Heart, Neuro and Kidney.
  • Coverage for surgeries, radiotherapy and chemotherapy for cancer treatment.
  • Coverage for treatment of burns, surgical treatment for Polytrauma (except those cases covered under Motor Vehicles Act) and Cohlear Implantation (for children below 6 years age)
  • Entire premium borne by Government.
  • Aarogyamithras stationed from PHC’s to Network Hospitals for assisting patients.
  • Special wards for priority treatment in Network Hospitals.
  • Aarogyasri Health Care Trust to oversee the entire implementation of the Scheme.

AROGYASRI HEALTH CARE TRUST
Municipal Complex, 3rd Floor, Beside Koti Maternity Hospital, Sultan Bazar, Koti, Hyderabad – 500 095
Ph: 040 – 24652478, 24652540, Fax: 040 – 24657715
Web: www.aarogyasri.org

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)


Rajiv Aarogyasri Community Health Insurance Scheme(Aarogyasri II)
Encouraged by the success of the ongoing scheme, Government have now decided to launch with effect from 17th July, 2008, the Aarogyasri-II scheme to include a large number of additional surgical and medical diseases to enable many more BPL people who are now suffering from acute ailments, to lead a healthy life.
Aarogyasri-II scheme is an extension of the ongoing Health Insurance Scheme. The front end of the ongoing scheme viz., network hospitals, Aarogyamithras, Health Cards etc., will remain the same. Only difference would be that the pre-authorization and claim processing for the new diseases would be done by the Trust directly and funded from the C.M. relief fund.
30 groups of eminent doctors from the Government and corporate hospital sectors have through a series of discussions and in consultation with the managements of corporate hospitals finalized a list of 389 surgical and 144 medical diseases and also evolved package rates for its cashless treatment.
With the launch of Aarogyasri-II, cashless treatment of BPL population for all major diseases will become possible in Government / corporate hospitals. Diseases covered under ongoing Aarogyasri � I and those proposed to be covered under Aarogyasri-II are complimentary to the facilities available in Government hospitals and put together substantially meet the medical requirement of general population. The diseases specifically excluded from the list are:

  • High end diseases such as 'hip and knee replacement, bone morrow, cardiac and liver transplantation, gamma-knife procedures in neuro surgery, assisted devices for cardiac failures etc;
  • Diseases covered by National Programmes viz., TB, HIV / AIDS, Leprosy, infectious diseases, Malaria, Filaria, Gastroenteritis, Jaundice etc.

To the extent the scope of Aarogyasri - I is enlarged by Aarogyasri-II , it would no longer be permissible for the BPL population to approach the Government for providing relief for medical purposes from the CMRF.


NETWORK HOSPITALS UNDER RAJIV AAROGYASRI SCHEME

HYDERABAD DISTRICT

  • Apollo Hospitals, D. R. D. O.
  • Apollo Hospitals, Vikrampuri
  • Apollo Hospitals, Jubili Hills
  • Asian Institute of Gastroenterology, Somajiguda
  • Balaji Hospital, Medchal
  • Bibi Cancer & General Hospital, Malakpet
  • BBC Hospital, Nallakunta
  • Care Hospital, Banjara Hills
  • Care Hospital, Nampally
  • Durgabai Deshmukh Hospital & Research Centre, Vidyanagar
  • Gandhi Hospital, Musheerabad
  • Genesis Hospital, Basheerbagh
  • Global Hospital, Lakdi-ka-pool
  • Goodwill Kidney & Surgical Centre, Erragadda
  • General & Chest Hospital, Nayapool
  • Govt. Maternity Hospital, Nayapool
  • Govt. Maternity Hospital, Koti
  • Healing Touch Hospital, Kummariguda
  • Himabindu Hospitals, Hyderabad
  • Image Hospital, Ameerpet
  • Image Hospital, Madhapur
  • Indo-American Cancer Institute, Banjara Hills
  • Innova Children Heart Centre, Tarnaka
  • Kamala Hospital, Dilsukhnagar
  • Kamineni Hospital, L. B. Nagar
  • Kamineni Hospital, King Koti
  • Kamineni Wockard Hospital, King Koti
  • Kamineni Wockard Heart Centre, L. B. Nagar
  • Krishna Institute of Medical Sciences, Minister Road
  • Life Hospital, DD Colony
  • Lotus Childrens Hospital, Lakdi-ka-pool
  • MNJ Cancer Institute, Lakdi-ka-pool
  • Mahaveer Hospital, Masabtank
  • Mamatha Super Speciality Hospital, Kukatpally
  • Medicare Hospital, Hyderabad
  • Medicity Hospital, Secretariat
  • Medicity Institute of Medical Science, Medchal
  • Medwin Hospital, Nampally
  • Newlife Hospital, Chaderghat
  • NIMS, Panjagutta
  • Osmania Hospital, Afzalgunj
  • Niloufer Hospital, Red Hills
  • Poulomi Hospital, A. S. Rao Nagar
  • Premier Hospital, Mehdipatnam
  • Prime Multi Speciality Hospital, Ameerpet
  • Rainbow Childrens Hospital, Vikrampuri
  • Rainbow Childrens Hospital, Hyderabad
  • Remedy Hospitals, Balanagar
  • S. V. R. Super Speciality Hospital, Ameerpet
  • Sai Bhavani Hosital, Shapurnagar
  • Sai Vani Hospital, Domalguda
  • Shravana Multi Speciality, MJ Market
  • Sri Hrishikeshaiah Hospitals, Uppal
  • Sigma Hospital, Secunderabad
  • Sigma Hospital, Dilsukh Nagar
  • Soumya Hospital, Trimulgherry
  • Sridhar Multi Speciality Hospital, Hyderabad
  • Suraksha Multi Speciality Hospital, Hyderabad
  • Vasavi IST Institute, Khairatabad
  • Vijaya Health Care, Kummarguda
  • Woodlands Hospital, Barkatpura
  • Yashoda Hospital, Malakpet
  • Yashoda Hospital, Secunderabad
  • Vital statistics of last 24 hours (taken from net on Saturday, November 15, 2008 at 12.00 noon)

     Medical Camps

    18

     People Screened

    2542

     Out Patients

    715

     In Patients

    811

     Pre authorizations

    748

     Surgeries/Therapies

    215

     Amount Claimed

    Rs. 4064500


    At a Glance (Since April 1st 2007)


     Medical Camps

    5546

     People Screened

    1166763

     Out Patients

    126549

     In Patients

    142492

     Pre authorizations

    133915

     Surgeries/Therapies

    119673

     Amount Claimed

    462.14 Cr