YSR Aarogyasri Health Scheme

The Andhra Pradesh Government has introduced the YSR Aarogyasri Health Scheme to provide free healthcare to the belonging to the Below Poverty Line (BPL) category. Under this scheme, the health coverage of up to Rs.5 lakhs for each family will be provided every year. This article explains about the YSR Aarogyasri Health Scheme in detail.

Also, read about AP YSR Navodayam Scheme

Objectives

The objectives of the YSR Aarogyasri Health Scheme are listed below:

• To provide quality and free health care to BPL families.
• To strengthen the Government Hospitals through demand-side financing in health.
• To give financial security against catastrophic health expenditures.
• To issue universal health coverage for both urban and rural poor of the Andhra Pradesh State.

Eligibility Criteria

The eligibility criteria to apply for the YSR Aarogyasri Health Scheme are given below:

• Any family holding BPL ration card (Annapurna and Anthyodaya Anna Yojana, RAP and TAP) issued by Civil Supplies Department are eligible to apply for the scheme.
• Any people whose name and photo appear on BPL ration card or Health card and suffering from identified diseases are eligible to avail benefits under this scheme.
• The annual income of the family should be below Rs.5 lakhs while applying for the scheme.

Health Insurance Coverage

The health insurance coverage under the scheme are specified here:

Financial Coverage

Under this scheme, the coverage of up to Rs.5 lakhs for the free health care service will be provided to the beneficiaries.

Note: There is no co-payment under this scheme. i.e. apart from the amount covered under this scheme, no amount has to be paid by a patient to the service provider.

Benefit Coverage

The following are the benefits provided under benefit coverage:

Out-Patient

Under this coverage, the benefits in the primary care are addressed through free screening and outpatient consultation is processed in both health camps and in the network hospitals, which is registered as part of scheme implementation.

In-Patient

Under this coverage, the service would be provided for the 1059 listed therapies and identified diseases in the thirty categories are listed below.

• General Surgery
• ENT Surgery
• Ophthalmology
• Gynaecology & Obstetrics
• Orthopedic Surgery And Procedures
• Surgical Gastroenterology
• Cardiothoracic Surgery
• Paediatric Surgeries
• Genito Urinary Surgeries
• Neuro Surgery
• Surgical Oncology
• Medical Oncology
• Radiation Oncology
• Plastic Surgery
• Polytrauma
• Prostheses
• Critical Care
• General Medicine
• Infectious Diseases
• Paediatrics
• Cardiology
• Nephrology
• Neurology
• Pulmonology
• Dermatology
• Rheumatology
• Endocrinology
• Gastro Enterology
• Psychiatry

Note: In addition to the above, the coverage will include the following services are:

• The cashless facility will be offered through a network hospital from the time of reporting of the patient who undergoes therapy mentioned above.
• The OP evaluation of patients who do not undergo listed therapies will be done at free of cost.
• Also, all the pre-existing cases under-listed therapies are covered under the scheme.

Follow-up Services

The follow-up services to the patients are provided for one year through fixed packages, and additionally, long term follow-up services are also provided to get optimum benefit under this scheme. The follow-up package for consultation, drugs, investigations, etc., for the period of one year for listed therapies formulated by the Technical Committee of the Trust in consultation with a specialist.

Implementing Agency

The YSR Aarogyasri Health Care Trust will act as the implementing agency will implement the scheme directly by entering into a contract agreement with network hospitals.

Network Hospitals

A health care service provider will be the hospital or nursing home in the Andhra Pradesh State, which is established for indoor medical care and treatment of disease.

District Administration

District level monitoring committee will be set up to review the implementation of the scheme through regular review meetings but also to encourage patients to attend health camps, conducting awareness through Self Help Groups, peoples representatives and other field functionaries.

Enrolment Process

The implementing agency will provide the details of the eligible family covered under the scheme through the eligibility card. This eligibility card will be considered as the proof of enrolment and identification process for availing the health insurance coverage.

Budget Allocation

The Trust has allocated an amount as mentioned in the scheme budget. This fund has been organised through tax revenues of the Andhra Pradesh Government and allocated to the Trust. The Government is the agency which is collecting the prepayment from the beneficiaries through taxes the Trust/ Government will be the insurer for this scheme.

YSR Aarogyasri Health Card Download

The Andhra Pradesh Government issues an Aarogyasri health card, and the beneficiary can use it in both Government and private hospitals to obtain the services at free of cost. In order to facilitate scheme implementation, the State Government has established the Aarogyasri Health Care Trust under the chairmanship of the Chief Minister.

Implementation Process

The YSR Aarogyasri Health Scheme will be implemented in a step by step procedure as specified below:

Step 1: Any beneficiary is suffering from the disease listed above can registration under the scheme. The registration can be done in the health camp organised by the network hospitals.

Biometric Registration

Step 2: Under biometric registration, the digital image of the patient fingerprint will be captured while registering online in a network hospital.

Evaluation and Admission

Step 3: After registration, the patient is admitted and evaluated, the patient may be evaluated as an out-patient initially, and after diagnosing treatment, the mode will be finalised and converted as “in-patient” through an online process.

Final Diagnosis

Step 4: After the verification of the patient if the patient is found to be suffering from listed therapies, then the MEDCO (Medical and Dental College) of Andhra Pradesh should submit the pre-authorization through the Trust official portal within 24 hours. If the patient is observed to be suffering from diseases other than listed therapies, then the patient would be referred to nearest Government Hospital for further proceedings.

Step 5: In pre-authorization, if found the patient is suffering from the listed therapies, the MEDCO is required to upload all the relevant documents.

Step 6: Then, the network hospital will provide complete treatment to the patient after obtaining pre-authorization.

Health care Service

Step 7: The network hospital would provide cashless services within the package. However, the network hospital would apply for enhancement of the package price in case of the prior discharge as per Trust guidelines.

Discharge

Step 8: The patient is discharged after complete recovery, and at the time of discharge, a letter of satisfactory services will be obtained from the beneficiary. As per the scheme norms and obtained receipt, the patient will be reimbursed with transport charges.