Dr. YSR Aarogyasri Health Insurance Scheme

Dr. YSR Aarogyasri Health Insurance Scheme

Dr. YSR Aarogyasri Health Insurance Scheme was specially designed for the poorer class of the society and was launched in 2007 by the Karnataka Government with the aim of providing universal and quality health coverage to the families living below the poverty of the state. This plan offers cashless medical treatments to low-income people in the government hospitals of Andhra Pradesh. This scheme is managed by Aarogyasri Health Care Trust, which issues an Aaarogyasri Card to facilitate the entire process in a smooth and easy way. The following table showcases a brief overview of this scheme.

Highlights of Dr. YSR Aarogyasri Scheme

Scheme nameDr. YSR Aarogyasri Health Insurance Scheme
Launched byChief Minister of Andhra Pradesh, Dr. YS Rajasekhar Reddy
Launching year2007
Applicants and beneficiaries of the schemeResidents of Andhra Pradesh
Objectives of the scheme
  1. To provide free quality hospital care and equity of access to BPL families by the purchase of quality medical services from an identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
  2. To provide financial security against catastrophic health expenditures.
  3. To strengthen the Government Hospitals through demand side financing.
  4. To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.
Official websitehttps://ysraarogyasri.ap.gov.in/ysr-aarogyasri-scheme

Eligibility Criteria

The followings are the eligibility criteria to avail of the benefits of this scheme.

  • The applicant has to be a local resident of Andhra Pradesh.
  • The annual income of the applicant’s family has to be below RS. 5 lakhs.
  • The applicants have to have a white ration card.
  • The applicants must not possess lands (wet or dry) more than 35 acres.
  • The applicants must not own more than 1 car.
  •  They must come under municipal property tax-paying families.
  • Families that pay income tax up to Rs. 5 lakhs can avail of the benefits of the scheme.

Benefits and features of Dr. YSR Aarogyasri Health Insurance Scheme

The scheme is complementary to facilities available in government hospitals and, put together, provides Universal Health Coverage to the BPL population, including Prevention, Primary care, and In-Patient care. To know more about the key highlights and benefits of this plan, have a look at the following mentions.

  • In-patient hospitalization – All the listed medical procedures and surgeries that require hospitalization will be covered under this scheme.
  • Out-patient treatment – The scheme is designed in such a way that the benefit of 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.
  • Pre-existing diseases – All the pre-existing ailments under listed therapies meaning the diseases for which the beneficiary is diagnosed before availing of the scheme, are covered under the scheme. This benefit is not provided under many standard health insurance policies.
  • Cashless treatment – End-to-end cashless service offered through an 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).
  • Follow-up services – Follow-up services are provided for a period of one year through fixed packages to the patients who require long term follow-up therapy in order to get optimum benefit from the procedure and to avoid complications.
  • Family floater health insurance cover This scheme covers every member of the family. Therefore for each member of the family, you do not have to buy a separate health insurance policy, which is proved to be very cost-effective.

Treatments covered under Dr. YSR Aarogyasri Health Insurance Scheme

The treatments that are covered under this scheme are as follows:

  • General surgery 
  • ENT Surgery
  • Ophthalmology
  • Gynecology 
  • Obstetrics 
  • Orthopedic surgery and procedures
  • Surgical gastroenterology
  • Cardiothoracic surgery
  • Pediatric surgeries
  • Genito urinary surgeries 
  • Neurosurgery
  • Surgical oncology
  • Medical oncology
  • Radiation oncology
  • Plastic surgery
  • Polytrauma
  • Prostheses 
  • Critical care
  • General medicine
  • Infectious diseases
  • Pediatrics 
  • Cardiology
  • Nephrology
  • Neurology
  • Pulmonology
  • Dermatology
  • Rheumatology
  • Endocrinology
  • Gastro enterology 
  • Psychiatry

Covid-19 cover under Dr. YSR Aarogyasri Health Insurance Scheme

The global pandemic created by Covid-19 had put the entire world at a standstill position and thousands of people died out of this contagious virus. It virus has had an adverse effect on the health condition of people resulting in serious lung and throat problems. For that reason, Dr. YSR Aarogyasri Health Insurance Scheme has included 15 new medical procedures to address this problem, and those are as follows.

  • Septic Shock Intensive Care Management
  • Medical Management of Acute Respiratory Failure (with ventilator)
  • Medical Management of Acute Respiratory Failure (without ventilator)
  • Medical Management of Acute Severe Asthma with Acute Respiratory Failure
  • Medical Management of Acute Bronchitis with Pneumonia and Respiratory Failure
  • Medical Management of ARDS.
  • Medical Management of ARDS with DIC (Blood and Blood Products) (D65)
  • Medical Management of ARDS with DIC (Blood and Blood Products) (D65) in Paediatrics
  • Medical Management of ARDS with Multi-organ Failure (R65.1)
  • Medical Management of ARDS with Multi-organ Failure in Paediatrics
  • Medical Management of Confirmed Covid-19 (stable)
  • Medical Management of Confirmed Covid-19 with Comorbidities – HTN, DM, COPD, HIV, Chr. Liver Diseases, Chr. Enal Disease.
  • Medical Management with COPD with Respiratory Failure (Infective Exacerbation)
  • Medical Management of Pneumonia
  • Medical Management of Suspected Covid-19 (stable)

Exclusions of Dr. YSR Aarogyasri Health Insurance Scheme

There is a list of medical procedures and surgeries for which this scheme does not offer any coverage, which means that the beneficiary has to bear the expenses of the medical costs of those treatments. The list is mentioned below.

  • Knee replacement surgeries 
  • Gamma-knife procedures in neurosurgeries 
  • Medical treatments related to bone marrow
  • Leprosy
  • Filaria
  • Assisted devices for cardiac failure
  • Cardiac and liver transplants
  • Malaria
  • HIV/AIDS
  • Tuberculosis
  • Infectious diseases
  • Gastroenteritis 
  • Jaundice 

Registration Process for Dr. YSR Aarogyasri Health Insurance Scheme

It would be advisable to go through the eligibility criteria first and if you find yourself eligible to avail of this scheme, you have to do the registration, first. You can opt for either an online or offline process to register yourself, according to your convenience. Here are the steps of both procedures.

Online Process:

  • Go to the official website of the scheme.
  • Login to the portal with your valid ID and password.
  • Fill in the application form with the required details
  • Upload the necessary documents.
  • Submit the application form
  • You are done here. Just take a print out of it.

Offline Process:

  • Go to the official website of the scheme
  • Click on the YSR Aarogya Health Card Performa
  • Download the YSR Aarogyasri Scheme application form
  • Take a print out of the form
  • Fill in the form with the required details
  • Submit the duly filled and signed form physically to the concerned department
  • Verification will be done
  • Once the verification is completed and no discrepancy is found, the applicant will be provided with the YSR Health Card.

Documents Required For This Scheme:

  • Aadhar card
  • Valid address proof
  • Income certificate
  • BPL certificate

How To Download Dr. YSR Aarogyasri Health Insurance Scheme Card?

If you are registered under this scheme, you can download YSR Health Card very easily online by following the below steps.

  • Go to the official website of Dr. YSR Aarogyasri Health Care Trust
  • On the homepage, you will find an EHS tab. Click on that.
  • After that, go for the Download Health Card option
  • Put the relevant user ID and click on the Go option
  • An online form will appear before you. Fill in the blanks with the required details.
  • Once you are done, submit the form.
  • Now, download the softcopy of the health card and use it whenever it is required.

Claim Procedure of Dr. YSR Aarogyasri Health Insurance Scheme

To make the claim process hassle-free and user-friendly, this scheme has come up with two types of claim procedures, one for the hospitals and the other for the beneficiaries. Here are the details of both procedures.

Claim Process For The Beneficiaries:

  • The claim process for the beneficiaries is very easy and short. YSR Aarogyasri Health Cards play a pivotal role in this case.
  • They have to take their health card to a Vaidya Mitra to receive medical treatment in an empanelled hospital.
  • The Vaidya Mitra will collect the information from that card and the treatment will start after that.
  • If the beneficiary does not possess a health card, then he/she has to give the card number to Vaidya Mitra.
  • If the beneficiary is unable to produce any card number, in or case, the Aarogyasri Trust can be contacted to obtain the relevant information.
  • Once all the necessary verifications are done, the claim amount will be given to the beneficiary within the stipulated time.

The beneficiary can also use the Dr. YSR Aarogyasri official website to settle all the claims, collect claim documents, claim intimation, review claim documents, etc. Once the filing of the claim is done, the following verifications are carried out:

  • Identity of the patient
  • Evidence of the treatment
  • Claim amount concerning the authorized amount
  • Case management as per the pre-authorization

Claim Process For The Hospitals:

In the case of planned hospitalization or planned surgical treatment, the hospital has to seek pre-authorization. The hospital has to meet the following criteria, only after that will the trust accept the claim.

  • The hospitals have to have the pre-authorization to perform a treatment that is on the approved and specified treatment list.
  • The claim has to be intimated as soon as the incident occurs.
  • The claim amount has to be less than the pre-authorization amount.
  • For settlement of the claim, photographic documentation has to be provided to the trust.

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