SAST JSS Jyothi Sanjeevini Scheme For Government Employees Karnataka

Organization : Government of Karnataka
Service Name : JSS Jyothi Sanjeevini Scheme For Government Employees
Applicable State: Karnataka
Website : http://www.sast.gov.in/

Jyothi Sanjeevini Scheme:

The Government of Karnataka has approved a Health Assurance Scheme vide Government order No. DPAR/14/SMR/2013 dated 18/08/2014, specially designed for the Government Employees, named “Jyothi Sanjeevini”.

Related : Social Welfare Karnataka Book Bank Scheme : www.statusin.in/9757.html

It is a comprehensive health care to the Government employees, wherein the Scheme provides cashless treatment to all the Government Employees and their dependants through an empanelled Network of Hospitals for Tertiary Care .

Objectives :
To provide quality “tertiary health care” for the treatment of catastrophic illnesses involving hospitalization, surgery, and other therapies through an identified Network of Super Speciality Hospitals.

Specialty covered:
The scheme covers tertiary treatment of 7 broad specialities viz Cardiology, Oncology, Genito Urinary Surgery, Neurology , Burns, Poly-Trauma cases (excluding medico legal cases) and Neo-Natal & Paediatric Surgery.

Beneficiaries & Coverage :
“Beneficiary” means and relates to all State Government Employees and their dependant family members defined by the Government of Karnataka from time to time; and as such all of them are covered under this Scheme.

Beneficiaries Identification :
** The beneficiary is identified by virtue of Karnataka Government Insurance Department’s Policy Number which get interacted with the HRMS data base of the Department of Personnel and Administrative Reforms of the Government of Karnataka.
** The Government has allowed Suvarna Arogya Suraksha Trust to access the data base of the Government Servants for the purpose of identifying the Government Servants and their dependants.
** The dependant family members of a Government Servant includes as defined under Rule 2(1) of clause (i) (ii) & (iii) of Karnataka Government Servants (Medical Attendant) Rules, 1963 which defines as under

(i) The wife or husband of the Government Servant.
(ii) The father and mother (including step-mother) if they ordinarily reside with the Government Servant and their total monthly income does not exceed Rs. 6,000 and
(iii) Children including adopted children and step children, of a Government Servant who are wholly dependent on such Government servant. The above details shall be declared and certified by the Government Servant.

Ineligibility :
The Government Servants will not be eligible, if the benefits are already availed “in any of the other” Government sponsored health schemes

Scheme Design :
The scheme is implemented in an “Assurance Mode” through Suvarna Arogya Suraksha Trust to the “State Government Employees and their dependants” by a network of “Empanelled Hospitals” with no financial cap.

The process of identification and empanelment is a continuous one from “time to time”. Only such of those Network Hospitals who are already empanelled and gets empanelled for “Vajpayee Arogyashree Scheme”, alone are empanelled under “Jyothi Sanjeevini Scheme”.

It is “cashless” to the beneficiaries except in following cases :
(i) where the beneficiary opts/desires an higher implants, stents, prosthesis etc., which are costlier than the ones included in the benefit package and
(ii) where the beneficiary opts for superior wards other than the one for which he/she is entitled. In the aforesaid circumstances, the beneficiaries shall bear the additional cost.

Benefit Packages :
The scheme covers tertiary treatment of 7 broad specialities viz cardio-vascular diseases, cancer, renal diseases, neurological diseases, burns, poly-trauma cases* and neo-natal cases. It includes “663 procedures“ pertaining to seven specialities stated above.

The package includes consultation, diagnostics, procedure cost, food, hospital charges and post hospitalization services up-to 10 days include medicines. Upper limit is fixed for those procedures requiring implants, stents etc., exceeding which the difference of cost will be borne by the beneficiaries.

In addition, the scheme covers “138 defined follow-up packages” that include post hospitalization care for a subset of covered procedures, including consultations, diagnostics and drugs