Organisation : Dr. YSR Aarogyasri Health Care Trust
Scheme Name : Dr.Ysr Aarogyasri Scheme
Applicable For : BPL Families
Applicable State/UT : Andhra Pradesh
Website : https://www.ysraarogyasri.ap.gov.in/
What is Dr.Ysr Aarogyasri Scheme?
Dr.YSR Aarogyasri Health Insurance scheme is unique in its applicability since no other State/ government agency has provided universal health coverage to the poor. The choice of hospital for treatment is with the patient. The entire process from the time of conduct of health camps to the screening, diagnosing , treatment, follow- up and claim payment is made transparent through online web based processing to prevent any misuse and fraud.
Related / Similar Facility : Know YSR Aarogyasri Aasara Status Online
Objective of Dr.Ysr Aarogyasri Scheme
** To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust).
** To provide financial security against the catastrophic health expenditures.
** To strengthen the Government Hospitals through demand side financing.
** To provide universal coverage of health for both urban and rural poor of the State of Andhra Pradesh.
Geometry of Health Insurance Coverage
** Population coverage (Breadth of Universal Health coverage) The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card linked with Adhar card and available in Civil Supplies Department database.
** Financial coverage (Height of Universal Health coverage) The scheme shall provide coverage for the services to the beneficiaries up to Rs.5 lakh per family per annum on floater basis. There shall be no co-payment under this scheme.
** Benefit Coverage (Depth of Universal Health coverage)
** Out-Patient The scheme is designed in such a way that the benefit in the 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.
** In-Patient The scheme shall provide coverage for the 3255 “Listed Therapies” for identified diseases in the 31 categories ‘€“ Are listed in website: www.ysraarogyasri.ap.gov.in
Package includes the following services:
** End-to-end cashless service offered through a 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).
** Free OP evaluation of patients for listed therapies who may not undergo treatment for “listed therapies.
** All the pre-existing cases under listed therapies are covered under the scheme.
** Food and Transportation.
Categories of Dr.Ysr Aarogyasri Scheme
The scheme provides coverage for the procedures under following categories:
** Cardiac & Cardiothoracic Surgery
** Cardiology
** Cochlear Implant Surgery
** Critical Care
** Dermatology
** Edocrinology
** Ent Surgery
** Epidemic Disease
** Gastroenterology
** General Medicine
** General Surgery
** Genito Urinary Surgeries
** Gynaecology And Obstetrics Surgery
** Infectious Disease
** Medical Oncology
** Nephrology
** Neurology
** Neurosurgery
** Opthalmology Surgery
** Organ Transplantation Surgery
** Orthopedic Surgery And Procedures
** Pediatric Surgeries
** Pediatrics
** Plastic Surgery
** Poly Trauma
** Psychiatry
** Pulmonology
** Radiation Oncology
** Surgical Gastro Enterology
** Rheumatology
** Surgical Oncology
Follow Up Services:
Follow-up services are provided for a period of one year through fixed packages to the patients whoever require long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up package for consultation, investigations, drugs etc., for one year for listed therapies were formulated by Technical committee of the Trust in consultation with specialists are listed in the website
Implementation Process of Dr.Ysr Aarogyasri Scheme
** Modes of OP capture A beneficiary suffering from an ailment can approach any of the following first point of contact’ for registration under the scheme.
** There are three modes of OP capture. Aarogya mithra counters at PHC. Registration in a Health Camp organized by the PHCs or NWHs and Directly at the NWH in case of emergencies or through referral.
** Referral from CMCO center Referral from 104 and 108 services
** Biometric registration: Capturing digital image (finger impression) of the patient while registering online for the first time in a network hospital.
** Evaluation and Admission After the initial evaluation of the patient, the patient is admitted if needed and evaluated further.
** The patient may be evaluated as an out-patient initially and after ascertaining the diagnosis and finalization treatment mode admitted and converted as “in-patient” in the online workflow.
** Final diagnosis and categorization After the evaluation of the patient: If the patient is found to be suffering from listed therapies, MEDCO shall submit the pre-authorization through the Trust portal within 24 hours.
** If the patient is found to be suffering from diseases other than listed therapies, he shall be counseled and referred to nearest Govt. Hospital for further management.
** Pre-authorization MEDCO shall upload all the relevant documents and send the case for pre-authorization .
** Treatment The NWH shall render complete treatment to the patient after obtaining pre-authorization.
** Treatment The NWH shall render complete treatment to the patient after obtaining pre-authorization.
** Enhancement (Package price adjustment) The NWH shall provide end to end cashless services within the package.
** However NWH may apply for enhancement of the package price in case of exigencies prior to discharge as per Trust guidelines.
** Discharge The patient is discharged after complete recovery. The NWH shall issue discharge summary, 10 days post-discharge medication, counsel the patient for follow-up.
** A letter of satisfactory services shall be obtained from the beneficiary at the time of discharge.The patient is reimbursed transport charges as per the scheme norms and obtains receipt.
** Claim submission The NWH will raise the claim after the 10 days of satisfactory discharge of the patient.) Emergency Registration and Admission All the beneficiaries shall be admitted by a NWH and treated immediately.
** MEDCO or treating doctor shall obtain emergency telephonic pre-authrorisation through dedicated round the clock telephone lines of the Trust, if the patient is suffering from listed therapies.
** Health camp Services Dr.YSR Aarogyasri is the flag ship scheme of the state government and the aim is to achieve “Universal Health Care ” to poor people in Andhra Pradesh, and the benefit in the primary care is addressed through health camps as part of scheme implementation.
** Health Camps are main source of mobilizing the Beneficiaries. The important role played by the health camps includes conducting IEC activity, screening, counselling , treatment of common ailments and refer the patients to Government and Corporate Network Hospitals for treatment under Dr.YSR Aarogyasri