Arogya Raksha Yojana


Social protection in health is key to addressing poverty, and ensuring income security and access to health services at an affordable cost. More than half of our population is excluded from this social protection net – this goes against basic human rights even as it impacts income generation and causes illness-inflicted unemployment and disability. In many cases, ill health leads to a poverty trap or results in illnesses going untreated or under treated amongst those who cannot afford health services. High out-of-pocket payments can push people further into poverty, forcing them to sell assets or take on more debts. From an economic point of view, consequences of untreated diseases and barriers to accessing health services include lower productivity and per capita income, and loss of years of income owing to reduced life expectancy and lower health status. SURGICAL COVER – HIGHLIGHTS Over 1600 surgeries covered Treatment to be done ONLY at the listed Network Hospitals (Annexure 1) Treatment ONLY in General Ward SURGICAL COVER – DETAILS OF COVER The surgical cover includes the following: Admission Charges Anesthesia Charges Surgeon’s Fee Nursing Charges OT Charges Bed Charges Medicines and Consumables Used During Surgery. NOTE: This is a ‘cashless’ facility – when an ARY member is admitted for surgery s/he does not need to pay for anything. SURGICAL COVER – PROCEDURE FOR USAGE STEP 1: When the ARY member goes to a Network Hospital (NWH) s/he must show the ARY card (and a photocopy) at the reception counter ARY members are entitled to free registration at the NWH After registration, the hospital coordinator will guide the member to the appropriate doctor for consultation STEP 2: If a super-specialty consultation is required, the member may have to pay a nominal fee If the doctor advises the patient to undergo investigations or tests, after the consultation the member will be asked to go to the cash counter and pay for the investigation. The member will be charged the subsidized rate fixed by the ARY trust. (Minimum 15% of hospital regular rates) STEP 3: If the doctor advises the patient to undergo surgery: The patient must return to the reception counter along with photocopy of the card and show the ARY coordinator the doctor’s prescription The hospital authorities will take all the necessary details from the patient to get approval from the TPA The TPA will verify the data sent by the hospital and give approval for the surgery as per the conditions of the scheme Once the hospital gets the TPA’s approval, they will admit the patient for surgery. The doctor will discharge the patient when s/he deems that the patient is fit for discharge. THE PATIENT LEAVES THE HOSPITAL WITHOUT PAYING ANY MONEY TO THE HOSPITAL SURGICAL COVER – EXCLUSIONS Implants – incl. valves; graft mesh; stents; nails; screws. Joint Replacement Surgeries Transplants Burn Cases Malignancies and Chemotherapy Cosmetic Surgery Deviated Nasal Septum Road Traffic Accidents Medico Legal Cases Angioplasty Autoimmune Diseases Vaccination Dental Surgeries Incision and Drainage – Local & GA Skin Grafting for Wound – Small and Large Spectacles and Hearing Aids Dialysis Ambulance Services Food Artificial Limb Biopsies Vitamins, Tonic & Sanitary Items Telephone Charges Any other expenditure not related to hospitalization MEDICAL COVER Medical Hospitalization refers to hospitalization of a patient that DOES NOT LEAD TO SURGERY Maximum of 3 days PER ADMISSION & PER CARD amounting to a maximum of Rs. 650 Hospitalization MUST be for a minimum of 24 hours Treatment and investigations to be done ONLY in Network Hospitals Treatment ONLY in the General Ward MEDICAL COVER – DETAILS Room charges Professional Fees Nursing Care MEDICAL COVER – PROCEDURE FOR USAGE STEP 1: When an ARY member goes to a NWH, s/he must show the ARY card (and a photocopy) at the reception counter ARY members are entitled to free registration at the NWH After registration, the hospital coordinator will guide the member to the appropriate doctor for consultation STEP 2: If super-specialty consultation is required, the member may have to pay a nominal fee If the doctor advises the patient to undergo investigations or tests, after the consultation the member will be asked to go to the cash counter and pay for the investigation. The member will be charged the subsidized rate fixed by the ARY trust. (Minimum 15% of hospital regular rates) STEP 3: After the investigations are over and the reports received, the member will go back to the consulting doctor with the reports Based on the reports: If the doctor prescribes a course of medication for the patient, s/he will have to pay for the same If the doctor advises the member to get admitted to hospital for medical treatment, this will be treated as a MEDICAL ADMISSION (not leading to surgery) The patient must return to the reception counter along with photocopy of the card and show the ARY coordinator the doctor’s prescription The hospital authorities will take all the necessary details from the patient to get approval from the TPA The TPA will verify the data sent by the hospital and give approval for the surgery as per the conditions of the scheme Once the hospital gets the TPA’s approval, they will admit the patient for in-patient treatment. During treatment, the patient needs to pay for medicines and consumables. If the hospitalization stay extends for more than three days, on completion of day three, the member must pay for their hospital stay. The hospital will offer a discount on their regular charges. MEDICAL COVER – COMMON ILLNESSES Viral Fever Diarrhea and Dysentery Dehydration Typhoid MEDICAL COVER – EXCLUSIONS Cost of Medicines and Consumables Cost of Oxygen Cost of Ventilator If the hospital stay exceeds three days, the cost will have to be borne by the patient.