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Introduced in 2017 by the Chief Minister of Hyderabad, the Arogya Raksha policy represents a landmark initiative in providing affordable healthcare for the residents of Andhra Pradesh. This health insurance scheme offers cashless facilities, ensuring that beneficiaries have access to premium-quality healthcare without facing financial strain. With an extensive network of hospitals, including both government and private institutions, the scheme facilitates accessibility during medical emergencies.

Key Features of Arogya Raksha Policy

Here are some main features of opting for the Arogya Raksha Policy:

  • Cashless Facilities: With cashless health insurance, hospital bills are directly settled by network hospitals with insurers. This eliminates the need for beneficiaries to pay for medical expenses out of their own pockets.

  • Large Network of Hospitals: Arogya Raksha has established affiliations with numerous government and private hospitals. This extensive network ensures that enrolled individuals have seamless access to healthcare services when faced with medical emergencies.

Arogya Raksha Policy Benefits

The Arogya Raksha scheme offers a plethora of benefits, ensuring extensive coverage and financial relief for policyholders. Here's a breakdown of the notable benefits:

  • Extensive Scope of Coverage: The Arogya Raksha policy encompasses a diverse range of diseases, providing coverage for over 1,000 different types of treatments. This expansive coverage minimises the likelihood of patients being denied treatment for specific ailments, ensuring comprehensive healthcare support.

  • Coverage for Follow-up Treatments: A unique feature of the Arogya Raksha scheme is its provision for follow-up treatments. Acknowledging the financial challenges that come with post-treatment care, this benefit provides coverage for follow-up treatments, easing the financial strain on patients and their families.

  • Ayurvedic Treatment Coverage: The Arogya Raksha scheme extends coverage to Ayurvedic treatments as well. Beneficiaries opting for Ayurvedic treatment at government hospitals will find it covered under the policy. Additionally, treatments received at the Quality Council of India/National Accreditation Board on Health-accredited hospitals are included, promoting alternative healthcare options for policyholders.

Arogya Raksha Premium and Beneficiaries

The Arogya Raksha Scheme offers flexibility with three distinct plans catering to varying coverage needs and beneficiaries. Each plan comes with a total sum insured ranging from ₹1 lakh to ₹10 Lakhs. Here's a detailed breakdown of the plans and their respective premiums:

  • Plan A: Geared towards individuals with an exit age of 35 years, this plan covers the account holder, along with two dependent children and a spouse. The annual premium for Plan A falls within the ₹2,000 to ₹14,500 range, providing comprehensive coverage.

  • Plan B: With an exit age of 70 years, this plan extends coverage to the account holder, two dependent children, and a spouse. Plan B offers flexibility and security, with an annual premium ranging from ₹3,000 to ₹25,500.

  • Plan C: Also featuring an exit age of 70 years, Plan C is designed for those seeking broader coverage. It includes the account holder, two dependent children, dependent parents, and a spouse. Plan C's premium varies from ₹5,000 to ₹62,500 per year, accommodating diverse healthcare needs.
     

It's essential to note that the premium amount is influenced by the chosen coverage amount.

Arogya Raksha Policy Coverage Inclusions

The Arogya Raksha policy provides extensive coverage to its beneficiaries, ensuring comprehensive healthcare support. The coverage inclusions encompass various medical expenses and treatments:

  • Hospitalisation Expenses: Covers room rent, boarding, nursing expenses, ICU charges, surgeon and specialist fees, blood, oxygen, operation theatre charges, and more.

  • Daycare Treatment: Inclusive of pre and post-hospitalisation ayurvedic treatment, and medical or surgical treatments falling under daycare treatment.

  • Advanced Medical Procedures: Includes modern treatments like Uterine Artery Embolisation, HIFU, oral chemotherapy, and robotic surgeries.

  • Maternity Expenses: Covers expenses for the first two childbirths.

  • Personal Accident Death Cover: Provides 100% coverage for the account holder, 50% for spouses, and 25% for children.

  • Co-payment: A 10% co-payment is applicable on claims for insured individuals above 65 years.

  • In-Patient Hospitalisation Expenses: Covers up to 25% of the sum insured, with a maximum limit of ₹3,00,000 per year. Mental illnesses such as Depression, Obsessive Compulsive Disorders, Psychosis, Schizophrenia, and Bipolar Affective Disorders are also covered.

Arogya Raksha Policy Coverage Exclusions

Certain situations are excluded from the Arogya Raksha health insurance scheme, and insurance companies are not liable to pay for these exclusions. The coverage exclusions include:

  • Cosmetic or plastic surgery (Unless required as a part of the treatment for injuries due to an accident)

  • Change of gender surgeries

  • Eyesight correction, expenses for spectacles, contact lenses, or hearing aids

  • Dental treatment for aesthetic purposes without accidental injury

  • Obesity treatment

  • Psychiatric and psychosomatic disorders

  • Attempted suicide or suicide

  • Infertility or sterility

  • Venereal diseases

  • Congenital anomalies

  • Treatment arising from excessive use of intoxicating substances

  • AIDS treatment

  • Cost of vitamins and tonics, unless prescribed by a certified medical professional

  • Stem cell implantation/surgery

  • Injuries due to war

Eligibility and Enrollment for Arogya Raksha Scheme

The Arogya Raksha Scheme stands as an inclusive health insurance initiative for the people of Andhra Pradesh, with no specific eligibility criteria based on poverty lines. Both individuals and families, whether above or below the poverty line, can enroll in this government health insurance scheme. The enrollment process is straightforward, requiring only an Aadhaar Card and address proof for registration.

Enrollment Procedure:

The Arogya Raksha enrollment can be initiated through two convenient methods: via an insurance company or by visiting a local kiosk. Here's a detailed guide:

1. Via an Insurance Company:

  • Navigate to your preferred insurance company's website and locate the Arogya Raksha section

  • Access the Arogya Raksha application forms provided on the webpage

  • Complete the required details and finalise the process by making the necessary payment

  • Your insurer will guide you through the steps to download your Arogya Raksha card

2. Visiting the Local Kiosk:

  • Carry your Aadhaar card and an active mobile phone linked to your Aadhaar card when visiting the local kiosk

  • Provide your Aadhaar number to the kiosk operator, who will generate a One-time Password (OTP) for authentication

  • After the registration process is completed, the kiosk operator will print your Arogya Raksha card for immediate use

Arogya Raksha Health Card

Upon successful enrollment in the Arogya Raksha Scheme, beneficiaries are issued a valuable health card. This Arogya Raksha health card serves as the key to unlocking the scheme's coverage, offering a range of health benefits. The card can be obtained either directly from the kiosk operator or through a simple downloading procedure.

How to Apply for Arogya Raksha Health Card

The following is the procedure to apply for an Arogya Raksha Health Card:

  • Navigate to the official Arogya Raksha website under Dr. YSR Arogyasri Healthcare Trust at https://www.ysraarogyasri.ap.gov.in/arogyaraksha

  • Locate and click on 'Click here to enrol' to initiate the enrollment process

  • Enter your Aadhaar number in the designated box and click 'Go' to proceed

  • Provide your mobile number and click on 'Send OTP' to receive a One-Time Password

  • Enter the OTP received and click 'Verify' to authenticate your details

  • Choose a family member from the list and click on 'Download Health Card’

Arogya Raksha Claim Process

The Arogya Raksha Scheme ensures a seamless and expeditious claim settlement process for beneficiaries. Claims can be initiated through two distinct methods, each designed to cater to diverse preferences and needs. Here are the details of the Arogya Raksha policy claim process:

1. Cashless Claim

  • To benefit from cashless claims, beneficiaries must seek treatment exclusively from network hospitals. These are healthcare facilities pre-approved to offer cashless treatment under the Arogya Raksha insurance

  • The pre-approval is obtained from the insurer before commencing treatment

  • Cashless claims are then registered, and the beneficiary is required to pay only the excess amount, if any

2. Reimbursement Claim

  • Under this claim type, the insured bears the entire treatment cost and subsequently approaches the insurance company for reimbursement

  • Reimbursement claims are applicable at any hospital, regardless of its empanelment, offering flexibility for beneficiaries to choose their preferred healthcare facility

  • In case of a reimbursement claim, the insured should inform the insurer within 24 hours of hospitalisation

  • Essential documents such as discharge summaries, doctor's prescriptions, receipts, medical reports, and bills should be collected for filing a reimbursement claim

Read More

Checking Arogya Raksha Claim Status

Beneficiaries can conveniently check their Arogya Raksha claim status by contacting the customer care number or reaching out directly to the health insurance TPA/insurance company. This streamlined approach ensures that individuals can stay informed about the status of their claims promptly.

Arogya Raksha Policy Renewal via Indian Bank

Renewing your Arogya Raksha policy is simple and hassle-free, ensuring uninterrupted health coverage. Follow the steps below for a hassle-free renewal via Indian Bank:

1. Renewal Period

  • Initiate the Arogya Raksha renewal process during the last 30 days of the policy period. Please note that renewal cannot be processed before this period

  • The renewal window is available between 6 AM and 9 PM

2. Account with Indian Bank

  • Ensure you have an active account with Indian Bank. An account number with Indian Bank is essential for viewing or renewing the existing Arogya Raksha policy

3. Payment Options

  • To facilitate the renewal, an account holder can use the net banking facility provided by Indian Bank

  • The payment process is streamlined, making it convenient for beneficiaries to renew their Arogya Raksha Policy seamlessly

 

For detailed information and to proceed with the renewal, visit the Arogya Raksha Renewal Portal.

Arogya Raksha Follow-Up Packages

The Arogya Raksha scheme prioritises holistic healthcare by extending its coverage to include post-hospitalisation or follow-up treatments. Understanding the significance of ongoing medical care, the scheme offers cashless benefits for follow-up treatments, ensuring continued recovery and well-being. Here are the key features of Arogya Raksha Follow-Up Packages:

  1. Commencement of Cashless Follow-Up: Cashless follow-up treatment kicks in from the 11th day post-discharge from the hospital.

  2. Covered Expenses: The scheme encompasses various expenses related to follow-ups, including diagnostic tests, consultations, and medicines.

  3. Simplified Claim Process: Beneficiaries are relieved from the hassle of filing separate claims for follow-up treatments, streamlining the process for enhanced convenience.

  4. Quarterly Division of Follow-Up Packages: Follow-up packages are structured across four quarters in a year, with the highest compensation available in the initial quarter following hospitalisation.

 

For detailed information on the cost associated with each follow-up package, beneficiaries can refer to the official Arogya Raksha website.

Arogya Raksha Contact Information for Assistance

For prompt assistance, the Dr YSR Arogyasri Health Care Trust is readily available to address queries and grievances. You can find the contact details below

Contact Numbers for General Inquiries:

  • 0863 222 2802

  • 0863 225 9861

Address:

CEO, Dr.YSR Aarogyasri Health Care Trust

MGM Capital Building, Near NRI Y Junction,

Chinna Kakani(V),Managalagiri(M),

Guntur - 522508

Grievance Contact Details:

  • Contact Number: 83338 17424/23/20/07 (during office hours)

  • Extension: 0863 225 9861 (Ext: 326)

  • Email Address: ap_grievance@ysrArogyasri.ap.gov.in

 

Medical Reimbursement Inquiries:

 

While the Arogya Raksha policy stands as a commendable initiative offering health coverage to Andhra Pradesh residents, it's essential to note that individuals residing outside the state cannot avail themselves of this government health insurance initiative.

 

For those ineligible for government health schemes or seeking to boost their coverage, Bajaj Markets offers a range of outstanding private health insurance plans. The company’s insurance policies provide additional benefits such as cashless claims across an extensive network of hospitals and seamless health insurance renewals online. Elevate your health coverage today by purchasing a health insurance plan from Bajaj Markets!

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FAQs

How do I renew my Arogya Raksha Policy?

You can renew your Arogya Raksha policy within the last 30 days of your policy term by making a renewal payment through Indian Bank.

How can I obtain an Arogya Raksha health card?

The Arogya Raksha health card is provided to all successful registrants under the government health scheme.

What is the waiting period for coverage under the Arogya Raksha policy?

There is a 30-day waiting period before beneficiaries can avail coverage under the scheme.

When is coverage available for cataracts under the Arogya Raksha scheme?

Coverage for cataract treatment is available after 24 months of continuous coverage for Arogya Raksha beneficiaries.

What is the waiting period for pre-existing diseases under Arogya Raksha health insurance?

Beneficiaries need to renew the plan at least twice before availing benefits for any pre-existing disease, resulting in a waiting period of 48 months.

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