Aarogya Raksha Scheme - Eligibility, Features and Exclusions

What is Arogya Raksha Policy?

Arogya Raksha is a health insurance scheme launched by then Hyderabad Chief Minister N. Chandrababu Naidu on January 01, 2017. As the name ‘Arogya Raksha’ suggests, it is a health insurance scheme introduced to provide low-cost healthcare services to everyone. In this article, we’ll take a detailed look at the Arogya Raksha policy, how to apply for it, and the claim process.

Arogya Raksha Policy Features and Benefits

Arogya Raksha is a well-thought health insurance scheme that facilitates premium quality healthcare for beneficiaries. Below are some of the Arogya Raksha policy features and benefits:

Arogya Raksha Policy Features

• Cashless Facilities

Beneficiaries can take advantage of the cashless health insurance facility, meaning they do not have to pay for hospital bills out of their own pockets. The network hospitals directly settle the bills with the insurers without you having to worry about the finances.

• Huge Network of Hospitals

One of the best features of the scheme is that a number of both government and private hospitals are affiliated with the plan. The wide range of network hospitals ensures that people enrolled under this scheme have access to healthcare in case of medical emergencies.

Arogya Raksha Policy Benefits

• Large Scope of Coverage

A wide range of diseases are covered in the Arogya Raksha scheme. This includes more than 1,000 different kinds of treatments. This reduces the chance of any patient being denied treatment for a particular ailment.

• Coverage for Follow-up Treatments

This is a one-of-its-kind feature that can be availed with the Arogya Raksha scheme. It provides coverage for follow-up treatments as these can cost a large sum of money to the patient and their family.

• Ayurvedic Treatment Coverage

If a beneficiary wishes to avail Ayurvedic treatment at a government hospital, it will be covered under the scheme. Treatments availed at a Quality Council of India/National Accreditation Board on Health-accredited hospitals are covered.

About Arogya Raksha Premium and Beneficiaries

Arogya Raksha is available in three different plans based on the number of beneficiaries covered. The total sum insured of each plan ranges from ₹1 lakh to ₹10 lakh. Here are the details:

Plan A: With the exit age of 35 years, this plan covers the account holder, two dependent children, and a spouse. The premium of this Plan is between ₹2,000 to ₹14,500 per year.

Plan B: The exit age of this plan is 70 years and covers the account holder, two dependent children, and a spouse. The premium of Plan B is between ₹3,000 to ₹25,500 per year.

Plan C: The exit age of Plan C is 70 years which covers the account holder, two dependent children, dependent parents, and a spouse. The premium of this plan is between ₹5,000 to ₹62,500 per year.

Note that the price of the premium depends on the amount of coverage chosen.

Arogya Raksha Policy Coverage Inclusions

The Aarogya Raksha policy offers the following coverage to its beneficiaries:

• The hospitalisation expenses like room rent, boarding and nursing expenses, ICU expenses, surgeon, specialist fees, blood, oxygen, operation theatre charges, etc.

• Daycare treatment, pre and post hospitalisation ayurvedic treatment are also covered. The medical and/or surgical treatments that fall under daycare treatment of the policy wordings under Section 3 are covered. Medical expenses up to 30 days before hospitalisation and up to 60 days after your discharge will be covered as well. This will be subject to a maximum of 10% sum insured for both scenarios.

• Several advanced medical procedures (modern treatments) like Uterine Artery Embolisation, HIFU, oral chemotherapy, robotic surgeries are covered as well.

• Maternity expenses for the first two child births also come under the coverage of this policy.

• Personal accident death cover of 100% for the account holder is covered. For spouses, this coverage is 50% of the sum insured and for children, this is 25%.

• A co-payment of 10% is also applicable on every claim of an insured person who is above 65 years of age.

• The actual in-patient hospitalisation expenses will also be covered up to 25% of the sum insured. This is subject to a maximum of ₹3,00,000 per year of the policy. The mental illnesses that are covered are Depression, Obsessive Compulsive Disorders, Psychosis, Schizophrenia, Bipolar Affective Disorders.

Arogya Raksha Policy Coverage Exclusions

Situations that are not covered under a health insurance policy are called exclusions. Insurance companies are not liable to pay their policyholders for these exclusions. Here are the exclusions of the Arogya Raksha health insurance scheme:

• Cost of vaccination or inoculation, unless required as a treatment after an animal bite

• Cosmetic or plastic surgery unless the same is a part of the treatment for injuries due to an accident. A cosmetic surgery done for aesthetic purposes without an accidental injury is not covered

• Change of gender surgeries

• Eyesight correction

• Expenses related to spectacles, contact lenses, or hearing aids

• A dental treatment done for aesthetic purposes without an accidental injury is not covered

• Obesity treatment

• Expenses related to psychiatric and psychosomatic disorders

• Attempted suicide

• Suicide

• Infertility or sterility

• Venereal diseases

• Congenital anomalies

• Expenses related to medical treatment arising out of excessive use of intoxicating substances

• Expenses related to the treatment of AIDS

• Cost of vitamins and tonics unless prescribed by a certified medical professional as a part of treatment

• Stem cell implantation/surgery

• Injuries due to war

Eligibility Criteria for Arogya Raksha Scheme

There are no set criteria for Arogya Raksha Scheme; all people and families in Andhra Pradesh that are above or below the poverty line are eligible to enrol under this scheme. All you need for enrolment into this government health insurance scheme is your Aadhaar Card and address proof.

How to Enrol for Arogya Raksha Policy?

The enrolment process of the Arogya Raksha scheme is pretty simple. New registration or renewal process can be done quickly with the right set of documents in place. The registration process can be done in two ways – through the insurance company or by visiting the local kiosk. Following are the details:

You can register as a new beneficiary in the following two ways:

1. Visit an Insurance Company

Visit your preferred insurance company’s website and navigate to the Arogya Raksha webpage. You will see the Arogya Raksha application forms. Fill out the details and complete the process by making payment. Your insurer will now guide you on downloading Arogya Raksha health card.

2. Visit the Local Kiosk

You need to carry your Aadhaar card and an active cell phone linked to the Aadhaar card. These will help the operator to complete your registration process. The operator will ask for your Aadhaar number and then you will receive a One-Time Password. The kiosk operator will get your Arogya Raksha health card printed for you after the completion of the registration process.

What is Arogya Raksha Health Card?

Once you register and do the enrolment process for Arogya Raksha Scheme, you will be issued a health card. With this Arogya Raksha health card, you can make use of the coverage provided to you. You can get your Arogya Raksha health card from the kiosk operator or by doing the downloading procedure. Here is a look at how to download the Arogya Raksha health card.

What is the Procedure to Apply for Arogya Raksha Health Card?

Note that you will require a printer for printing the Arogya Raksha health card. Here are the steps to download your health card:

Step 1: Visit Dr YSR Arogyasri Healthcare Trust’s official website.

Step 2: Click on the ‘Arogya Raksha’ button.

Step 3: Click on ‘Click here to enrol’.

Step 4: Enter your Aadhaar number in the box and click ‘Go’.

Step 5: Enter your mobile number and click on ‘Send OTP’.

Step 6: Enter OTP and click on ‘Verify’.

Step 7: Select a family member and click on ‘Download Health Card’.

What is the Claim Process of Arogya Raksha?

The government has ensured that claims are settled smoothly and quickly. A claim can be made in the following ways.

Let’s take a look at the two different methods of the Arogya Raksha policy claim process:

Cashless Claim

The beneficiary, in this case, must avail treatment from a network hospital only if he/she wishes to file cashless claims. Network hospitals are those healthcare facilities that are pre-approved to provide cashless treatment to the beneficiaries of Arogya Raksha insurance. The beneficiary will receive a list of network hospitals for reference. Before starting the medical treatment, the insurer will provide approval and the cashless claims can then be registered. The beneficiary then needs to pay only the excess amount, if any.

Reimbursement Claim

With this type of claim, the insured pays for the entire cost of treatment and then approaches the insurance company for reimbursement. This claim can be availed at any hospital irrespective of its empanelment. A reimbursement claim is beneficial in a situation where the beneficiary has adequate financial aid and wishes to visit a hospital of his/her choice.

You should note that you need to inform the insurer within 24 hours of hospitalisation. They should acquire documents like discharge summaries, doctor’s prescriptions, receipts, medical reports and bills, etc., for the purpose of filing a reimbursement claim.

How to Check Arogya Raksha Claim Status?

You can check your Arogya Raksha claim status either by calling the customer care number or by getting in touch with the health insurance TPA/insurance company right away.

How to Renew Arogya Raksha Policy (via Indian Bank)?

The Arogya Raksha policy is valid for approximately one year depending on the date of enrolment. Take a look at the Arogya Raksha renewal process below:

• The process of Arogya Raksha renewal can be done during the last 30 days of the policy period and not before that.

• This process can be completed between 6 AM and 9 PM.

• An account number with Indian Bank is required to view or renew the existing policy. To pay for the Arogya Raksha Policy, a beneficiary can also use the net banking facility.

• For more details, check out - https://portal.uiic.in/ArogyaSuraksha/renewLandingCustomer.jsp

Arogya Raksha Hospital List

List of Private Hospitals

Arogya Raksha Follow-Up Packages

Post hospitalisation or follow-up medical expenses often account for a chunk of the medical bills. Without follow-up treatments, a patient’s recovery may slow down or even deteriorate. Fortunately, the Arogya Raksha scheme has provisions for cashless coverage of follow-up treatments. Let’s take a look at the follow-up benefits offered by the Arogya Raksha scheme:

Cashless follow-up treatment begins from the 11th day of discharge from the hospital.

• The expenses related to diagnostic tests, consultation, medicines, etc., are covered under Arogya Raksha.

• Patients do not need to file separate claims for follow-up treatments.

• The follow-up packages are divided among the four quarters of a year with the maximum compensation available in the first quarter after hospitalisation.

   

The cost for each follow-up package can be viewed by visiting the official website of Arogya Raksha at https://ysrArogyasri.ap.gov.in/web/guest/follow_up.

Arogya Raksha Toll-Free Number and Address

The Dr YSR Arogyasri Health Care Trust is very responsive in terms of grievances and queries. Here are their contact details:

Arogya Raksha Toll-Free Number: 1800 599 1111

Contact Number: 0863 222 2802 or 0863 225 9861

Arogya Raksha Address:

D.No. 25-16-116/B, Chuttugunta,

Behind Gautam’s Hero Showroom,

Guntur, Andhra Pradesh 522004

India

For further grievances related to Arogya Raksha, you can use the following 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

In case you have queries related to medical reimbursement status and issues, use these details:

Contact number: 83338 17363

Extension: 0863 225 9861 (Ext:329)

Email address: ap_mr@ysrArogyasri.ap.gov.in

To Conclude

The Arogya Raksha policy is an excellent government initiative that aims to provide health coverage to everyone in Andhra Pradesh. However, remember that people not living in Andhra Pradesh cannot make use of this government health insurance initiative.

If you and your family are not eligible for any government health schemes or are looking to enhance your health insurance by buying a private health insurance policy, the health insurance plans available on Bajaj MARKETS are excellent options. With the health insurance policies on Bajaj MARKETS, you can also benefit from cashless claims at a wide network of hospitals and swift Health Insurance Renewals Online. Buy a health insurance plan today!