Aarogya Raksha Scheme – Benefits, Coverage, Beneficiaries & Hospital List

What is Aarogya Raksha?

What are the features and Benefits of Aarogya Raksha

Arogya Raksha is a well thought after health insurance scheme that facilitates beneficiaries to avail premium quality health care. Below are some of the features offered by Aarogya Raksha scheme:

Cashless Facilities

All the beneficiaries of Aarogya Raksha are exempted from paying for the entire cost of a medical emergency. This scheme also provides cashless facilities across associated hospitals.

Huge Network of Hospitals

One of the best features of the scheme is that a number of both – government and private hospitals are covered in the plan. This is most beneficial for a patient as he/she can begin their treatment sooner.

Large Scope of Coverage

A wide range of diseases are covered in the Aarogya Raksha scheme. This includes more than 1000 treatments. Thus reducing the chances 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 Aarogya Raksha scheme. It provides coverage for follow-up treatments as these can cost a large sum of money to the patient and his/her family.

Ayurvedic Treatment Coverage

If a beneficiary wishes to avail Ayurvedic treatment in a Government Hospital, it will be covered under the scheme. Treatment availed in a Quality Council of India/National Accreditation Board on Health accredited hospital is taken care of.

About Arogya Raksha Premium and Beneficiaries?

Aarogya Raksha is available in three different plans based on the number of beneficiaries covered. The total sum insured of each plan ranges from Rs. 1 lakh to 10 lakhs. 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 Rs. 2000 to 14500.

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 this plan is between Rs. 3000 to 25500.

Plan C: The exit age of this plan is 70 years and covers the account holder, two dependent children, dependent parents, and a spouse. The premium of this plan is between Rs. 5000 to 62500.

What is Not Covered?

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 Aarogya Raksha health insurance scheme:

1. Cost of vaccination or inoculation unless required as a treatment after an animal bite

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

3. Change of gender surgeries

4. Eyesight correction

5. Expenses related to spectacles, contact lenses, or hearing aids

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

7. Obesity treatment

8. Expenses related to psychiatric and psychosomatic disorders

9. Attempted suicide

10. Suicide

11. Infertility or sterility

12. Venereal disease

13. Congenital anomalies

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

15. Expenses related to the treatment of AIDS

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

17. Stem Cell implantation/surgery

18.Injuries due to war

What are the documents required for Aarogya Raksha Scheme?

All Above Poverty Line (APL) and Below Poverty Line (BPL) families belonging to Andhra Pradesh are eligible to enrol under this health scheme. There are no criteria set on the minimum income of a family.

What are the documents required to enrol for the Aarogya Raksha scheme?

Irrespective of the method of registration, the beneficiary will require the following documents along with an active contact number that is linked to the Aadhaar card:

Aadhaar card

Address proof

How to Enrol for Aarogya Raksha?

The enrolment process of Aarogya 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 of both:

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

1. From an insurance company

Visit your preferred insurance company’s website (for example United India Insurance Co. Ltd) and navigate to the Aarogya Raksha webpage. You will see the Aarogya Raksha Application Forms. Fill out the details and complete the process by making payment. Your insurer will now guide you on downloading Aarogya Raksha Health Card.

2. Visit to the local kiosk

You need to carry your Aadhaar card and an active cell phone which is 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 the One Time Password. Please share this OTP with the Kiosk operator. The kiosk operator will get your Aarogya Raksha health card printed for you after the completion of the registration process

What is the procedure for Applying for Aarogya Raksha Health Card? 

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

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

Step 2: Click on Aarogya 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 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 Aarogya Raksha?

A claim can be made in the following two ways. The government has ensured that a claim will be settled in a smooth and quick manner irrespective of its type.

Cashless Claims

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 health care facilities that are pre-approved to provide cashless treatment to the beneficiaries of Aarogya Raksha insurance. The beneficiary will receive a list of network hospitals for reference. Before starting the medical treatment, the TPA will provide an 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 where 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 must make a note that the insured or family members need to inform the TPA within 24 hours of hospitalization. They should acquire documents like discharge summary, doctor’s prescriptions, receipts, medical reports and bills, etc. for the purpose of filing a reimbursement claim.

How to Check Aarogya Raksha Claim Status?

You can check your Aarogya Raksha Claim Status either by calling the customer care number or by getting in touch with the TPA/insurance company right away.

How to Renew Aarogya Raksha policy?

The Aarogya Raksha policy is valid for approximately one year depending on the date of enrolment. Take a look at the following renewal details:

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. INDIAN BANK account number is required to view or renew the existing policy. To pay for the Arogya Raksha Policy, a beneficiary can use INDIAN BANK net-banking facility.

What are the hospitals covered under Aarogya Raksha Scheme?

There are a number of laptops covered under this scheme. Below is the list of some Government and Private hospitals.

List of Government Hospitals: 

List of Private Hospitals:

For the complete list of hospitals, visit this link:

http://ysraarogyasri.ap.gov.in/web/guest/privatehosp

Aarogya Raksha Follow Up Packages

A medical contingency can be divided into various parts. One of these parts is follow-up treatment. Without appropriate follow-up, medical treatment may not be of any good use. Considering this fact, the Aarogya Raksha scheme includes cashless follow-ups for certain treatments. Here are the details:

The expenses related to diagnostic tests, consultation, medicines, etc. are covered under Aarogya Raksha. Cashless follow-up treatment begins from 11th day after discharge from the hospital. A patient covered under Aarogya Raksha benefits can continue to make use of follow-up services for one year. It is not required to raise a separate claim for availing follow-up treatment

The follow-up packages are divided into four parts corresponding to four quarters of one year. More amount is dedicated to the first quarter as comparatively more follow-up is required during this time after hospitalization. These treatments are facilitated by MEDCO along with VAIDYAMITHRA

The cost for each follow-up package can be viewed by visiting the official website of Aarogya Raksha. You can also use the follow-up registration form to keep track of treatment and visits.

Aarogya Raksha Toll-Free Number and Address

The Dr.YSR Aarogyasri Health Care Trust is very responsive in terms of grievances & queries. Here are the details of their contact information.

Aarogya Raksha Toll-Free Number:

1800-599-1111

Contact Number:

0863 – 2222802 / 2259861

Aarogya Raksha Address:

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

Behind Gautam’s Hero Showroom,

Guntur – 522004.

Andhra Pradesh

India

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

Contact number: 8333817424/23/20/07 (Office Timings)

Extension: 0863-2259861 (Ext:326)

Email address: ap_grievance@ysraarogyasri.ap.gov.in

In case you have queries related to Medical Reimbursement Status and Issues, use these details:

Contact number: 8333817363

Extension: 0863-2259861 (Ext:329)

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

FAQs About Aarogya Raksha Scheme

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

The beneficiary needs to wait for 30 days before availing any coverage under the scheme.

2. When can the beneficiary be covered for Cataract under the scheme?

The beneficiary of Arogya Raksha can avail treatment for Cataract after 24 months of continuous coverage.

3. What is the waiting period of Arogya Raksha health insurance for pre-existing diseases?

The beneficiary needs to renew the plan at least 2 times before availing benefits for any pre-existing disease. Thus, the waiting period for the pre-existing disease is 48 months.