Arogya Raksha: Eligibility, Benefits & Hospital List

In recent years, the concept of healthcare has gained importance and awareness among societies. India is also witnessing an increase in healthcare facilities and healthcare schemes for everyone. The aim is to provide affordable and effective healthcare facilities globally.One such initiative is the Arogya Raksha scheme, which aims to safeguard individuals and families from financial burden of medical expenses. This article delves into Arogya Raksha Policy details: eligibility, coverage, criteria, features and its benefits.

• Arogya Raksha Scheme was launched on January 1, 2017 by Andhra Pradesh Chief Minister N Chandrababu Naidu. The Arogya Raksha scheme aims to provide accessible and affordable healthcare, promoting universal health coverage (UHC).
• Key features of this scheme include cashless treatment, an extensive hospital network, smart health cards, telemedicine services, and maternity and newborn care.
• Benefits of Arogya Raksha scheme includes universal coverage, medical expenses, pre-existing conditions, and transport allowance.
• The premium and plans of Arogya Raksha scheme includes three plans (A, B, C) with coverage ranging from ₹1 lakh to ₹10 lakhs annually, tailored to different family sizes and needs.
• Arogya Raksha policy includes hospitalisation expenses, surgical procedures, maternity and newborn care, and ambulance charges.
• Arogya Raksha policy excludes cosmetic procedures, dental treatments, and vision correction.
• You can enrol yourself via insurance companies or local kiosks using Aadhar card and other required documents.
• Renewal process of Arogya Raksha card is managed through Indian Bank branches or online portals, ensuring continuous coverage.

Arogya Raksha translates to "Health Protection" in English. This health insurance scheme was launched by then Andhra Pradesh Chief Minister N Chandrababu Naidu on 1st January 2017. The scheme is operated by the Ministry of Health and Family Welfare, with a primary objective of making healthcare services accessible and affordable. It is part of the broader strategy to achieve universal health coverage (UHC) for all citizens.With a broad range of private and public hospitals, this scheme promotes accessibility, especially during family emergencies. Below Poverty Line (BPL) and Above Poverty Line (APL) holders can apply for this scheme.

Key Features of Arogya Raksha

Here are the key features of Arogya Raksha scheme:

• Cashless treatment: The scheme provides a 100% cashless treatment across empanelled hospitals. The patients do not have to worry about paying or covering different costs for any medical emergency.
• Large network of hospitals: Arogya Raksha includes a large network of public and private hospitals. This extensive network ensures that people have appropriate access to healthcare services in times of dire need.

You can take advantage of a number of benefits in aarogyaraksha policy. These are mentioned below:

• Universal coverage: The Arogya Raksha scheme aims to provide health coverage to all eligible families in the state of Andhra Pradesh. It encourages people to get accessible healthcare irrespective of their category. Keep in mind that it targets families that are not covered under any other health insurance scheme.
• Beneficiary contribution: The scheme involves a nominal contribution from the beneficiaries. This contribution is typically low, making healthcare more accessible to economically vulnerable families.
• Coverage of medical expenses : The scheme covers expenses related to hospitalisation for various medical and surgical procedures. This includes coverage for treatments for specified illnesses and conditions including cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal disease, fistula in anus, piles, sinusitis and related disorders, gall bladder stone removal, gout and rheumatoid arthritis, and calculus diseases.
• Pre-existing conditions: Unlike many insurance schemes, Arogya Raksha covers pre-existing illness as well. From day one of the policy, the individuals with chronic health conditions can claim this benefit.
• Transport allowance : The scheme provides transport allowance to the beneficiaries for hospital visits, which helps in reducing the financial burden of travel costs associated with healthcare.
• Smart health cards : Beneficiaries receive smart health cards that contain their health information and facilitate easy access to healthcare services at empanelled hospitals.
• Telemedicine services : Arogya Raksha gives telemedicine services that further allows beneficiaries to consult with doctors remotely. This proves to be helpful for people who are living in rural areas where specialists may be limited.
• Maternity and newborn coverage : The scheme includes coverage for maternity expenses, including pre and post-natal care, and newborn care.
• Coverage of Ayurvedic treatment: The Arogya Raksha scheme covers Ayurvedic treatment as well. You can take advantage of this feature at a government hospital. Treatments received at a medical facility should be accredited by the Quality Council of India/National Accreditation Board.

Also Read : Everything You Should Know About a Preventive Health Care Plan

Arogya Raksha policy details include 3 different plans based on the number of beneficiaries. You can avail each plan with a sum insured from ₹1 lakh to ₹10 Lakhs. Catering to every need, here is a breakdown of the plans and their premium:

• Plan A: Focused towards individuals with an exit age of 35 years, this plan provides a comprehensive coverage premium of ₹2,000 to ₹14,500 annually. The plan covers the individual i.e. the account holder with two dependent children and a spouse.
• Plan B: Geared towards individuals with an exit age of 70 years, this plan provides a comprehensive coverage premium of ₹3,000 to ₹25,500 annually. The plan covers the individual i.e. the account holder with two dependent children and a spouse.
• Plan C: Also geared towards individuals with an exit age of 70 years, this plan provides a comprehensive coverage premium of ₹5,000 to ₹62,500 annually. The plan covers the individual i.e. the account holder with two dependent children, dependent parents, and a spouse. It offers a broader range of coverage to provide flexibility to big families.

Note: Keep in mind that the premium amount is determined by the chosen coverage amount.

The Arogya Raksha scheme provides an extensive healthcare access, reducing financial burden, and enhancing health outcomes for eligible families in Andhra Pradesh. Here are the main inclusions of the Arogya Raksha policy:

• Hospitalisation Expenses : The policy covers expenses related to hospitalisation, including room rent, nursing charges, doctor's fees, and ICU charges.
• Surgical Procedures : Costs associated with surgeries, including surgeon's fees, anesthesia, operation theatre charges, and surgical appliances are covered.
• Medical Investigations : Diagnostic tests such as blood tests, X-rays, MRI, CT scans, and other investigations necessary for the treatment, are included in the coverage.
• Maternity and Newborn Care : The policy includes coverage for maternity expenses, including pre-natal and post-natal care, childbirth expenses, and newborn care. This facility is available only for the first two childbirths.
• Pre-Existing Conditions : Unlike many other health insurance schemes, Arogya Raksha covers pre-existing illnesses from the beginning of the policy period, ensuring immediate coverage for chronic health conditions.
• Ambulance Charges : Costs incurred for using ambulance services during emergencies are typically covered under the policy.
• Transport Allowance : Beneficiaries receive a transport allowance to cover the costs of travel to and from the hospital for treatment, reducing the financial burden of transportation.
• Daycare Treatment: This scheme includes pre and post-hospitalisation Ayurvedic treatment. It also includes medical and surgical treatments falling under the category of daycare treatment.
• Personal Accident Death Cover: It provides a 100% coverage to the account holder, 50% for spouses, and 25% for children.
• Co-payment: A 10% co-payment is applicable for individuals above the age of 65 years.
• In-Patient Hospitalisation Expenses: It covers up to 25% of the sum insured. The maximum limit for the same is ₹3,00,000 per year. Illnesses such as Depression, Obsessive Compulsive Disorders, Psychosis, Schizophrenia, and Bipolar Affective Disorders come under this scheme.

Also Read: Health Insurance: Advantages, Disadvantages, and Important Considerations

While the Arogya Raksha policy in Andhra Pradesh provides comprehensive coverage for various healthcare needs, it also has certain exclusions. Exclusions refer to medical treatments, conditions, or situations that are not covered under the policy. Here are some exclusions found in the arogya raksha policy review :

• Pre-Existing Conditions Waiting Period : Although Arogya Raksha covers pre-existing conditions from the start, there may be a waiting period for certain specific treatments related to pre-existing conditions.
• Cosmetic Procedures : Procedures undertaken for cosmetic purposes rather than medical necessity are generally excluded from coverage.
• Dental Treatments : Routine dental care, including dental check-ups, fillings, and non-accidental dental treatments, are often excluded. Some policies may cover dental treatments in case of accidents.
• Vision Correction : Treatments such as corrective lenses or refractive surgeries like LASIK are excluded unless deemed medically necessary due to an accident or illness.
• Infertility Treatments : Fertility treatments, including in vitro fertilisation (IVF) and related procedures, are excluded unless specifically covered by a separate rider or policy.
• Alternative Therapies : Alternative or experimental therapies, treatments, or medicines that are not widely accepted or recognised by medical authorities may be excluded.
• Non-Medical Expenses : Expenses not directly related to medical treatment, such as personal comfort items, telephone charges, and guest meals, are excluded.
• Self-Inflicted Injuries : Injuries or illnesses resulting from attempted suicide or self-harm are not covered.
• Injuries from Hazardous Activities : Injuries sustained while participating in hazardous activities such as adventure sports or illegal activities are excluded.
• Pregnancy Termination : Expenses related to elective termination of pregnancy are usually excluded unless it's medically necessary for the health of the mother.
• Congenital Conditions : Conditions or treatments related to congenital disabilities or birth defects may have limited coverage, depending on the policy terms.
• Non-Emergency Transportation : Routine transportation costs for outpatient visits or non-emergency transfers are not covered.
• Stem cell implantation/surgery: This kind of surgeries are not included.
• Psychiatric and psychosomatic disorders: These kinds of disorders are exempted from the Arogya Raksha scheme.

The Arogya Raksha scheme launched by the Government of Andhra Pradesh, is one of the plans that was launched to provide healthcare to everyone. It's sole purpose is to ensure cashless facilities to beneficiaries who have financial burden. Due to this objective, this scheme was made applicable for all with no eligibility criteria based on poverty lines.

Enrolment Procedure for Arogya Raksha Registration

Arogya Raksha registration can be completed either through an insurance company or by visiting a local kiosk.Here are the detailed methods to register for the Arogya Raksha scheme.

• Decide on your preferred insurance company. Visit the website for details of the Arogya Raksha scheme.
• Fill in all the essential details and finalise the process with the help of your agent.
• You insurer will give you all the details. Finally, you can download your Arogya Raksha card.

• Carry your Aadhar card and a mobile phone number registered with the Aadhar card.
• On visiting the local kiosk, you have to give your Aadhar number to the kiosk operator. They will generate a One-time password (OTP) for you for authentication.
• Once the authentication process is completed, the kiosk operator will issue your Arogya Raksha card for immediate use.

• Via an Insurance Company: You can register via an insurance company as well. You can do so by following these steps:
• Via the Local Kiosk: Arogya Raksha registration can also be done through local kiosks. You have to visit one nearer to your house and show your Aadhar card. Note that keeping an Aadhar card is important for the process of registration. Here are some points to keep in mind:

Documents Required For Arogya Raksha Registration

For Arogya Raksha card download through either method, certain mandatory documents are required. Here is a list to review:

• Aadhar Card
• Address Proof
• An active phone number

Procedure for Applying for Arogya Raksha Card:

Here are the steps to download your Arogya Raksha card:

• Step 1: Open the Dr. YSR Aarogyasri Healthcare Trust’s website.
• Step 2: Click on Arogya Raksha button.
• Step 3: Tap on "Click here to enroll."
• Step 4: Fill in your Aadhar card number in the box and clock on "Go."
• Step 5: Enter your mobile number and select "Send OTP."
• Step 6: Enter the OTP that has been sent on your mobile and click on "Verify."
• Step 7: Choose a family member and click on "Download Health Card."

Also Read: Tips to Choose the Health Insurance Plan in India

The claim process for Aarogya Raksha, the health insurance scheme, involves specific steps to facilitate reimbursement or cashless treatment for medical expenses incurred by beneficiaries. Here's an outline of the typical claim process:

Cashless Claim Process:

• When a beneficiary requires hospitalisation, they should choose a hospital that is empanelled under the Arogya Raksha scheme.

• Before undergoing treatment, the beneficiary or their representative should inform the hospital about their Aarogya Raksha coverage and request pre-authorisation for cashless treatment.
• The hospital will then contact the insurer or Third Party Administrator (TPA) to seek approval for the treatment.

• The insurer or TPA verifies the beneficiary's eligibility and the treatment's coverage under the Arogya Raksha scheme.
• Upon verification, approval is granted for cashless treatment. The hospital receives an approval letter or confirmation from the insurer/TPA.

• The beneficiary undergoes the necessary treatment as per the approved plan.
• After treatment, the hospital prepares the final bill including all medical expenses incurred during hospitalisation.

• The insurer/TPA settles the approved expenses directly with the hospital as per the terms of the Arogya Raksha scheme.
• The beneficiary does not need to pay for the approved expenses covered under the scheme, except for any deductibles or non-covered items as per policy terms.

• Hospitalisation at Network Hospital :
• Pre-Authorisation :
• Verification and Approval :
• Treatment and Discharge :
• Settlement :

Reimbursement Claim Process (for Non-Cashless Claims):

• If the beneficiary opts for treatment at a non-network hospital or cannot obtain pre-authorisation for cashless treatment, they pay for the treatment expenses directly.

• The beneficiary collects all original documents related to medical treatment and expenses, including bills, receipts, discharge summary, and any other relevant documents.

• The beneficiary submits a reimbursement claim form along with the original documents to the insurer or TPA within the stipulated time frame (usually within a specified number of days after discharge).

• The insurer/TPA reviews the submitted documents and verifies the claim details, including eligibility and coverage under Arogya Raksha .
• Additional information or clarification may be requested from the beneficiary or hospital if needed.

• Upon approval, the insurer/TPA processes the reimbursement claim and settles the approved amount directly into the beneficiary's bank account.
• Rejected claims or queries are communicated to the beneficiary, with reasons for denial or clarification required.

• Hospitalisation and Treatment :
• Collection of Documents :
• Submission of Claim :
• Claim Processing :
• Approval and Settlement :

Note: Keep in mind that the beneficiary has to initiate the claim within 24 hours of the hospitalisation.

A follow-up treatment under Arogya Raksha scheme is cashless. The beneficiary can claim a follow-up treatment, but the hospitals have to send the following information to the insurance company:

• Proof of follow-up services once in three months
• Investigation reports
• Consultation details
• List of medicines prescribed
• Acknowledgement of medicines from patients
• Photographs showing that the patient has acknowledged the given medicines
• Scanned copies of bills and diagnostic tests
• Name and code number of the disease as per the package list

You can reach out to your third party administrator (TPA) or by calling the customer care number for checking the status of your application. This step is to ensure that the individuals can check the status of their claim easily.

Arogya Raksha Policy Renewal via Indian Bank

Renewing your Arogya Raksha policy through Indian Bank involves a straightforward process. This is managed by your bank's branches or through online services.Here is how you can apply for a renewal through Indian Bank:

Renewal Process:

• Bank Branch : You can visit any branch of Indian Bank to initiate the renewal process. Approach the customer service desk or the insurance section for assistance.
• Online Portal : Many banks, including Indian Bank, offer online banking services where you can renew your insurance policies. Log in to your Indian Bank account through their official website or mobile app.
• Provide Policy Details : Whether you are renewing at the branch or online, provide your Arogya Raksha policy details such as policy number, insured details, and any other required information.
• Payment of Premium : Pay the renewal premium amount using the preferred payment method accepted by Indian Bank. This could include cash payment at the branch, online banking transfer, or using debit/ credit cards .
• Confirmation and Receipt : After your successful payment, you will receive a confirmation of renewal. This may include a renewed policy certificate.

• Policy Expiry Notification : First, you will receive a notification from Indian Bank or the insurance provider. They will inform you about your policy expiry date before hand. In this way, you can apply for a timely renewal. The notification may be sent via email, SMS, or through physical mail.
• Visit the bank branch or online portal :

For more information, visit the Arogya Raksha policy renewal portal.

Arogya Raksha Hospital List:

The Arogya Raksha hospital list has all the hospitals that have been empanelled. This includes both private and public hospitals. You can visit these following hospitals and get cashless facilities and faster claims.Here is a list of empanelled hospitals under Arogya Raksha scheme:

Government Hospitals:

Check out the empanelled government hospitals here .

Private Hospitals:

Check out the empanelled private hospital here .

You do not have to worry about post-hospitalisation charges anymore. Under the Arogya Raksha scheme, you can get benefits of holistic healthcare with follow-up treatments. You can avail this benefit via cashless services that ensure continued recovery of the patient.Here are the key components of Arogya Raksha Follow-up packages:

• Cashless Follow-up: Cashless follow-up treatment begins at the 11th day from the day of discharge.
• Covered Expenses: Follow-up packages include consultations with healthcare providers to monitor recovery progress after surgery or treatment, and diagnostic tests such as blood tests, X-rays, CT scans, or MRIs.
• Easy Claim Process: The claim process for follow-up treatment is easy to follow, negating the hassle of filling multiple forms.
• Quarterly Division of Follow-Up Packages: The follow-up packages are done in four parts annually. More funds can be availed during the first quarter, as patients often require additional support during this period after hospitalisation.

Note: You can view the cost for each follow-up on the website of Arogya Raksha .

In case of any inconvenience, you can reach the Dr YSR Arogyasri Health Care Trust via their contact number or reach their office address.

Contact Numbers for General Inquiries:

• 0863 222 2802
• 0863 225 9861

Address:

CEO, Dr. YSR Aarogyasri Health Care TrustMGM 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:

• Contact Number: 83338 17363
• Extension: 0863 225 9861 (Ext: 329)
• Email Address: ap_mr@ysrArogyasri.ap.gov.in

The Arogya Raksha scheme stands as a significant initiative in India's healthcare landscape, particularly in Andhra Pradesh, aimed at achieving universal health coverage. By offering cashless treatment, extensive hospital networks, and coverage for a wide array of medical expenses, including pre-existing conditions, maternity care, and surgical procedures, it addresses critical healthcare needs efficiently.You can also explore multiple Government health insurance policies that are implemented for different sections of society. If you are opting for health insurance from companies, keep yourself aware of the tips to lodge a complaint in case of issues.