YSR Aarogyasri

YSR Aarogyasri scheme is a unique PPP model in the field of Health Insurance, tailor made to the health needs of poor patients and provides end-to-end cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.

Objectives of YSR Aarogyasri

The objective of YSR Aarogyasri scheme are:

• To provide free quality hospital care and equity of access to BPL families by purchase of quality medical services from identified networks of health care providers through a self-funded reimbursement mechanism (serviced by Trust).

• To provide coverage to the beneficiaries up to Rs. 5 lakh per family per annum on floater basis.

• To provide financial security against catastrophic health expenditures.

• To strengthen the Government Hospitals through demand side financing.

• To provide universal coverage of health for both urban and rural poor.

Services Provided under YSR Aarogyasri

Following are the services provided under YSR Aarogyasri.

• End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a "listed therapy(ies).

• Free OP evaluation of patients for listed therapies who may not undergo treatment for "listed” therapies.

• All the pre-existing cases under listed therapies are covered under the scheme.

• Food and Transportation.

Eligibility Criteria of YSR Aarogyasri

Following are the eligibility criteria of YSR Arogyasri.

• Families/Households not having more than one personal car.

• All households whose annual income is less than or up to Rs. 5.00 Lakhs (Salary certificate evidence).

• Total family land holding:

• Less than 12.00 Acres of wetland.

• Less than 35.00 Acres of dry land.

• Total less than 35.00 Acres (Wet & Dry).

• Government employees are covered under Employee Health Scheme (EHS), and hence are not covered under YSR Aarogyasri.

• Families who are filing Income Tax Returns for annual income up to Rs. 5.00 Lakhs are eligible (Income Tax Return evidence is needed).

• All households paying Municipal Property Tax for area less than 3000 Sqft. (334 Sq. Yds). 

• All Rice Card Holders are eligible.

• Families which are eligible for YSR Pension Kanuka Card and Jagananna Vidya and Vasathi Deevena Card are also eligible.

Treatment and Specialities Covered under YSR Aarogyasri

The scheme provides coverage for the procedures under following categories:

• CARDIAC & CARDIOTHORACIC SURGERY

• CARDIOLOGY

• COCHLEAR IMPLANT SURGERY

• CRITICAL CARE

• DERMATOLOGY

• ENDOCRINOLOGY

• ENT SURGERY

• EPIDEMIC DISEASE

• GASTROENTEROLOGY

• GENERAL MEDICINE

• GENERAL SURGERY

• GENITOURINARY SURGERIES

• GYNAECOLOGY AND OBSTETRICS SURGERY

• INFECTIOUS DISEASE

• MEDICAL ONCOLOGY

• NEPHROLOGY

• NEUROLOGY

• NEUROSURGERY<

• OPHTHALMOLOGY SURGERY

• ORGAN TRANSPLANTATION SURGERY

• ORTHOPEDIC SURGERY AND PROCEDURES

• PEDIATRIC SURGERIES

• PEDIATRICS

• PLASTIC SURGERY

• POLYTRAUMA

• PSYCHIATRY

• PULMONOLOGY

• RADIATION ONCOLOGY

• SURGICAL GASTROENTEROLOGY

• RHEUMATOLOGY

• SURGICAL ONCOLOGY

Health Insurance Coverage under YSR Aarogyasri

Following are the health insurance coverage under YSR Aarogyasri. 

• Population coverage (Breadth of Universal Health coverage) The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card linked with the Aadhar card and available in the Civil Supplies Department database.

• Financial coverage (Height of Universal Health coverage) The scheme shall provide coverage for the services to the beneficiaries up to Rs.5 lakh per family per annum on floater basis. There shall be no co-payment under this scheme.

• Benefit Coverage (Depth of Universal Health coverage)

• Out-Patient The scheme is designed in such a way that the benefit in the primary care is addressed through free screening and outpatient consultation both in the health camps and in the network hospitals as part of scheme implementation.

• In-Patient The scheme shall provide coverage for the 3255 "Listed Therapies" for identified diseases in the 31 categories.

References

While crafting this guide, we have consulted reliable and authoritative sources, including official government directives, user manuals, and pertinent content sourced from government websites.

• YSR Aarogyasri

• Navasakam Beneficiary Management