Arogya Raksha Yojana


 

Social protection in health is a key instrument to address poverty, income security and access to health services at an affordable cost. More than half of our population is excluded from this social protection net – this goes against basic human rights and it impacts income generation, it causes illness inflicted unemployment and disability. In many cases, ill health leads to a poverty trap and results in illnesses going untreated amongst those who cannot afford access to health services. High out-of-pocket payments might push people further into poverty and lead to applying welfare threatening strategies such as selling of assets or increasing debts. From an economic point of view, consequences of untreated diseases and barriers to access health services include lower productivity and per capita income, loss of years of income due to reduced life expectancy and lower health status.

SURGICAL COVER – HIGHLIGHTS
  1. Over 850 surgeries covered
  2. Treatment to be done  ONLY at the listed Network Hospitals (Annexure 1)
  3. Treatment only in GENERAL WARD


SURGICAL COVER – DETAILS OF COVER

The surgical cover includes the following:
  1. Admission Charges
  2. Anesthesia Charges
  3. Surgeon’s Fee
  4. Nursing Charges
  5. OT charges
  6. Bed charges
  7. Medicines & Consumables during surgery.

NOTE: This is a “cashless” facility – when an ARY member is admitted for surgery he won’t have to pay for anything.



SURGICAL COVER – PROCEDURE FOR USAGE

STEP 1:
  • When ARY member goes to a NWH he must show the ARY card (and a photocopy) at the reception counter.
  • ARY members are entitled to free registration at the NWH
  • After registration the hospital coordinator will guide the member to the appropriate doctor for consultation.

STEP 2:

  • If super specialty consultation is required then the member may have to pay a nominal fee
  • After the consultation, if the doctor advises the patient to get any investigations done, the member will be asked to go to the cash counter and pay for the investigation. The member will be charged the subsidized rate fixed by the ARY trust. (Minimum 15% on hospital regular rates).

  
STEP 3:
If the doctor advises the patient to undergo surgery

  • The patient should go back to the reception counter along with photocopy of the card and show the ARY coordinator the doctor’s prescription.
  • The hospital authorities will take all the necessary details from the patient to get approval from the TPA.
  • The TPA will verify the data sent by the hospital and give approval for the surgery as per the conditions of the scheme.
  • Once the hospital gets the approval from the TPA they will admit the patient for surgery. The doctor will discharge the patient when he deems that the patient is fit for discharge. THE PATIENT LEAVES THE HOSPITAL WITHOUT PAYING ANY MONEY TO THE HOSPITAL.


SURGICAL COVER – EXCLUSIONS
  1. Implants – incl. valves; graft mesh; stents; nails; screws.
  2. Joint Replacement Surgeries
  3. Transplants
  4. Burn Cases
  5. Malignancies & Chemotherapy
  6. Cosmetic Surgery
  7. Deviated Nasal Septum
  8. Road Traffic Accidents
  9. Medico Legal Cases
  10. Angioplasty
  11. Autoimmune Diseases
  12. Vaccination
  13. Dental Surgeries
  14. Incision and Drainage – Local & GA
  15. Skin Grafting for wound – small and large
  16. Spectacles & hearing aid
  17. Dialysis
  18. Ambulance Services
  19. Food
  20. Artificial Limb
  21. Biopsies
  22. Vitamins, Tonic & Sanitary Items
  23. Telephone charges

Any other expenditure not related to hospitalization



MEDICAL COVER
  1. Medical Hospitalization refers to hospitalization of a patient that DOES NOT LEAD TO SURGERY
  2. Maximum of 3 days PER ADMISSION & PER CARD amounting to a maximum of Rs. 650.
  3. Hospitalization MUST be for a minimum of 24 hours.
  4. Treatment and investigations to be done ONLY in Network Hospitals.
  5. Treatment ONLY in the General Ward.
 

MEDICAL COVER – DETAILS
  1. Room charges
  2. Professional Fees
  3. Nursing Care


MEDICAL COVER – PROCEDURE FOR USAGE

STEP 1:
  • When ARY member goes to a NWH he must show the ARY card (and a photocopy) at the reception counter.
  • ARY members are entitled to free registration at the NWH
  • After registration the hospital coordinator will guide the member to the appropriate doctor for consultation.

STEP 2:

  • If super specialty consultation is required then the member may have to pay a nominal fee
  • After the consultation, if the doctor advises the patient to get any investigations done, the member will be asked to go to the cash counter and pay for the investigation. The member will be charged the subsidized rate fixed by the ARY trust. (Minimum 15% on hospital regular rates).    

STEP 3:

  • After the investigations are over and the reports received, the member will go back to the consulting doctor with the reports.
  • Based on the reports:
    • If the doctor prescribes a course of medication for the patient, he / she will have to pay for the same.
    • If the doctor advises the member to get admitted to hospital for medical treatment, this will be treated as a MEDICAL ADMISSION (not leading to surgery.)
  • The patient should go back to the reception counter along with photocopy of the card and show the ARY coordinator the doctor’s prescription.
  • The hospital authorities will take all the necessary details from the patient to get approval from the TPA.
  • The TPA will verify the data sent by the hospital and give approval for the medical admission surgery as per the conditions of the scheme. (Maximum of Rs. 650/- only).
  • Once the hospital gets the approval from the TPA they will admit the patient for in patient treatment. During treatment the patient needs to pay for medicines and consumables. If the hospitalization stay extends for more than three days, on completion of day three, the member must pay for their hospital stay. The hospital will offer a discount on their regular charges.


MEDICAL COVER – COMMON ILLNESSES
  1. Viral Fever
  2. Diarrhea and Dysentery
  3. Dehydration
  4. Typhoid


MEDICAL COVER – EXCLUSIONS
  1. Cost of Medicines & Consumables
  2. Cost of oxygen
  3. Cost of ventilator
  4. If the hospital stay exceeds 3 days, the cost will have to be borne by the patient.