Aarogya Raksha Scheme Premium Enrollment dates Guidelines, Dr NTR VaidyaSeva scheme, Implementation of Health for All under AarogyaRaksha, AarogyaRaksha Scheme guidelines, Employee Health Scheme, journalists Health Scheme, Dr.NTR-VaidyaSeva and EHS Package, NTR-VS Trust.
GOVERNMENT OF ANDHRA PRADESH, HM&FW Dept -Implementation of Health for All under AarogyaRaksha – Designing of the scheme – Formation of Guidelines – Orders – Issued.
HEALTH, MEDICAL AND FAMILY WELFARE (I.1) DEPARTMENT
G.O.RT.No. 59 Dated: 07-02-2017
Read: G.O.Ms.No.165, HM&FW(I.1)Dept, Dt:31.12.2016
ORDER: In the G.O read above Government of Andhra Pradesh has launched “AarogyaRaksha” scheme for providing health security to all its citizens including that above the poverty line, in addition to the existing Dr NTR- VaidyaSeva scheme for families below the poverty line, health scheme for working journalists and Employee Health Scheme.
2. Subsequent to meetings/delegations held with stakeholders, Govt. of AP after careful review of various issues related to the execution of existing and proposed coverage plans, hereby approved the following additions and improvements in the scheme design:
I. Health cover of Rs.2.00 lakhs per annum per individual for all members of the APL family for 1044 procedures for AarogyaRaksha Scheme. The benefits package under Dr.NTR-VaidyaSeva and EHS shall remain as before.
II. The benefit package of each member of the family under AarogyaRaksha is non-transferable to other family members. The procedures covered shall be same as NTR-VaidyaSeva (1044 procedures), however, care shall be provided in the semi-private ward.
III. Semi-private ward charges shall apply for reimbursement to hospitals apart from the procedure charges as under Dr.NTR-VaidyaSeva.
IV. The premium for Year: Under AarogyaRaksha, a premium of Rs.1200 per year per individual in the family shall be collected by NTR-VS Trust. While the enrolment is voluntary, it is mandatory to apply for enrolment on a family basis as per data available with PrajaSadhikartaSurvery linked to Aadhar numbers of all the family members of the applicant family.
V. Enrollment dates in Every year: Enrollment shall be made ‘only family-wise’ from 1st January to 28th February of every year. No exemptions will be given to that who miss enrolment in the enrolment window period. The extension in the enrolment window period shall be decided by Dr NTR-VaidyaSeva Trust, if necessary.
VI. Benefits: Benefits shall be given in AarogyaRaksha scheme from 7th April 2017 (World Health Day). The existing schemes: NTR-VaidyaSeva and EHS shall continue as before without any change.
VII. Enrolment Website: The enrolment under AarogyaRaksha Scheme shall be done through the website of NTR-VaidyaSeva and through mee-Seva counters.
VIII. The empanelled hospitals shall be required to meet pre-accreditation status for NABH within 2 years of empanelment and full accreditation (appropriate the level and size of the hospital) within 4 years of empanelment. This time frame would be valid for all hospitals from the date of fresh empanelment of all the respective hospitals.
IX. The principles of Insurance shall be made applicable, in a manner that for NABH empanelled hospitals, NABH incentives shall be made applicable uniformly for all categories of patients under all schemes. The rate shall be placed realistically at 2% of the package costs.
X. Dr.NTR-VS Trust shall empanel clinical audit agencies and it would be mandatory for hospitals to undergo third party clinical audit from any of the empanelled agencies, for appropriateness and adequacy of care. Non-compliance to audit shall attract a penalty of 2%. The clinical audit sample size and periodicity shall be notified by Dr NTR-VaidyaSeva Trust.
XI. Hospitals would need to undergo fresh empanelment before 31st March 2017 declaring all specialities they have. Empanelment application shall be made for all specialities existing with the respective hospitals and not a piece-meal basis to reduce rejection of patients.
XII. Coverage in Hyderabad, Chennai and Bangalore hospitals shall be extended only for cancer care, Paediatric Cardiac Surgery for all Dr.NTR-VaidyaSeva and AarogyaRaksha patients.
XIII. Hospital Empanelment shall be made for both the schemes- NTR-VaidyaSeva and AarogyaRaksha. Therefore the hospital shall not be empanelled for any one of them.
2. The Chief Executive Officer, Dr.NTRVaidyaSevaTrust shall take necessary action accordingly.