30 November, 2023
Arogya Raksha Scheme

Medical insurance is a type of insurance that covers unexpected medical expenses caused by a disease. These expenses could be related to the cost of hospitalisation, medications, or medical visits. The government engages in beneficial actions for the population’s welfare by promoting health insurance, guaranteeing a robust infrastructure, and raising awareness of health-related concerns.

What is Arogya Raksha?

The term arogya means “health”, and raksha means “protection”. On January 1, 2017, N. Chandrababu Naidu, the then-chief minister of Hyderabad, introduced this insurance policy for Indian citizens holding a bank account. As the name suggests, Aarog is a health insurance programme created to offer low-cost, high-quality healthcare to families from both low and middle-income classes. It provides cashless facilities, an extensive network of hospitals and financial coverage for medical treatments.

Arogya Raksha Policy Features

This policy has two main features, which are listed and explained below:

  • Cashless facilities: The cashless health insurance facility is available to beneficiaries, so they can avoid paying their hospital bills out of pocket. Without you having to worry about money, the network hospitals directly settle the invoices with the insurance companies.
  • An extensive hospital network: One of the best aspects of the programme is how many public and private hospitals are associated with it. People registered in this programme have access to healthcare in case of emergencies thanks to the extensive network of hospitals.

Benefits of the Arogya Raksha Policy

Coverage of many medical conditions, Ayurvedic treatment, and follow-up treatment are some benefits of the Ariogya raksha policy. It also covers the following benefits:

  • Comprehensive coverage: The Arogya Raksha scheme offers coverage for various conditions. The coverage covers more than a thousand different types of therapies. As a result, it’s possible that some patients will not receive therapy for a particular ailment.
  • Financial coverage for subsequent treatments: This programme offers this unique benefit. Any additional therapies are covered under the plan, which might be financially burdensome for the patients and their families.
  • Coverage for ayurvedic treatment: A recipient of this programme is entitled to coverage for Ayurvedic care received at a government hospital. The programme will cover procedures carried out at medical facilities that have been granted accreditation by the Quality Council of India/National Accreditation Board on Health.

Arogya Raksha Policy Premium & Beneficiaries

There are three different plans in this policy, depending on how many beneficiaries are included. The plan’s sum insured goes from Rs. 1 lakh to Rs. 10 lakh. Details of the premium and beneficiaries are as follows:

  • Plan A: The account holder, two dependent children, and a spouse are all covered by this plan, which has a 35-year exit age. This plan’s premium ranges from Rs. 2000 to Rs. 14500.
  • Plan B: The account holder, two dependent children, and a spouse are all covered by this plan, which has a 70-year departure age. This plan’s premium ranges from Rs. 3000 to Rs. 25500.
  • Plan C: The account holder, two dependent children, dependent parents, and a spouse are all covered by this plan, which has a 70-year departure age. A premium of Rs. 5000 to 62500
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Arogya Raksha Policy Inclusions & Exclusions

The following facilities are included under this policy: 

  • This policy covers hospitalisation expenses, such as room rent, board and lodging costs, nursing costs, ICU costs, surgeon and specialist fees, blood, oxygen, operating room costs, and so on.
  • It also offers daycare services, as well as ayurvedic treatments both before and after hospitalisation. Up to 30 days prior to hospitalisation and up to 60 days following discharge will have their medical costs covered.
  • Robotic surgery, HIFU, uterine artery embolisation, oral chemotherapy, and other cutting-edge medical methods are also covered.
  • This policy also includes coverage for the prenatal costs of two deliveries.
  • The account holder is given a 100% personal accident death benefit. 50% of the spouses’ total insured is covered by this policy.
  • Any claim made by an insured person over 65 will also demand a 10% co-payment.

Exclusions are circumstances that are not covered by health insurance coverage. For example, some of the exclusions under the policy are:

  • The policyholders of insurance firms are not entitled to compensation for these exclusions, such as vaccination or immunisation fees, unless needed as part of an animal bite treatment.
  • Unless it is a necessary element of the therapy for injuries sustained in an accident, cosmetic or plastic surgery, cosmetic procedures performed for aesthetic reasons without deliberate damage are not covered under this scheme.
  • Surgical procedures for changing a person’s gender, vision correction, costs associated with eyeglasses, contact lenses, or hearing aids, and dental work performed for aesthetic reasons without an unintentional injury are not covered.
  • It excludes costs associated with psychiatric and psychosomatic illnesses, suicide, and obesity treatment.

Eligibility Criteria for Arogya Raksha Policy

This scheme has no established eligibility requirements; anyone in Andhra Pradesh who is above or below the poverty level is welcome to apply. The only requirements for enrollment in this government health insurance programme are an address verification document and an Aadhaar card.

How to Get Enrolled Under Arogya Raksha Scheme ?

The enrollment process for the Arogya Raksha scheme coverage is simple. The renewal and registration processes are simple if the proper paperwork is present. The insurance company or a kiosk can be used to complete the new registration process. You have two options for becoming a new beneficiary:

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Visit an insurance company

Visit the website of the insurance provider of your choice. The forms for applying for this policy are available on the page. Fill up the forms, then complete the process by making the necessary online payment. Your supplier of an Arogya Insurance Policy will now assist you in downloading your Arogya Raksha card.

Visit a nearby kiosk

A cell phone connected to an Aadhaar card and the card itself must be carried. This will help the operator complete the registration process. Then, the kiosk operator would produce their own health insurance card.

How to Apply for a Health Card Under Arogya Raksha Policy?

You will receive an Arogya Raksha card after registering and completing the scheme enrollment process. Utilise the coverage granted to you with this health card. You can download your health card or obtain it from the kiosk operator. Follow the below steps to apply for a health card:

  • Go to the Dr. YSR Aarogyasri Healthcare Trust’s official website.
  • Select “Arogya Raksha” from the menu.
  • Click the “Click here to enrol” link.
  • Fill out the box with your Aadhaar number and press “Go.”
  • Type in your cell phone number and press “Send OTP.”
  • Enter the OTP and press “Verify.”
  • Choose a family member and click “Download Health Card.”

Arogya Raksha Claim Process

The administration has ensured that disputes are resolved quickly and without incident. The two distinct procedures for filing an insurance claim:

Cashless Claims

  • If recipients want to submit cashless claims, they must receive care from a network hospital. Network hospitals are medical centres that have been given the go-ahead to treat insurance beneficiaries without using cash.
  • A list of network hospitals will be sent to the beneficiary for their reference.
  • The insurer will consent before beginning the medical treatment, at which point the cashless claims can be registered.

Reimbursement Claims

  • In this category of claims, the insured is responsible for covering the entire cost of medical care before requesting reimbursement from the insurance provider.
  • This claim is available at any hospital, regardless of panel status. A reimbursement claim is advantageous when a beneficiary has access to sufficient financial aid and wants to travel to the hospital of their choice.
  • You should be aware that you must notify the insurer 24 hours after being admitted to the hospital.
  • To submit a reimbursement claim, they should gather documentation such as discharge summaries, doctor’s prescriptions, receipts, medical reports and bills, etc.
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How to Check the Arogya Raksha Claim Status?

You can call the customer service line or immediately get in touch with the health insurance TPA/insurance company to find out the status of your claim.

Renew the Policy using Indian Bank Account

Depending on the enrollment date, the policy is valid for about one year.

  • Policy renewal can only be completed within 30 days of the policy period and not earlier.
  • You can finish this process any time between 6 AM and 9 PM.
  • You must have an INDIAN BANK account number to access or renew your current policy.
  • Using the INDIAN BANK net banking capability, a recipient can pay for the policy.

Toll-Free Helpline & Address

If you are facing any issue related to the scheme information, execution, claim settlement or anything related to this scheme, you can contact them at the below number and address.

  • Address:

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

Behind Gautam’s Hero Showroom,

Guntur, Andhra Pradesh 522004

India

Everyone in India has access to health insurance because of this outstanding programme. Every time you receive medical care, it pays your medical costs. Everything is covered under this plan, including hospitalisation costs, prescription drug costs, and consultation fees. Regardless of the therapy’s actual cost, this coverage guarantees a fixed claim amount.

FAQs

  1. How long does it take to receive coverage under the Arogya Raksha policy?

The beneficiary must wait 30 days before utilising any scheme coverage.

  1. When is the beneficiary eligible for the plan’s coverage for cataracts?

After 24 months of uninterrupted coverage, the beneficiary can receive cataract therapy.

  1. What is the health insurance waiting period for pre-existing conditions under this policy?

Before receiving benefits for any pre-existing conditions, the recipient must renew the plan at least twice. Consequently, there is a 48-month waiting time for pre-existing conditions.

  1. Which payment options are accepted here?

At this olicy, cash, credit card, debit card, UPI, Visa cards, Master cards, and Rupay cards are all accepted forms of payment.

  1. How do I obtain a health card under this policy?

Everyone who has successfully registered for the government health programme is given a health card under this policy.

  1. Does this policy accept cash?

Arogya Rakshak is a cashless service offered by all affiliated hospitals. This feature is tremendously helpful for individuals and families with family floater plans in medical crises.

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