VAJPAYEE AROGYASHREE , KARNATAKA

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Introduction

Government of Karnataka has taken the initiative to provide Health protection to families living below poverty line for the treatment of major ailments, requiring hospitalization and surgery. In order to bridge the gap in provision of Tertiary care facility and the specialist pool of doctors to meet the statewide requirement for the treatment of such diseases particularly in rural areas of Karnataka. Health assurance could be a way of removing the finiancial barriers and improving accessibility to quality medical care by the poor. Government of Karnataka intends to implement Health assurance Scheme by name Vajpayee Arogyashree for the BPL families of Karnataka.


Objectives :

To improve access of BPL families towards quality tertiary medical care for treatment of identified diseases involving hospitalization, surgery and therapies through an identified network of health care providers.

(i) To Cover Catastrophic Illness.

(ii) Universal Coverage of BPL (Rural + Urban).

(iii)Catastrophic illnesses can wipe out decades of savings of BPL families.

(iv)To protect life time savings of BPL families which would be wiped out in case of catastrophic illness.

 

Special Features of the Scheme :

(i) To For availment of the benefit of the scheme there is no age limit.

(ii) Pre-existing disease is no bar.

(iii) The tariff fixed for the procedure is inclusive of Investigations, Procedures Implants, Transport, Food and Medicine for the patient.

(iv) Each NWH is provided with the services of one Arogaymitra to guide the NWH & beneficiary & to ensure that the benefit of the scheme reaches the beneficiary.

(v) The treatment provided to the beneficiary is totally free. 

(vi) No premium is collected from the beneficiary. 

(vii) The entire expenditure towards treatment is met by the Government.

(viii) Follow up treatment in selected 50 procedures is provided for a period of one year.

 

Suvarna Arogya Suraksha Trust (SAST) :

Suvarna Arogya Surakha Trust has been established and registered as a separate body under the aegis of Health and Family Welfare Department under the Indian Trust Act, 1882 in order to implement Suvarna Arogya Suraksha Scheme (now Vajpayee Arogya Shree scheme) vide GO No. HFW  216 CGE 2008, Bangalore dated 20th February 2009.  The Trust has started functioning since April 2009.  Initially the scheme has been taken up in all the districts of Gulbarga & Belgaum Division and extended to Bangalore & Mysore Division during July 2012 providing cashless high end Medical Care & Surgeries in the Empanelled Super Specialty Hospitals.

Area :

Government has decided to extend the benefit of the scheme to the BPL families of the State on phased manner.Accordingly..


(i) It was first started in Gulbarga Division covering 14.39 lakhs BPL families in February 2010.

(ii) It was extended to Belgaum Division in the month of August 2010 covering 16.91 lakhs BPL families.

(iii) It was Subsequently extended to Bangalore & Mysore Division in the month of June 2012 thus, covering the entire state.

 

Beneficiaries :

BPL famalies of the identified area of both Rural and Urban are eligible to avail the benefits of the scheme. The BPL family is identified on the basis of BPL Ration Card issued by the Food, Civil Supplies and Consumer affairs Department of Karnataka Government.

Beneficiaries are identified on the basis of :

(i) Laminated BPL cards with photograph issued by Food and Civil Supplies Department (Permanent BPL cards).

(ii) Temporary BPL cards with seal suggesting payment towards attesting permanent cards with attestation of the Tahasildar.

Families :

The Health Assurance Scheme will cover 5 members of a family as enumerated and photographed on the BPL card. The name/ photograph indicated in the BPL card will be taken as proof of identity of the Beneficiary.

Enrolment :

Department of Foods and Civil Supplies, Govt. of Karnataka will provide the details of each BPL family covered under the scheme through the BPL card. This BPL card will be a part of enrollment/ identification for availing the health assurance facility.

Payment of Premium :

Government of Karnataka / Trust will pay the complete treatment cost to the concerned Network Hospital on behalf of the BPL beneficiaries.

Benefit Package :

(i) The benefit is restricted to only five members of a BPL family in a year.

(ii) Sum assured will be Rs.1.50 lakh on a family floater basis per year. Additional buffer of Rs.50, 000/- per year for the entire family on a case to case basis will be available.

(iii)The beneficiaries are required to avail the benefits of the scheme only in NWH's empanelled by the Trust .

Cashless Transaction :

It is envisaged that during each hospitalization the transaction shall be cashless for procedures covered under this scheme. Enroled BPL beneficiary can go to a network hospital and obtain treatment without making any payment to the hospital for procedures provided under the scheme.

Pre-Existing Diseases :

All diseases proposed under the scheme shall be covered under the scheme from day one. A person suffering from any of the identified diseases prior to the inception of the policy shall also be covered.

Procedure for Enrolment of Hospitals :

All public Hospitals (District Hospitals, Government/ Private Medical Colleges) and identified Private Hospitals/ Nursing Homes shall individually be empanelled. Private Hospitals/ Nursing Homes means, any institution in Karnataka established for in-patient surgical care and the Networked Hospital should comply with minimum qualifying criteria for empanelment. For the empanelment of Super Specialty treatment of Neurology, Heart, Cancer treatment (Surgery, Chemotherapy and Radiotherapy), Renal, Burns and Poly-Trauma cases (not covered by the Motor Vehicles Act) and Neo-natal care, the Hospital should have super specialty infrastructure of the same along with services of specialists.

The concerned agency will provide supporting services of Health Assurance, like creating awareness among the community by conducting Health awareness/ check up camps, through “Arogyamitras” in the concerned areas.

Memorandum of Understanding (MoU) with Network Hospitals :

The trust shall sign the MoU with all the Hospitals to be empanelled under the scheme. The Empanelled Medical Institutions will extend Medical Aids to the beneficiary under the scheme.

Claims Settlement :

Vajpayee Arogyashree shall settle the claim within 21 days of receving the claims from the network hospital.

Camps :

Health Camps will be conducted at Taluk, Sub-divisions & District Level. A minimum number of one free medical camp will be conducted by each Network Hospital per week at a place suggested by the Trust. They will carry necessary screening equipment along with specialist and other Para-medical staff as suggested by the Trust and will also work in close liaison with Regional Consultants, District Coordinator, District Health Officer in consultation with Deputy Commissioner.

Hospitalization Period :

The minimum period for which the beneficiary is admitted in the hospital as in-patient and stays there for the sole purpose of receiving the necessary and reasonable treatment for the disease/ ailment contracted/ injuries.

State Level Co ordination :

(i) Call center with toll free help line - 1800-425-8330.

(ii) MIS to collect and report data on a real-time basis. Collect hourly round the clock information from Arogya Mitra, Regional Consultants, District Coordinators etc. MIS shall follow up the cases at all levels. They shall also generate reports as desired by the Executive Director ,Suvarna Arogya Suraksha Trust.

(iii) 24 X 7 online computer control room to ensure that the website with e-preauthorization, claims settlements, and real-time follow-up is to be maintained and updated.

 


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