Rajiv Aarogya Sree- Scheme Phase Ii

About Scheme phase II

MONITORING MECHANISM: Regular review meetings on the performance/administration of the Scheme would be held between the GoAP/Trust and the Insurer at District level and at the State Level. The composition of the monitoring committees shall be as follows: District level: Chairman: Distirct Collector

1. 2. 3.

Project Director. DRDA District coordinator of the Insurer. Representative of Zilla Samakhya.

State level: Chairman: Principal Secretary, HM & FW Department and Vice Chairman of Aarogyasri Health Care Trust. Members:

1. 2. 3. 4.

CEO, Aarogyasri Health Care Trust (Convener) State Coordinator/Zonal Manager of the Insurer. Any member of the trust Board Technical Committee member nominated by the Trust

The Chairmen of the above committees may invite any Member of the Legislative Assembly whose constituency falls in the th districts/elected members of Panchayati Raj Institutions for the meetings. Fortnightly meetings shall be organised at both district a State level preferably on alternate Mondays. The agenda and issues to be discussed would be mutually decided in advance. The minu of the meeting at the district and state level will be drawn and a copy will be forwarded to GoAP and Trust. The Insurer shall also pu place a mechanism of their own to monitor the scheme on a real time basis. Detailed reports on the progress of the scheme and issue any emerging out of such meetings shall be reported to GoAP/Trust. GRIEVANCE MECHANISM: District Level Committee:

Committee chaired by District Collector with following members will form the grievance redressel cell at the district level. The decis by the committee at the state level is preferred. Members of the Committee:

1. 2. 3. 4.

District Coordinator (DCHS) Superintendent of District Hospital Member from the Technical Committee(Nominated by the trust) Representative from the Insurance firm.

Members of the Committee:

1. 2. 3.

Representative of the Trust Technical Committee Member Representative from the Insurance firm.

A toll-free number will be made available at Hyderabad where any complaints can be registered. The insurer shall keep track of complaints and report on the action taken to the Central Committee. The beneficiaries can also send telegrams to CEO of the Tru CMD's Secretariate/Zonal Office of the Insurer. The details of toll-free Numbers/addresses will be made available with supervision Executive Director of the Insurer at the Corporate Office will be made.

Beneficiary

The scheme is intended to benefit below poverty line (BPL) population in the 5 districts of the State viz. West Godavari, East Godav Nalgonda, Ranga Reddy and Chittoor. There are 48.23 lakh BPL families in the five districts comprising of a population of 1.68 cror Database and photograph of these families will be available in 'Health Cards' to be issued by the Trust based on the BPL ration c issued by the Civil Supplies Department Premium The Government has borne the entire premium on behalf of the beneficiary Benefits

If any of the family members require surgeries in Heart, Kidney Brain, Cancer and surgical treatment of Burns , Poly trauma (exc cases covered under Motor Vehicles Act) and Cochlear Implant Surgery for Children Below 6 Years, the entire cost of such surgeries covered under the scheme. The patient will be operated without having to pay any money to the hospital. The insurance cover family is upto Rs. 1.50 Lakhs. A buffer of additional Rs. 0.50 Lakhs is earmarked for deserving cases on an individual basis. Surgery List - Phase-II

205

6.1

Neurosurgical Trauma

30,000

206

6.2

Polytrauma

50,000

207

6.3

Longbone Fractures (Surgical Correction)

15,000

Top

7

Cochlear Implant Surgery For Children Below 6 Years

Cost

208

7.1

Cochlear Implant Surgery

5,20,000

209

7.2

Initial Mapping/Switch on

50,000

210

7.3.1

Post Switch on Mapping/Initiation of AVP and training of Mother - First Installment

20,000

7.3.2

Post Switch on Mapping/Initiation of AVP and training of Mother - Second Installment

20,000

7.3.3

Post Switch on Mapping/Initiation of AVP and training of Mother - Third Installment

20,000

7.3.4

Post Switch on Mapping/Initiation of AVP and training of Mother - Fourth Installment

20,000

Packages for cancer chemotherapy and radiotherapy

• • • o o o o o • • •

Chemotherapy and radiotherapy should be administered only by professionals trained in respective therapies (i.e Medi Oncologists and Radiation Oncologists) and well versed with dealing with the side-effects the treatment can cause Patients with hematologic malignancies- (leukemias, lymphomas, multiple myeloma ) and pediatric malignancies ( Any patient 14 years age) should be treated by qualified medical oncologists only Each cycle cost includes Cost of chemotherapy drugs Hospital charges All the infusional chemotherapy cancer cases must be treated as inpatients only. Doctors fees Supportive care medications (i.e. i. v. fluids, steroids, H2 blockers, anti-emetics) All Investigations An average of 2000 to 5000/- has been added to the above cost, to cover for treatment of complications. A cap of 30,000/- has been set on palliative chemotherapy

Tumors not included in this list, if have a chemotherapy regimen that is proven to be curative, or provide long te improvements overall survival will be reviewed on a case by case basis by the technical committee of the Trust. Working Pattern

Process Flow Process

Flow

of

the

Beneficiary

Step

Treatment

in

the

Network

Hospi

1:

Beneficiaries approach nearby PHC/Area Hospitals/District Hospital/Network Hospital. Aarogya Mithras placed in the above hospit facilitate the beneficiary.If beneficiary visits any other PHC/Government hospital other than the Network Hospital, he/she will be give referral card to the Network Hospital after preliminary diagnosis by the doctors. The Beneficiary may also attend the Health Camps be conducted by the Network Hospital in the Villages and can get the referral card based on the diagno Step

2:

The Aarogya mithras at the Network Hospital examines the referral card and BPL ration card and facilitates the beneficiary to unde preliminary diagnosis and basic tests. Step

3:

The Network Hospital, based on the diagnosis, admits the patient and sends preauthorization request to the Insurance company and Aarogyasri Health Care Tru Step

4:

Specialists of the Insurance Company and the Trust examine the preauthorization request and approve preauthorization if all conditions are satisfied. Step The Step

5: Network

Hospital

extends

cashless

treatment

and

surgery

to

the

beneficiary.

6:

Network Hospital after performing the surgery forwards the original bill, discharge summary with signature of the patient and ot relevant documents to Insurance Company for settlement of the claim. Step

7:

Insurance Company scrutinize the bills and gives approval for the sanction of the bill.