What Are The Key Features And Benefits Of Arogya Raksha Policy?
Arogya Raksha means “health protection.” “Arogya” means “health,” and “Raksha” means “protection.” Arogya Raksha was launched by then-Hyderabad Chief Minister N. Chandrababu Naidu on January 1, 2017. As the name implies, Arogya Raksha is a health insurance scheme designed to provide minimal-priced quality healthcare services to both low-income class and middle-income class families.
Features of Arogya Raksha Policy
Arogya Raksha is a well-planned health insurance scheme that provides beneficiaries with high-quality healthcare. The following are some of the features and benefits of the Arogya Raksha Policy.
Arogya Raksha Policy Features
- Cashless Services: Beneficiaries can use the cashless health insurance facility, which means they will not be required to pay medical fees out of their own pockets. The network hospitals instantly end up settling the fees with the Arogya Raksha health insurer, so one will be worry-free about unnecessary spending their money.
- A Massive Hospital Network: One of the core advantages of the Arogya Raksha policy is its affiliation with several private and government hospitals. The extensive network of network hospitals ensures that people enrolled in Arogya Raksha Policy have access to healthcare in the event of medical urgency.
Benefits of Arogya Raksha Policy
- Extensive coverage: The Arogya Raksha scheme covers a wide variety of disorders and diseases. The policy covers more than 1,000 different types of treatments. Due to this, the possibility of any patient being denied treatment of a specific condition.
- Financial Cover for Subsequent Treatments: This is a one-of-a-kind feature available through the Arogya Raksha scheme. The coverage envelopes financial reimbursement for any subsequent treatments, which can be financially overbearing for the patients and family members.
- Arogya Raksha Coverage for Ayurvedic Treatment: The Arogya Raksha scheme covers Ayurvedic treatment received at a government hospital by a beneficiary. Treatments received at a medical facility that has been accredited by the Quality Council of India/National Accreditation Board on Health will be covered under the scheme.
Also Read: Arogya Sanjeevani Health Insurance Policy: Features, Eligibility & Benefits
Arogya Raksha Policy Coverage Inclusions
Beneficiaries of the Arogya Raksha policy are entitled to the following benefits:
- Hospitalisation expenses such as room rent, boarding and nursing costs, ICU costs, surgeon and specialist fees, blood, oxygen, operating room charges, and so on.
- Day care services, as well as an ayurvedic treatment before and after hospitalisation, are also provided. Medical expenses will be covered for up to 30 days before hospitalisation and up to 60 days after discharge.
- Several advanced medical procedures (modern treatments) are also covered, such as HIFU, Uterine Artery Embolisation, oral chemotherapy, and robotic surgeries.
- Prenatal fees for 2 childbirths are also covered by this policy.
- A personal accident death cover of 100% is provided for the account holder. This coverage is 50% of the sum insured for spouses and 25% for children.
- A 10% co-payment is also required for any claim made by an insured person over the age of 65.
- Actual in-patient care fees will also be covered by up to 25% of the insured amount. This is subject to a maximum of INR 3,000,000 per policy year. Depression, Obsessive Compulsive Disorders, Psychosis, Schizophrenia, and Bipolar Affective Disorders are among the mental illnesses covered.
Arogya Raksha Policy Coverage Exclusions
The following are the Arogya Raksha health insurance scheme’s exclusions:
- Several costs for vaccinations, unless required in case an injury caused by an animal has to be treated.
- Cosmetic or plastic surgery, unless it is part of the treatment for accident-related injuries. If there is a case where some kind of cosmetic procedure has been conducted without an accident or necessity, it will not be covered under the scheme.
- Sex reassignment surgery
- Correction of vision
- Treatment for Obesity
- Suicide attempt
- Sterility or infertility
- Venereal illnesses
- Anomalies present at birth
- Medical expenses arising out of excessive consumption of alcohol and other intoxicants
- Medical bills arising out of treatment for AIDS
- Cost of medicines that have been taken without a professional prescription
- Implantation of stem cells/surgery
- War-related injuries
Arogya Raksha Premium and Beneficiaries
Arogya Raksha Policy comes in three different plans, depending on the number of beneficiaries covered. Each Plan’s total sum insured ranges from INR 1 lakh to INR 10 lakh. Below are the details:
- Plan A: Plan A, with an exit age of 35 years, offers coverage to the account holder, their dependent children, and their spouse. This Plan’s annual premium is between INR 2,000 and INR 14,500.
- Plan B: Plan B has a 70-year exit age and covers the account holder, two dependent offsprings, and a partner. Plan B’s annual premium is between INR 3,000 and INR 25,500.
- Plan C: Plan C of the Arogya Raksha coverage has a 70-year exit age. It provides coverage to the account holder and their dependents (two) and their spouse (dependent). This Plan’s annual premium is between INR 5,000 and INR 62,500.
It should be acknowledged that the cost of the premium is determined by the amount of Arogya Raksha policy coverage opted for.
Eligibility Criteria of Arogya Raksha Policy
The Arogya Raksha Policy is suitable for families in the state of Andhra Pradesh who have registered as being above the poverty line or are BPL. The scheme does not set a basic wage criterion for eligibility.
What are the Documents Needed while Applying for Arogya Raksha Policy?
Regardless of the method of registration, the beneficiary has to submit certain documents, as well as an active contact number linked to the Aadhaar card. They are:
- Identity proof
- Proof of residence
How to Enroll for Arogya Raksha Policy?
The Arogya Raksha Policy coverage’s enrolment procedure is straightforward. With the right documents in place, renewal and registration processes are straightforward. The process of new registration can be done via the insurance company or with the help of a kiosk. You can sign up as a new beneficiary in one of two ways:
1. Go to an Insurance Agency
Visit the Arogya Raksha section on the online portal of your preferred insurance company. You will find the policy application forms on the page. Fill in the blanks and finish the process by paying the required fee online. One’s Arogya Insurance Policy provider will now guide you through the process of downloading your Arogya Raksha healthcare card.
2. Go to the Local Kiosk
One must carry their Aadhaar card along with a mobile phone linked to their Aadhaar card. This will assist the operator in finalising their registration. The Arogya Raksha Policy provider will ask for the Aadhaar number prior to providing you with a One-Time Password. After completing the steps, the kiosk operator will have their Arogya Raksha health insurance card printed for themself.
What is Arogya Raksha Health Card?
When users register and enrol in the Arogya Raksha Scheme, they will be given a health card. Users can use the coverage provided by this Arogya Raksha health card. Users can get their Arogya Raksha health card from the kiosk operator or by downloading it. This is how one can avail of their Arogya Raksha health card.
How to Apply for an Arogya Raksha Health Card?
Please keep in mind that you will need a printer to print the Arogya Raksha Health Card. The following are the steps to downloading your health card:
- Go to the official website of Dr YSR Arogyasri Healthcare Trust at https://ysraarogyasri.ap.gov.in/web/guest/arogyaraksha
- Select the Arogya Raksha option.
- Select ‘Click here to enrol.’
- Enter your Aadhaar number in the box and press the ‘Go’ button.
- Enter your mobile phone number and click the ‘Send OTP’ button.
- Enter the OTP and click the ‘Verify’ button.
- Choose the member and click the ‘Download Health Card’ button.
Also Read: A Guide To Government Health Insurance For Senior Citizens
Claim Process of Arogya Raksha Policy
To file your claim under the Arogya Raksha policy can be done in two different ways. The government makes sure that any claim, regardless of its nature, will be settled easily and accurately.
Cashless Claims:
The hospital network under the scheme are health care facilities already approved as eligible for receiving cashless coverage to Arogya Raksha insurance beneficiaries. The receivers will be presented with a list of medical facilities to choose from. The TPA will provide approval before beginning treatment to register for cashless claims. The beneficiary is then only obligated to pay the excess, if any.
Reimbursement Claim
In this type of claim, the insured pays for the entire hospital bills. They are then eligible to receive coverage from the insurer. This claim can be utilised at any of the enlisted medical facilities, exclusive of its status of empanelment. A reimbursement claim is useful when the beneficiary has sufficient monetary support and wishes to go to a medical facility to visit a hospital of their choice.
Users should keep in mind that they must positively inform the Arogya Raksha Policy provider within one day of claiming to be hospitalised. Important documents such as discharge summaries, physician’s prescriptions, invoices, hospital records and expenses, etc., should be collected to file a reimbursement claim.
Claim for Rehab Treatment
Although a subsequent diagnosis is free of charge for the beneficiary, hospitals must submit the updated information under the Arogya Raksha policy insurer to receive complete reimbursement for the claim:
- Follow-up treatments’ proof
- Specifics on the consultation
- Reports on investigations
- List of medications prescribed or administered
- Patients’ acknowledgement of medicines
- Photographic evidence showing the patient’s affirmation about the medicines that have been given to them.
- Scanned medical receipts and diagnostic examinations copies
Final Word
Thus, Arogya Raksha policy is an excellent government initiative that provides health coverage to everyone in India. It covers your medical expenses whenever medical treatment is availed. Be it hospitalization, cost of medicine, or consultation fees, everything is covered under this plan. This policy offers you a fixed amount of claim no matter what the actual cost of the treatment will be. It is a great health plan that helps you cover your whole family under one scheme.
FAQs on Arogya Raksha Policy
Ans: Arogya Raksha’s toll-free number is 1800-599-1111. Users can also call 104 to get their questions answered. It is applicable throughout India.
Ans: It is very simple to check the claim status of your Arogya Raksha policy. All you have to do is call the policy’s customer service number or contact the insurance company or TPA directly.
Ans: If there is no gap in the policy, the beneficiary can receive cataract treatment under the Arogya Raksha policy after 24 months.
Ans: The initial waiting period for the Arogya Raksha policy is 30 days. This means that the beneficiary can make a claim and receive policy benefits only after a 30-day queueing period has passed.
Ans: Cash, Credit Card, Debit Card, UPI, Visa Card, Master Card, and RuPay Card are all acceptable methods of payment at Arogya Raksha Policy.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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