Dr YSR Aarogyasri Health Insurance Scheme: Benefits, Coverage & Eligibility

Dr. YSR Aarogyasri is a government-funded health insurance scheme launched by the Andhra Pradesh Government to provide cashless treatment to eligible low-income families. The scheme offers health coverage of up to ₹5 lakh per family per year (with additional support in specified cases) for hundreds of medical and surgical procedures at empanelled hospitals across the state.

The YSR Aarogyasri Scheme is a health insurance scheme started by the then-Chief Minister Dr. Y. S. Rajasekhar Reddy in 2007. The Aarogyasri Health Care Trust is currently in charge of this scheme, which enables low-income families to obtain high-quality healthcare services without having to pay for them. Highlights of Dr. YSR Aarogyasri

Features and Benefits of AP YSR Aarogyasri Scheme

The Dr. YSR Aarogyasri health insurance policy is highly beneficial for accessing high-quality healthcare services in Andhra Pradesh and Telangana. The following are its features and benefits:

1. Hospitalization (In-patient)

   All diseases requiring hospitalization and listed under the scheme are covered.

2. Out-Patient Treatment

   These treatments can be accessed in a cashless manner at health camps and network hospitals.

3. Cashless Service

   The scheme provides a financial cover of ₹5 lakh per year per family to its beneficiaries. Registered family members can use this cover if they need medical assistance.

4. Coverage for Pre-existing Diseases

   This plan provides coverage for diseases a beneficiary may have been diagnosed with before enrolling under the scheme. This is a feature not commonly included in many commercial health insurance plans.

5. Coverage for Follow-up Treatments

   The Dr. YSR Aarogyasri plan also covers procedures requiring follow-up after hospitalization.

6. Family Floater Health Insurance Cover

   The scheme provides health coverage to every member of the family, eliminating the need to buy separate health insurance plans for each member.

What is Not Covered under the Dr. YSR Aarogyasri Scheme (Exclusions)?

Certain procedures are not covered under the Dr. YSR Aarogyasri Scheme. Beneficiaries will be responsible for the costs of these medical procedures:

• Knee replacement surgeries
• Gamma-knife procedures in neurosurgery
• Medical treatment related to bone marrow
• Leprosy
• Filaria
• Assisted devices for cardiac failures
• Cardiac and liver transplantations
• Malaria
• HIV/AIDS
• Tuberculosis
• Infectious diseases
• Gastroenteritis
• Jaundice
• etc.

Eligibility for YSR Aarogyasri Scheme

The eligibility criteria for the YSR Aarogyasri Scheme are as follows:

• Applicants must be residents of Andhra Pradesh or Telangana.
• Family income of less than ₹5 lakh per annum.
• Possession of a white ration card.
• Land ownership not exceeding 35 acres.
• Ownership of not more than one car.
• Families paying municipal property tax.
• Income tax payers with an annual income up to ₹5 lakh.

How to Register for YSR Aarogyasri Scheme

You can follow these steps to register for the scheme:

Online Procedure

• Go to the official website.
• Log in with your ID and password.
• Fill out the application form.
• Upload required documents.
• Submit the application form.
• Take a printout for your records.

Offline Procedure

• Go to the official website.
• Click on the YSR Aarogya Health Card proforma.
• Download the scheme application form.
• Take a printout.
• Fill out the application form.
• Submit the application form physically to the concerned department.
• Application form verification will be conducted.
• The beneficiary will receive the YSR Health Card.

Required Documents to Apply for YSR Aarogyasri Scheme

The following documents will be required at the time of enrollment for the scheme:

• Aadhaar card
• Address proof
• BPL certificate
• Income proof

Dr. YSR Aarogyasri Health Card and its Features

In Andhra Pradesh and Telangana, this Health Card provides access to cashless medical services at empanelled hospitals. It includes a unique card number, a photo of the cardholder, and other beneficiary information. Here are some of its features:

• Reimbursement up to ₹5 lakh.
• Additional benefit of ₹50,000 if expenses exceed ₹5 lakh.
• Coverage for serious illness treatment up to ₹2 lakh.
• Covers 938 medical and surgical treatments.

How to Download the Aarogyasri App?

A mobile application can be used to access various details about the Dr. YSR Aarogyasri Yojana. For Android devices, the Aarogyasri App can be downloaded from the Play Store. Follow these steps to get the app:

• Go to the Google Play Store.
• Search for "Aarogyasri Trust".
• Tap on ’Install’.

Andhra Pradesh Government’s Dr. YSR Aarogyasri COVID-19 Coverage

To address the health challenges posed by COVID-19, the Dr. YSR Aarogyasri plan now includes 15 new procedures. The following treatments are available:

• Intensive Care Management of Septic Shock
• Medical Management of Acute Bronchitis with Pneumonia and Respiratory Failure
• Medical Management of Acute Respiratory Failure (With Ventilator)
• Medical Management of Acute Respiratory Failure (Without Ventilator)
• Medical Management of Acute Severe Asthma With Acute Respiratory Failure
• Medical Management of ARDS
• Medical Management of ARDS with DIC (Blood & Blood Products) (D65)
• Medical Management of ARDS with DIC (Blood & Blood Products) (D65) in Paediatrics
• Medical Management of ARDS with Multi-Organ Failure (R65.1)
• Medical Management Of ARDS with Multi-Organ Failure in Paediatrics
• Medical Management of Confirmed COVID-19 (Stable)
• Medical Management of Confirmed COVID-19 with Comorbidities - HTN, DM, COPD, HIV, Chr. Liver Disease, Chr. Renal Disease
• Medical Management of COPD with Respiratory Failure (Infective Exacerbation)
• Medical Management of Pneumonias
• Medical Management of Suspected COVID-19 (Stable)

How to Claim the YSR Aarogyasri Scheme?

Thanks to the active Dr. YSR Aarogyasri portal, the claim process for this scheme is hassle-free. The claim process for both beneficiaries and hospitals is as follows:

Claim Process for Beneficiaries

Beneficiaries of the Dr. YSR Aarogyasri scheme do not have to go through a lengthy claim process to receive medical treatment. YSR Aarogyasri Health Cards are issued at the time of enrollment. To receive treatment at an empanelled hospital, beneficiaries simply need to show their health card to a Vaidya Mitra, who will collect the information, and treatment will begin.

If a beneficiary does not have a YSR card, they can provide the Vaidya Mitra with their YSR Aarogyasri Health Card number. It is advisable to keep a picture of the health card. In rare instances where patient verification as a Dr. YSR Aarogyasri scheme beneficiary is not immediate, information can be obtained by contacting the Aarogyasri Trust.

Claim Process for Hospitals

For planned surgical treatments, hospitals must seek pre-authorization. A claim can be fulfilled by the Dr. YSR Aarogyasri Healthcare Trust only if the following conditions are met by the hospital authorities:

• The hospital has pre-authorization to perform a treatment on the approved list.
• The claim is intimated as early as possible.
• The claim amount is less than the pre-authorization limit.
• Photographic documentation of treatment is provided for claim settlement.

The Dr. YSR Aarogyasri site is used to settle all claims. This portal can also be used to collect claim documents, submit claim intimation, and review claim documents. After receiving a claim, the following verifications are carried out:

• Patient’s identity
• Evidence of treatment
• Claim amount relative to the authorized amount
• Case management as per pre-authorization

Dr. YSR Aarogyasri Health Care Trust Toll-Free/Helpline Number and Address

Beneficiaries can contact the Dr. YSR Aarogyasri Health Care Trust for any questions or queries. Contact information is provided below:

Aarogyasri Helpline Number:

• 1800-599-1111
• The PAN India helpline number 104 can also be used for query resolution.

Contact Number:

• 0863 - 2222802 / 2259861

Dr. YSR Aarogyasri Address:

• D.No. 25-16-116/B, Chuttugunta, Behind Gautam’s Hero Showroom, Guntur, Andhra Pradesh, India - 522004.

Details for Grievance Resolution related to Dr. YSR Aarogyasri:

• Contact Number: 8333817424/23/20/07 (Office Hours)
• Extension: 0863-2259861 (Ext. 326)
• Email Address: [email protected]

Contact Details related to Medical Reimbursement Status and Issues:

• Contact Number: 8333817363
• Extension: 0863-2259861 (Ext. 329)
• Email Address: [email protected]