Tripura Health Assurance Scheme

An initiative by the government of Tripura and supported by the Central Government of India, the Tripura Health Assurance Scheme for Poor (THASP) was launched to financially support those in the state that are below the poverty line. All families in the state of Tripura that have an annual income less than Rs.1.5 lakh are eligible for the scheme. Launched in the year 2014, the Tripura Health Assurance Scheme for Poor (THASP) was amended a year later, and offers financial support to the poor in the country in the case of hospitalisation, to cover the cost of treatment of surgeries, therapies, critical illnesses and so on.

Through the Tripura Health Assurance Scheme for Poor (THASP), each family is granted a health cover up to Rs.1.15 lakh p.a. At all empanelled hospitals, beneficiaries under the scheme can make use of the cashless facility to cover the cost of hospitalisation or treatment. All listed hospitals under the scheme will offer coverage according to the rate set by the Central Government Health Scheme.

Eligibility criteria for the Tripura Health Assurance Scheme for Poor (THASP):

In order to be covered under the Tripura Health Assurance Scheme for Poor (THASP), families have to meet the conditions as listed below:

  • The annual income of the family has to be less than Rs.1.5 lakh.
  • The Tripura Health Assurance Scheme for Poor (THASP) covers up to 5 family members. They may include the legal spouse, parents of the policyholder, and unmarried children only up to the age of 25 years.
  • In order to be covered by the Tripura Health Assurance Scheme for Poor (THASP), all the names of the family members have to be mentioned on the family ration card that is issued by the Government of Tripura.

Objective of the Tripura Health Assurance Scheme for Poor (THASP):

With soaring medical costs for treatments and hospitalisation sighted as one of the main reasons behind financial instability, the Tripura Health Assurance Scheme for Poor (THASP) aims to offer financial support to those in the state that are below the poverty line. With the sum assured of Rs.1.15 lakh, the scheme aims to reduce the out-of-pocket expense of the families and individuals when receiving treatment at any empanelled hospital in the state. The Tripura Health Assurance Scheme for Poor (THASP) covers the cost of treatments, hospitalisation, critical care, and surgeries up to the ceiling limit.

Benefits of the Tripura Health Assurance Scheme for Poor (THASP):

Listed below are some of the key features and benefits of the Tripura Health Assurance Scheme for Poor (THASP):

  • The Tripura Health Assurance Scheme for Poor (THASP) is offered on a family floater basis.
  • The maximum sum assured is Rs.1.15 lakh. If the treatment at the listed hospital crosses the ceiling limit, then the patient will have to bear the additional expenses.
  • The scheme includes coverage of transportation expenses from Agartala to the listed hospital and back. The maximum coverage of the transportation expenses is Rs.10,000.
  • The expenses for the treatment up to Rs.1.15 lakh will be paid directly to the listed hospital.
  • With regard to financial assistance for transportation, the amount will be advanced from the scheme either via a bank draft or directly to the account of the beneficiary.

How Families will Receive Health Cover Under the Tripura Health Assurance Scheme for Poor (THASP):

Listed below is the procedure that ensures that those eligible for the coverage of the Tripura Health Assurance Scheme for Poor (THASP) will receive the cashless benefit from the empanelled hospital:

  • As soon as the application for coverage of medical expenses is received, the empanelled hospital will receive a fax or an email from the state officials of the health department of Tripura referring the patient for treatment. A copy of the referral letter will be given to the patient as well.
  • On receiving the referral letter, the hospital will examine whether the treatment can be covered, based on the terms and conditions of the scheme.
  • The facilities for the treatment will then be covered depending on whether the treatment is listed under those that are covered under the State Illness Fund.
  • If the treatment is given a green signal, then the State Government will offer coverage up to Rs.1.15 lakh. The empanelled hospital will inform the health department of Tripura on the cost of expenses and raise a bill for the coverage.
  • Along with the bill for the coverage of medical expenses, the empanelled hospital will send details of the healthcare facilities that have been provided to the patient to the director of the Tripura Health Assurance Scheme for Poor (THASP). The Director will then verify the bill and health department of Tripura will reimburse the amount to cover the medical expenses up to the ceiling limit of the scheme, which is Rs.1.15 lakh.

What needs to be submitted by the beneficiary to receive coverage from the Tripura Health Assurance Scheme for Poor (THASP):

  • The head of the family has to submit his/her name, current job designation, and contact details such as telephone number, mobile number, and email address.
  • The head of the family has to also submit his/her bank details and IFSC code of the bank.

What is covered by the Tripura Health Assurance Scheme for Poor (THASP):

Listed below are some of the main treatments, surgeries, and diseases that are covered by the Tripura Health Assurance Scheme for Poor (THASP):

  • Treatment for cancer
  • Cardiovascular surgeries
  • All renal and neo-natal diseases
  • Treatment for polytrauma
  • Expenses for eye surgeries
  • Medical cover for neuro surgeries

Based on the treatments and diseases that are covered under the Tripura Health Assurance Scheme for Poor (THASP), as set by the Family and Welfare Department of Tripura, only 7 critical diseases will be covered under the scheme. The treatment cost will be subject to the limit as per the Central Government health scheme.

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