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  • Rajiv Gandhi Jeevandayee Arogya Yojana, Maharashtra

    Introduction:

    The Rajiv Gandhi Jeevandayee Arogya Yojana is a health care policy that has been run by the Maharashtra Government for all economically challenged people in the state. This policy can be availed by those who have one of the two cards - Orange Ration Card (for individuals above poverty line) or Yellow Ration Card (for individuals below poverty line). Initially, this scheme was launched in 8 districts in the state and followed by all 35 districts. This scheme provides free access to medical care in government hospitals for various surgeries, diseases and therapies.

    Why was Rajiv Gandhi Jeevandayee Arogya Yojana Launched?

    Through this scheme, financial protection is provided to below poverty line families for up to Rs. 1.5 lakhs annually. This scheme was launched so as to provide access to quality medical services through a network of health care services that were identified. 975 Medical and Surgical procedures in identified medical centres are covered under this plan. This identified network is needed to implement all schemes sponsored by the Maharashtra government. Certain minimum standards are maintained so as to provide quality medical services.

    Benefits and Features of Rajiv Gandhi Jeevandayee Arogya Yojana:

    These scheme comes with a number of benefits in the form of 971 procedures from which 131 are performed solely in government hospitals. Under this scheme illnesses that can be treated in certain primary level health centres or ordinary hospitals will not covered under this option.

    • The benefit of this scheme will be available to customers on a floater basis which means that the insurance of Rs. 1.5 lakh can be availed by the entire family or one individual in the family.
    • Hospitals that are on the panel of this scheme will provide cashless service and deposit need not be provided by the insured. No exclusions or pre-existing disease waiting period is also required.
    • Some of the private medical institutions on the panel include Tata Memorial Hospital and Research Centre, RN Cooper, Asian Heart and Research Centre, Seven Hills Healthcare and others.
    • Network hospitals also provide a follow up consultation session for free.
    • On producing health card, kidney transplants are also provided for free.
    • One free medical camp is also provided.

    Coverage Details:

    The total procedures that are covered can be divided into 30 categories:

    These categories include general surgery, plastic surgery, ENT surgery, ophthalmology surgery, paediatric surgery, neurosurgery, radiation surgery, burns, critical care, general medicine, infectious diseases, cardiology and neurology among others. Although knee and hip replacement surgeries were not included originally, these are under consideration.

    Covered Not Covered
    Lobar pneumonia, Aspiration pneumonia, Broncho pneumonia, pneumothorax, pneumoconiosis, pneumonectomy. Pneumonia
    Numerous medical and surgical gastroenterology related procedures Diarrhoea
    Diabetic retinopathy, Uncontrolled diabetes with infectious emergencies, Diabetic ketoacidosis Diabetes
    Snakebite with ventilation support Snakebite without ventilation support
    Diaphragmatic Hernia, Appendicular Perforation Hernia and Appendicitis (unless it is an emergency).

    Eligibility Criteria for Rajiv Gandhi Jeevandayee Arogya Yojana:

    For Customers -

    Only those families who are below poverty line or marginally above poverty line who have either of the two cards - Orange Ration Card (above poverty line) or Yellow Ration Card (below poverty line) can avail this scheme.

    For Agency -

    • Agency should be registered under Companies Act 1956.
    • Agency should have a valid OSP license to provide services at said location.
    • In the previous four financial years, agency must have an average yearly turnover higher than Rs. 15 crores.
    • Agency must have a positive net worth.

    For Hospital -

    • Should have a minimum of 50 inpatient beds with enough staff and spacing.
    • Should have separate general wards for males and females.

    Documents Required for the Scheme:

    The important documents required are Yellow or Orange ration card and Aadhaar card. In case Aadhaar number has not been procured, then customers can produce any of the following photo ID proofs provided by the Government of India.

    • Voter’s ID
    • Driving License
    • School ID
    • Other IDs issued by an authorized officer.
    • PAN Card

    Steps to Enrol in Rajiv Gandhi Jeevandayee Arogya Yojana:

    • Families/individuals can approach the closest network hospital in their area and in case they visit a facility that is not a part of the network then a referral card will be provided to the network hospital along after an initial diagnosis by the doctor. Information regarding this will be captured in the database.
    • Customers will have to then provide the referral card (if provided) along with yellow or orange ration card, Antyodaya or Annapurna card and their diagnosis and check-ups will be undertaken. These details will be noted down in the relevant database.
    • The patient will be admitted in the network hospital based on diagnosis and an E-preauthorization request will be sent to the insurance company and will also be reviewed by the Rajiv Gandhi Arogya Yojana Society.
    • Recognized doctors and other specialists of the Rajiv Gandhi Jeevandayee Arogya Yojana and the insurance company will examine the request and approve if necessary conditions are met. This will be done immediately in cases of emergency and will be valid for a week.
    • Cashless treatment and surgery will be provided and details will be documented.
    • All necessary bills, reports, procedures will be forwarded to the insurer for claim settlement after procuring required signatures. Discharge and follow-up details will be available on the Rajiv Gandhi Jeevandayee Arogya Yojana Society portal.
    • Network hospital will also provide free follow-up consultations, medicines and diagnostics as part of the scheme for a period of 10 days from discharge date.

    Conclusion:

    In a country with the second largest population in the world, it is important for the government to ensure that everyone’s health is accounted for, right from the higher strata of society to the lowest. It is generally those who come from lower financial background who suffer due to lack of facilities and awareness. Most times, they lose out on good treatments due to lack of money. The Rajiv Gandhi Jeevandayee Arogya Yojana provides individuals with a cover of up to Rs 1.5 lakhs. This scheme is highly beneficial due to its various benefits and features as listed above and also because it provides affordable top quality healthcare to those who cannot afford it. The Rajiv Gandhi Jeevandayee Arogya Yojana is a blessing in disguise to all who cannot access or pay for quality healthcare.

    Frequently Asked Questions (FAQs):

    1. What validation or identity proof will be required if a child is born after the health card is issued and name and photo is not available?

      If the above is the case, then parents will have to submit a photo of the child with any one of the parents and also provide the health card or yellow or orange card of the parent along with birth certificate.

    2. What is the ‘run-off’ period available for the scheme?

      After expiry of policy period, a runoff period of one month will be provided. This implies that pre-authorizations will be done till the end of the period of policy and surgeries for these can be performed.

    3. Will Claim Settlements be done online?

      The insurer will settle hospital claims online within a fortnight or 15 working days on receipt of complete document from the network hospital including all diagnostic reports, original bills, satisfaction letter from the individual and others.

    4. Will health camps be conducted?

      Health camps will be conducted in Major Gram Panchayat, Municipalities and Taluka Headquarters. At least one camp will be conducted by one empanelled hospital per week in all eight districts in one policy year. The insurance company will ensure that a minimum of one medical camp will be conducted for free by one network hospital every week at a location that has been suggested by the Rajiv Gandhi Jeevandayee Arogya Yojana Society. These activities will be coordinated by Rajiv Gandhi Jeevandayee Medical Camp Coordinator MCCOs of each hospital.

    5. Will customers with a white ration card be eligible to receive the benefits of this scheme?

      No, only families with a yellow ration card, orange ration card, Antyodaya Anna Yojana Card and Annapurna Card will be eligible to receive the benefits of this scheme.

    6. Will transaction be cashless for this scheme?

      Yes, transaction for covered procedures will be cashless.

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