The Vajpayee Arogya Shree is an initiative by the state government of Karnataka, to offer Below Poverty Line (BPL) families a medical cover for treatment of diseases that require surgery or hospitalisation. A need for tertiary care treatment was identified in the rural parts of Karnataka and hence, the government felt that health insurance would address this need. A health cover would help the economically challenged sections overcome financial barriers and give them access to quality healthcare facilities.
The Vajpayee Arogya Shree scheme, as stated above, is a health insurance scheme launched to offer cashless treatment to the BPL beneficiaries in empanelled hospitals. The scheme was initially rolled out to cover the districts of Belgaum and Gulbarga but was later extended to Mysore and Bangalore.
Objectives of the Vajpayee Arogya Shree Scheme:
The Vajpayee Arogya Shree scheme operates with an objective of boosting the access of poor households to quality tertiary healthcare facilities. The scheme will safeguard the beneficiaries against draining out their savings towards the treatment of acute illnesses as the expenses incurred for hospitalisation, surgery or therapy will be borne by the state government.
Features of the Vajpayee Arogya Shree Scheme:
Under the Vajpayee Arogya Shree scheme, beneficiaries can avail cashless treatment in both rural and urban areas in Karnataka. Some of the other features offered by the scheme have been listed below:
- There is no age limit to avail treatment under the scheme.
- As many as 5 members in a family can avail benefits under the scheme.
- An amount of Rs.1.5 lakh can be availed by a family per year on a floater basis. If the amount is exhausted, an additional Rs.50,000 will be provided as a buffer.
- Pre-existing diseases are also covered.
- The treatment availed by the beneficiaries will be free of cost and all members in a family can use a single card to avail the benefits.
- Beneficiaries need not make any premium payments as the treatment costs will be funded by the state government.
- 60 listed procedures are eligible for a follow-up treatment and this treatment can be availed for a period of one year.
Diseases Covered Under the Vajpayee Arogya Shree Scheme:
- Cardiovascular diseases
- Neonatal cases
- Neurological diseases
- Polytrauma cases
- Renal diseases
Identification of Beneficiaries:
All BPL families residing in both rural and urban areas are eligible to reap the benefits of the Vajpayee Arogya Shree scheme. Identification of the beneficiaries is done on the basis of a BPL ration card which the Food, Civil Supplies and Consumer Affairs Department will furnish. To avail benefits of the Vajpayee Arogya Shree, the beneficiaries have to mandatorily produce the BPL card.
Settlement of Claims Under the Vajpayee Arogya Shree Scheme:
As the treatment offered under the Vajpayee Arogya Shree is cashless, the beneficiaries need not worry about the claim settlement and treatments can be availed immediately at the network hospital. The claims will be settled directly between the state government and the network hospital.
The network hospitals under the Vajpayee Arogya Shree scheme will conduct at least one free health camp per week at the District, Taluk, and Sub-division level. While conducting the health camps, the medical practitioners will need to carry the necessary screening equipment and also consult the District Coordinator, Regional Consultants, District Health Officer, and the Deputy Commissioner.
Suvarna Arogya Suraksha Trust::
Suvarna Arogya Suraksha Trust (SAST) is a Special Purpose Vehicle established as per the Indian Trust Act, 1882 and functions under the purview of the Department of Health and Family Welfare of the Karnataka government. Its main function is to make sure that the out-of-pocket expenditure for healthcare is curtailed by employing strategic measures. One such measure is the purchase of super-specialty private and public healthcare providers who will deliver superior tertiary care to patients.
The SAST is responsible for managing government-sponsored schemes such as the Vajpayee Arogya Shree Scheme, Indira Suraksha Yojana, Rajiv Arogya Bhagya, Jyothi Sanjeevini, Rashtriya Swasthya Bima Yojana, etc.