A presentation on Rajiv Aarogyasri Community Health Insurance Scheme by the Hospital Management students of ASCI.

1. Rajiv Aarogyasri Community
Health Insurance Scheme.
Presented By :
Avin K
Srilata E
Varsha P
Presented By:
Avin K
Srilata E
Varsha P
Rajiv Aarogyasri Community
Health Insurance Scheme

2. Introduction
 Rajiv Aarogyasri is the flagship scheme of all health initiatives
of the State Government.
 Aim is to achieve “Health for All”.
 This scheme is to assist poor families from catastrophic health
expenditure.
 The scheme is a unique PPP model in the field of Health
Insurance.
 Provides end to end cashless services for identified diseases.
 Introduced on 1st April 2004 in three backward districts of
Mahboobnagar, Anantapur and Srikakulam.
 Free screening and outpatient consultation.
 The scheme was formulated in field of Medicine, Health and
Insurance.
 Function through ICT website (www.aarogyasri.org).

3. Below Poverty Line
Sell
assets
12.60%
Current
Income 6.10%
Other 6.10%
Saving
12.00% Borrow
63.10%
Escalatinghealthcarecosts: leadingtoruralindebtedness
Largeproportionofpeople,especiallybelowpovertylineborrowmoneyorsellassetstopayforhospitalization
Background: Hospitalization
Expenses in AP

4.  Universal Coverage All BPL Families 2.03 cores
 Cashless treatment Up to Rs 2 lakhs in a year
 Health Workers 3394 Aarogya mithras
 Health camps 8058 camps so far
Simple Procedure Health card/White Card
 Cost Borne by the Government
 Diseases Identified
 Packages For end-to-end treatment
 Choice of Hospital Left to patients
 Monitored On-line : 24 hour basis
 Implementation : Aarogyasri - I through Insurance Co.
Aarogyasri – II directly by Trust
Main Features

5. Expansion of the scheme

7. Cashless Packages

8. Disease Coverage

9. Health Card, Sum Insured
• BPL family covered means the group of individuals as indicated in ,
Health Card or White ration card (BPL card).
• Sum insured per family-Rs.1,50,000/- .
• Benefit on floater basis , can be availed by individual or family .
• Additional Rs.50,000/-in case of need from Buffer amount .

10. Patient Facilities and Beneficiary Choice
Aarogyamithra
 Help desk in PHCs/Government Hospitals
 Assistance Counters in Network Hospitals.
 24 hour call centre Toll free line for this scheme.

11. Implementation

12. Financial Model
 Aarogyasri-I is funded by the tax revenue collected
by the State of Andhra Pradesh and
 Aarogyasri-II from the Chief Minister’s Relief Fund.
 The scheme’s financial model is cost effective.
 To prevent from fraudulent claims , the trust
reviews the settlement history of each hospital at
regular intervals.
 Insurer is selected through an open, competitive
bidding process.

13. Infrastructure and Manpower
• Aarogyamithras at PHC/CHC/Area Hospital 1861
• Aarogyamithras at Network Hospitals 1596
• Operations team (Preauth, Claims, Health Camps, Grievance etc.) 745
• Doctors (Preauth, Claims, Inspections etc.) 180
• Field officers 247
• Call Centre Executives 283
• Work Stations/Systems ( Computer, Servers) 625
• Bandwidth Usage : Internet 40 mbps
• Bandwidth Usage : MPLS 105 mbps
• Application Server ,Web server ,Data Base Server ,File
Server ,Back up server for Application server and Web
server ,Back up server for data base server,
Application server cluster ,Web server cluster 1 Each
• TCS Professionals 55

14. Network Hospital-Responsibilities
365 Hospitals empanelled
• Organize Health Camps once in a week.
• Separate Reception and Registration.
• Dedicated Medical Coordinator (RAMCO-Doctor), Camp
• Coordinator
• Free Transport to and from Mandal HQ for in-patient.
• Free food for in- patient
• Free consultation, diagnostics and treatment, irrespective of
surgery
• Cashless services
• Follow-up consultation and distribution of follow-up medicines
• provided by the Trust
• Provide Computer, Printer, Scanner, Digital camera , Webcam and
• 2mbps connectivity

18. Key Stakeholders
 Aarogyasri Healthcare Trust
 The Insurance Company
 Network Hospitals
 District Administration
 Aarogyamithras
 Software Company

19. Achievements
 Targeting a specific health sector
 Involvement of Private Sector
 Wide Coverage
 Quality Medical Infrastructure and Expertise
 Follow-up Services
 Cost Effectiveness
 Effective monitoring Mechanisms
 Impact on the Performance of Government Hospitals.

20. Reference
• www.aarogyasri.org.in
• www.google.com
• Some data from Ministry of Health and Family
Welfare Website.

21. THANK YOU