Aarogya Raksha Scheme: Eligibility, Benefits, and Coverage

Posted on: Dec 16, 2024 | 3 mins | Written by: HDFC ERGO Team

Aarogya Raksha Scheme: Eligibility, Benefits, and Coverage

Launched in 2017 by the Chief Minister of Andhra Pradesh, Shri N Chandrababu Naidu, the Aarogya Raksha Yojana is a health insurance scheme that aims to provide affordable healthcare to the residents of the state. The scheme particularly targets low-income families and covers a wide range of medical expenses, including hospitalisation, surgeries, follow-up treatments, and Ayurvedic remedies. Moreover, the beneficiaries can also avail of cashless treatment at network hospitals and save themselves from the hassles of paying bills upfront. The scheme particularly helps underserved communities access quality and timely medical services without the burden of high expenses. Let’s understand the Aarogya Raksha scheme in detail.

Key features and benefits of the Aarogya Raksha Yojana

The following are the key features and benefits of the scheme —

1. Comprehensive coverage

The scheme offers coverage for various medical expenses, including hospital bills, the cost of surgeries, Ayurvedic treatments, and critical illnesses. Additionally, Aarogya Raksha Yojana covers both pre- and post-hospitalisation expenses of the beneficiaries, thereby alleviating their financial burden.

2. Many empanelled hospitals

The scheme includes numerous empanelled hospitals, both government and private. In case of a medical emergency, beneficiaries can visit the nearest network hospital and receive timely treatment without worrying about the bills.

3. Coverage for numerous diseases

Aarogya Raksha Yojana covers a wide range of diseases and over 1050 treatments. Therefore, the chances of getting denied coverage for an ailment are rare.

4. Coverage for follow-up treatments

The scheme also covers follow-up treatments, such as check-ups, monitoring, and physiotherapy prescribed by the doctor to ensure recovery.

5. Ayurvedic treatment

Aarogya Raksha covers Ayurvedic treatment availed in empanelled hospitals or approved treatment centres.

6. Affordable premiums

The scheme provides health insurance at low premiums, making it accessible even to those living below the poverty line.

7. Cashless treatment

Beneficiaries can avail of cashless treatment at network or empanelled hospitals, so they don’t have to worry about settling the bills out of pocket. Their healthcare bills are directly settled by the insurance provider.

8. No-claim bonus

The scheme offers a no-claim bonus to beneficiaries for claim-free years. This bonus increases the sum insured by their policy and ensures better financial security during expensive medical procedures.

Pre-existing disease coverage for Aarogya Raksha Yojana

The Aarogya Raksha Yojana scheme also provides coverage for pre-existing diseases, but there may be certain conditions and waiting periods involved. The following are some points to keep in mind —

• The waiting period for pre-existing conditions is mostly 36 months, which means that the beneficiaries cannot claim insurance benefits for existing conditions immediately after joining the scheme.

• After 3 years of continuous coverage, beneficiaries can claim treatment for pre-existing conditions, subject to policy terms and coverage limits.

Aarogya Raksha premiums and beneficiaries

The Aarogya Raksha Yojana is like a family health insurance policy that covers the immediate family members under one plan. It is available in three different plans, each with varying premiums, coverage amounts, and beneficiary types. The sum insured under all three plans ranges from INR 1 lakh to INR 10 lakh. Therefore, depending on your needs and premium affordability, you can choose a coverage amount within this range.

1. Plan A

This plan is ideal for younger families or individuals in the early stages of their working life. The following are the details of Plan A under the scheme —

• Exit age: 35 years

• Coverage: The account holder, his/her spouse, and two dependent children

• Premium: Between INR 2,000 and INR 14,500 (depending on the coverage sum insured and other factors)

2. Plan B

Plan B is suitable for individuals in their mid-career or nearing retirement. The details of Plan B under the scheme are —

• Exit age: 70 years

• Coverage: The account holder, his/her spouse and two dependent children

• Premium: Between INR 3,000 and INR 25,500

3. Plan C

This plan offers comprehensive coverage to the entire family and its sum insured is higher. The following are the details of Plan C —

• Exit age: 70 years

• Coverage: The account holder, his/her spouse, two dependent children and dependent parents.

• Premium: Between INR 5,000 and INR 62,500

Eligibility criteria for Aarogya Raksha Yojana

The Aarogya Raksha Yojana is accessible to all families in Andhra Pradesh, both Above Poverty Line (APL) and Below Poverty Line (BPL). There are no specific income criteria for family eligibility.

Enrolment process for Aarogya Raksha Yojana

The enrolment process for Aarogya Raksha Yojana is straightforward and can be completed easily with the necessary documents. Registration for the scheme or renewal can be done through two methods —

1. Via the insurance company

Visit the website of your chosen insurance company and go to the Aarogya Raksha section. There, you will find the application forms for Aarogya Raksha. Complete the form with the required details and make the payment. Once done, the insurance provider will guide you on how to download your Aarogya Raksha Health Card.

2. At the local kiosk

To register at a local kiosk, carry your Aadhaar Card and the mobile phone linked to your Aadhaar. The kiosk operator will ask for your Aadhaar number and send you an OTP (one-time password). Share the OTP with the operator to complete the registration process. Once the registration is done, the operator will print your Aarogya Raksha Health Card.

You can also apply for this health insurance online through the Aarogya Raksha portal or the Aarogya Raksha mobile app. All you must do is choose the relevant plan, fill out the required details correctly, and make the payment through an available online payment option. After the payment, you will receive the confirmation and your Aarogya Raksha Health Card.

Required documents for Aarogya Raksha Yojana scheme

You must provide the following documents to register for the Aarogya Raksha Yojana scheme:

• Aadhaar Card

• Address Proof

In addition to these, you must have an active mobile number linked to your Aadhaar Card.

Exclusions under Aarogya Raksha Yojana

The Aarogya Raksha Yojana scheme has certain exclusions, meaning the insurer is not liable to cover these conditions and situations. The following are the exclusions of the scheme —

• Eyesight correction treatment or surgery

• Expenses of contact lenses, spectacles, or hearing aids

• Cosmetic or plastic surgery done for aesthetic purposes

• Dental surgery for aesthetic purposes

• Change in gender surgeries

• Cost of vaccination or inoculation, unless these are required to treat an animal bite or condition

• Medical expenses related to psychiatric and psychosomatic disorders

• Costs of vitamins and tonics, unless these are a part of the treatment and are prescribed by a certified healthcare practitioner

• Obesity treatment

• Suicide or attempted suicide

• Congenital abnormalities

• Venereal disease

• Infertility or sterility

• Medical expenses arising out of excessive use of intoxicating substances

• Expenses related to AIDS treatment

• Stem cell implantation or surgery

• Injuries sustained during the war

Steps to apply for Aarogya Raksha Health Card

The following are the steps to apply for Aarogya Raksha Health Card —

• Step 1 Visit the official website of the Aarogya Raksha Yojana, which is under Dr YSR Arogyasri Healthcare Trust.

• Step 2 Click on the Aarogya Raksha option and then on “Click here to enrol”.

• Step 3 Enter your Aadhaar Card Number in the box and click on the ‘Go’ option.

• Step 4 Enter the mobile number linked to your Aadhaar Card and click on “Send OTP”.

• Step 5 Enter the OTP correctly and click ‘Verify’ to confirm your details.

• Step 6 Select a family member and click on the “Download Health Card” option for the Aarogya Raksha card download.

Conclusion

Summing up, Aarogya Raksha UIIC is a wonderful government initiative providing health coverage to economically weaker sections of society in Andhra Pradesh. It provides comprehensive coverage for beneficiaries, along with a cashless facility. Like health insurance and critical illness insurance coverage, the Aarogya Raksha policy is valid for approximately one year and should be renewed on time to ensure continuous coverage. The scheme is a reliable and affordable option for those seeking quality healthcare without the financial burden.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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