Aarogya Raksha: Eligibility, Coverage, Benefits

Aarogya Raksha literally translates to ‘the protection of health’, “Aarogya” means health and “Raksha” translates to protection. The aim of this health insurance scheme is to provide quality health care services to one and all, irrespective of the income group they belong to. In this article, we will take a look at the details about Aarogya Raksha health insurance plan.

What is Aarogya Raksha?

Aarogyaraksha is a health insurance scheme launched by Andhra Pradesh Chief Minister N Chandrababu Naidu on 1st January 2017. The aim of NTR Aarogya Raksha is to provide health insurance coverage for everyone. Thus, Aarogya Raksha covers both – Below Poverty Line and Above Poverty Line families.

Features and Benefits of Aarogya Raksha:

Arogya Raksha is a one-of-a-kind health insurance scheme that facilitates beneficiaries to avail quality health care.

Arogya Raksha Policy Features:

• Cashless Facilities : The beneficiaries of Aarogyaraksha do not have to worry about paying for the entire cost of a medical emergency. This scheme provides cashless facilities across empanelled hospitals.

• Numerous Empanelled Hospitals: One of the most advantageous features of the scheme is both – government and private hospitals are empanelled under the plan. This is highly beneficial for the patient as he/she can spend less time in travelling during a medical emergency and treatment can begin sooner.

Arogya Raksha Benefits:

• Large Scope of Coverage: A wide range of diseases is covered with Aarogya Raksha. This includes more than 1059 treatments. This mitigates the chances of a patient being denied treatment for a particular ailment.

• Coverage For Follow-up Treatments: This is a unique feature that is available with the Aarogya Raksha scheme. It provides coverage for follow-up treatments as these can cost a large sum of money to the patient and his/her family.

• Ayurvedic Treatment Coverage: If a beneficiary wishes to avail Ayurvedic treatment in a Government Hospital, it will be covered under the scheme. Treatment availed in any Quality Council of India/National Accreditation Board on Health accredited hospital is covered.

Arogya Raksha Premium and Beneficiaries:

Aarogya Raksha is available in three plans based on the number of beneficiaries covered. The sum insured of the plan ranges from Rs. 1 lakh to 10 lakhs. Here are the details:

1. Plan A: The exit age of this plan is 35 years and covers the account holder, two dependent children, and a spouse. The premium of this plan is between Rs. 2000 to 14500. 

2. Plan B: The exit age of this plan is 70 years and covers the account holder, two dependent children, and a spouse. The premium of this plan is between Rs. 3000 to 25500. 

3. Plan C: The exit age of this plan is 70 years and covers the account holder, two dependent children, dependent parents, and a spouse. The premium of this plan is between Rs. 5000 to 62500.

What is Not Covered?

Situations that are not covered under an insurance policy are called Exclusions. An insurance company is not liable to pay the policyholder for exclusions. In case a claim is still being raised for such exclusions, it will be rejected. Here are the exclusions of the Aarogya Raksha health scheme:

• Cost of vaccination or inoculation unless required as a treatment after an animal bite

• Plastic or cosmetic surgery unless required as a result of an accident. A cosmetic surgery done for aesthetic purposes without an accidental injury is not covered.

• Change of gender surgeries

• Eyesight correction 

• Expenses related to spectacles, contact lenses, or hearing aids

• Dental surgery is required as a result of an accident. A dental treatment done for aesthetic purposes without an accidental injury is not covered.

• Obesity treatment

• Expenses related to psychiatric and psychosomatic disorders

• Attempted suicide

• Suicide

• Infertility or sterility

• Venereal disease

• Congenital anomalies

• Expenses related to medical treatment arising out of excessive use of intoxicating substances

• Expenses related to the treatment of AIDS

• Cost of vitamins and tonics unless prescribed by a certified medical professional as a part of treatment

• Stem Cell implantation/surgery

• Injuries due to war

Eligibility Criteria of Aarogya Raksha:

All Above Poverty Line (APL) and Below Poverty Line (BPL) families belonging to Andhra Pradesh are eligible to enrol under this health scheme. There are no criteria set on the minimum income of a family.

Documents Required:

Irrespective of the method of registration the beneficiary will require the following documents along with an active contact number that is linked to the Aadhaar card:

• Aadhaar card

• Address proof

Also, check: Arogya Sanjeevani Health Insurance

How to Enrol for Aarogya Raksha?

The enrolment process of Aarogya Raksha Scheme, is fairly easy. New registration or renewal can be done quickly with the right set of documents. The registration process can be done in two ways – from the insurance company or by visiting the local kiosk. Following are the details of both:

How to Register as New beneficiary in Aarogya Raksha?

You can register as a new beneficiary in the following two ways:

1. From an insurance company: Visit your preferred insurance company’s website (for example United India Insurance Co. Ltd) and navigate to the Aarogya Raksha webpage. You will see the Aarogya Raksha Application Forms. Fill out the details and complete the process by making payment. Your insurer will now guide you on downloading Aarogya Raksha Health Card.

2. By visiting the local kiosk: You need to carry your Aadhaar card and an active cell phone which is linked to the Aadhaar card. These will help the kiosk operator to complete your registration process. The operator will ask for your Aadhaar number and then you will receive the One Time Password. Please share this OTP with the Kiosk operator. The operator will print your Aarogya Raksha health card after the registration process is complete.

Procedure for Applying for Aarogya Raksha Health Card:

Note that you will require a printer for printing the Aarogya Raksha Health Card. Here are the steps to download your health card:

• Step 1: Visit Dr.YSR Aarogyasri Healthcare Trust’s official website

• Step 2: Click on Aarogya Raksha button

• Step 3: Click on ‘Click here to enrol’

• Step 4: Enter your Aadhaar number in the box and click ‘Go’

• Step 5: Enter Mobile number and click on ‘Send OTP’

• Step 6: Enter OTP and click on ‘Verify’

• Step 7: Select a family member and click on ‘Download Health Card’

Claim Process of Aarogya Raksha:

A claim against Aarogyaraksha policy can be made in the following two ways. The government has made sure that a claim will be settled in a smooth and quick manner irrespective of its type.

1. Cashless Claims: The beneficiary of this scheme must avail treatment from a network hospital only if he/she wishes to file cashless claims. Network hospitals are those health care facilities that are pre-approved to provide cashless treatment to the beneficiaries of Aarogyaraksha insurance. The beneficiary will receive a list of network hospitals for reference. Before starting treatment, the TPA will provide approval and cashless claims can be registered. The beneficiary then needs to pay only the excess amount, if any.

2. Reimbursement Claim: This is a type of claim where the beneficiary pays for the entire cost of treatment and then approaches the insurer for reimbursement. This claim can be availed at any hospital irrespective of its empanelment. A reimbursement claim is beneficial in a situation where the beneficiary has adequate financial aid and wishes to visit a hospital of his/her choice.

Note that the beneficiary or family members need to intimate the TPA within 24 hours of hospitalization. They should acquire documents like prescriptions, discharge summary, reports and bills, receipts, etc. for the purpose of filing a reimbursement claim.

Claim for Follow-up Treatment:

A follow-up treatment is cashless for the beneficiary, however, hospitals need to send the following information to the insurance company to avail a claim settlement:

• Submission of proof for follow-up services once in three months

• Consultation details

• Investigation reports

• List of medicines prescribed/given

• Acknowledgement of medicines from patients

• Photographs show that the patient has Acknowledged the given medicines

• Scanned copies of bills and diagnostic tests

• Name and code number of the disease as per the package list that the patient is given treatment for 

Aarogya Raksha Claim Forms are available to the beneficiaries of the scheme. Please fill all the details correctly and in block letters as the form will be used for claim settlement.

How to Check Aarogya Raksha Claim Status?

Aarogya Raksha Claim Status can be checked either by calling the customer care number for the plan or by directly getting in touch with the TPA/insurance company.

How to Renew Aarogya Raksha Using Indian Bank Account?

The Aarogyaraksha policy is valid for approximately one year depending on the date of enrolment. Take a look at the following renewal details:

• The process of Arogya Raksha renewal can be done during the last 30 days of the policy period and not before that

• This process can be completed between 6 AM and 9 PM. 

• INDIAN BANK account number is required to view or renew the existing policy

• To pay for the Arogya Raksha Policy, a beneficiary can use INDIAN BANK net-banking facility

Aarogya Raksha Hospital List:

Many health care facilities form a part of NTR Arogya Raksha Hospitals. Visiting an empanelled hospital allows a patient to avail cashless facilities and faster claims. Aarogya Raksha Hospitals are either government affiliations or private hospitals. Here are the names of empanelled hospitals:

Government Hospital:

The complete Aarogya Raksha hospital list of Government hospitals is available here.

Private Hospital:

The complete Aarogya Raksha hospital list of private hospitals is available here.

Aarogya Raksha Follow Up Packages:

A medical contingency can be divided into various parts. One of these parts is follow-up treatment. Without proper follow-up, treatment can prove to be less useful. Considering this fact, the Aarogya Raksha scheme includes cashless follow-ups for certain treatments. Here are the details:

1. The expenses related to diagnostic tests, consultation, medicines, etc. are covered under Aarogyaraksha.

2. Cashless follow-up treatment begins from 11th day after discharge from the hospital. A patient covered under Aarogya Raksha benefits can continue to receive follow-up services until one year.

3. It is not required to raise a separate claim for availing follow-up treatment

4. The follow-up packages are divided into four parts corresponding to four quarters of one year. More amount is dedicated to the first quarter as comparatively more follow-up is required during this time after hospitalization.

5. These treatments are facilitated by MEDCO along with VAIDYAMITHRA

The cost for each follow-up package can be viewed by visiting the official website of Aarogya Raksha. You can also use the follow-up registration form to keep track of treatment and visits.

Also, read: Health Insurance for COVID-19

Aarogya Raksha Toll-Free Number and Address:

The Dr.YSR Aarogyasri Health Care Trust is very active in terms of grievances and queries. Here are the details of their contact information.

Aarogya Raksha Toll-Free Number:

1800-599-1111

You can also call 104 to get all your health queries resolved. It works PAN India

Contact Number:

0863 – 2222802 / 2259861

Aarogya Raksha Address:

• D.No. 25-16-116/B, Chuttugunta,

• Behind Gautam’s Hero Showroom,

• Guntur – 522004.

• Andhra Pradesh

• India

For Grievances related to Aarogya Raksha, you can use the following details:

• Contact number: 8333817424/23/20/07 (Office Timings)

• Extension: 0863-2259861 (Ext:326)

• Email address: [email protected]

In case you have queries related to Medical Reimbursement Status and Issues, use these details:

• Contact number: 8333817363

• Extension: 0863-2259861 (Ext:329)

• Email address: [email protected]

Frequently Asked Questions:

Here are few question and answers about Aarogya Raksha

What is the waiting period of Arogya Raksha health insurance for pre-existing diseases?

The beneficiary needs to renew the plan at least 2 times before availing benefits for any pre-existing disease. Thus, the waiting period for the pre-existing disease is 48 months.

What is the waiting period for availing coverage under the Arogya Raksha policy?

The beneficiary needs to wait for 30 days before availing any coverage under the scheme.

When can the beneficiary be covered for Cataract under the scheme?

The beneficiary of Arogya Raksha can avail treatment for Cataract after 24 months of continuous coverage.

What is the maximum sum insured offered under Aarogya Raksha?

The Aarogya Raksha policy offers a sum insured between Rs 1 lakh to 10 lakhs depending on the type of plan chosen - Plan A offers 1 lakh, Plan B offers up to 5 lakhs, and Plan C offers up to 10 lakhs sum insured.

Does Aarogya Raksha cover hospitalisation charges?

Yes, the policy provides coverage for hospitalisation expenses, including room charges, nursing charges, operation theatre, medicines, etc., for treatments that are covered. Cashless facilities are available at network hospitals.

What are the eligibility criteria to enrol under the Aarogya Raksha scheme?

All families belonging to Andhra Pradesh - both Above the Poverty Line (APL) and Below the Poverty Line (BPL) are eligible to purchase the Aarogya Raksha policy. There is no minimum income criterion.

What documents do I need to provide to apply for the Aarogya Raksha policy?

The documents required are - an Aadhar card, proof of address, and an active cell phone number linked to the Aadhar card. For APL families - relevant income documents may be needed.

How can I check the hospitals empanelled under Aarogya Raksha in my city?

You can check the list of network hospitals providing cashless facilities under Aarogya Raksha on the official website. Both government hospitals and private hospitals are part of the network.

Can I call any toll-free number to get more details on Aarogya Raksha benefits?

Yes, you can call 1800-599-1111, the toll-free number, for any queries on Aarogya Raksha or related to availing treatment benefits. You can also call the 104 helpline.

Can I avail cashless facility for treatment under Aarogya Raksha?

Yes, a cashless facility for hospitalisation is available at any of the empanelled network hospitals under Aarogya Raksha if prior approval is received from the insurer before admission.

Is Aarogya Raksha health insurance only for people Below the Poverty Line (BPL)?

No, the Aarogya Raksha policy can be purchased by any family residing in Andhra Pradesh, including middle-income Above Poverty Line (APL) households apart from BPL families.

Does the Aarogya Raksha policy cover consumables and diagnostics?

Yes, expenses incurred on medicines, consumables, diagnostic tests, etc., during hospitalisation are covered under the policy provided they relate to treatments/surgeries covered.

What is the procedure to raise a reimbursement claim under Aarogya Raksha after hospitalisation?

In order to claim reimbursement of expenses incurred on covered treatments, you need to inform the insurer within 24 hours of hospitalisation. After discharge, you must then submit all documents - bills, invoices, discharge summary, test reports, etc. A duly filled claim form also needs to be submitted. The claim will be processed and reimbursed as per policy terms and conditions.

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