The Indian state of Andhra Pradesh is situated in the south-eastern region of the country. Tirupati temple is one of the most popular tourist attractions of this coastal state. It has a mixed demographic of rich and poor, however, most families fall in low-income groups. One of the major challenges here is access to quality healthcare services. To combat this situation, the state government has introduced one of the most successful health plans – Dr. YSR Aarogyasri. It mainly caters to the medical needs of families that are not financially well equipped.

Dr YSR Aarogyasri By Government Of Andhra Pradesh: Eligibility, Coverage, Benefits - Acko

What is Dr YSR Aarogyasri?

The YSR Aarogyasri Scheme is a health insurance programme that was launched by the State Government of Andhra Pradesh by the then chief minister Dr Y S Rajasekhar Reddy in the year 2007. Currently, this scheme is administered by the Aarogyasri Health Care Trust. It allows low-income families to access good-quality health care services without spending money.

Features And Benefits of AP YSR Aarogyasri Scheme 2020?

Dr.YSR Aarogyasri health insurance scheme is highly beneficial for availing quality health care services in the states of Andhra Pradesh and Telangana. Here are the features and benefits of the plan:

  • Hospitalization (In-patient care): All the diseases that are listed under the programme and require hospitalization are covered.
  • Out-Patient Treatment: These treatments can be availed at health camps and in the network hospitals in a cashless manner.
  • Cashless Services: The beneficiaries of the plan have access to a financial cover of Rs. 5 Lakh per year per family. It can be used by any registered family member when they need medical attention.
  • Coverage For Pre-existing Diseases: A coverage for diseases that a beneficiary might already suffer from before registering under the scheme, is provided under this plan. This feature is not common among commercial health insurance plans.
  • Coverage For Follow-up treatments: A decent chunk of money is required for completing follow-up procedures after hospitalization. Such treatments are also covered under the Dr YSR Aarogyasri scheme.
  • Family-floater Health Insurance Cover: The whole family can make use of the allotted sum insured in these types of health insurance plans. One does not have to buy a separate plan for each member.

Treatments Covered Under YSR Aarogyasri Scheme (Inclusions):

Numerous treatments that range from simple medical procedures to special critical care treatments are covered under Dr YSR Aarogyasri scheme. Broadly, treatment for kidney failure, neurosurgical disease, cancer, heart disease that require hospitalization, etc. can be availed in a cashless manner in an empaneled hospital under this scheme. Here is a partial list of treatments for your reference:

  • General Surgery
  • ENT Surgery
  • Ophthalmology
  • Gynaecology & Obstetrics
  • Orthopedic Surgery And Procedures
  • Surgical Gastroenterology
  • Cardiothoracic Surgery
  • Paediatric Surgeries
  • Genitourinary Surgeries
  • Neuro Surgery
  • Surgical Oncology
  • Medical Oncology
  • Radiation Oncology
  • Plastic Surgery
  • Polytrauma
  • Prostheses
  • Critical Care
  • General Medicine
  • Infectious Diseases
  • Paediatrics
  • Cardiology
  • Nephrology
  • Neurology
  • Pulmonology
  • Dermatology
  • Rheumatology
  • Endocrinology
  • GastroEnterology
  • Psychiatry

Here is the complete list of treatments offered under Dr YSR Aarogyasri scheme.

What Is Not Covered?

Certain procedures are not included under the Dr YSR Aarogyasri scheme. These are called the exclusions of the scheme. Here is a list of treatments that are excluded from the scheme. The beneficiary will have to bear the cost of medical procedures in these cases:

  • Knee replacement surgeries
  • Gamma-knife procedures in neurosurgery
  • Medical treatment related to bone marrow
  • Leprosy
  • Filaria
  • Assisted devices for cardiac failures
  • Cardiac and liver transplantations
  • Malaria
  • HIV/AIDS
  • Tuberculosis
  • Infectious diseases
  • Gastroenteritis
  • Jaundice
  • Etcetera

Eligibility For YSR Aarogyasri Scheme:

The eligibility criteria for enrolling under Dr YSR Aarogyasri scheme are pretty straightforward. Families that are native to Andhra Pradesh and Telangana are allowed to enrol under the scheme. The annual income of a family should be below Rs. 5 Lakh. They should also be white ration cardholders. Aarogyasri Eligibility is also extended to members of the Antodaya Anna Yojana.

Also, read: Arogya Sanjeevani Health Insurance

How To Enroll In YSR Aarogyasri Scheme?

All eligible persons should reach the enrolment centre with the required documents (mentioned below) to complete the process. After verification of documents, the beneficiaries will receive the YSR Aarogyasri health card. This card can be used to avail cashless treatments. It is also possible to login to the Aarogyasri portal with the help of Login ID and Password. A beneficiary should visit the nearest MeeSeva centre to acquire the credentials. Various details related to the scheme can be accessed by logging in to the portal.

For direct registration, a beneficiary can use the following first point of contact:

  1. Vaidya Mitra counters at Primary Health Care (PHC)
  2. Health Camp organized by the PHCs or Network Hospital (NWH)
  3. Direct registration at an NWH via referrals
  4. Referral from Certified Medical Compliance Officer (CMCO)

Documents Required to Apply YSR Aarogyasri Scheme:

The following documents will be required at the time of enrolment 

YSR Aarogyasri Card:

The eligible families that enrol under Dr YSR Aarogyasri scheme receive the YSR Aarogyasri Health Card. This health card gives access to cashless medical facilities across empaneled hospitals in the states of Andhra Pradesh and Telangana. It contains a unique card number, a photograph of the cardholder, and other details related to the beneficiary. The YSR Aarogyasri Health Card also acts as proof of enrolment under the scheme at the time of a medical emergency.

YSR Aarogyasri Health Card Status Checking Process:

YSR Aarogyasri Health Card Status can be checked with the help of YSRAHCT i.e. YSR Health Care Trust’s mobile application. You can get in touch with the customer care centre using the helpline number in case user data is not available on the application. Employees and pensioners can check their health card status by visiting this webpage.

How To Download Aarogyasri App?

Various details related to Dr YSR Aarogyasri Yojana can be accessed with an online application. The Aarogyasri App download can be completed with the help of Play Store for Android devices. Here are the steps to download the application: 

  • Step 1: Open “Google Play Store” on your Android phone
  • Step 2: Search for “Aarogyasri Trust”
  • Step 3: Click on “Install”

Now you can now use various features of the Aarogyasri App.

Telangana Aarogyasri Programme Vs. Aayushman Bharat Yojana:

According to a leading publication house – Telangana Today, Dr YSR Aarogyasri is more beneficial as compared to the Aayushman Bharat Yojana which was introduced PAN India. Here is a comparison based on various factors related to both the health insurance schemes:

  1. Sum Insured: While the Dr YSR Aarogyasri Scheme offers Rs. 2 to 13 Lakh as the sum insured, the figure offered by Aayushman Bharat Yojana is set at Rs. 5 Lakh.
  1. Eligibility: The eligibility criteria is the major difference when it comes to why Dr. YSR Aarogyasri Yojana is more beneficial as compared to Aayushman Bharat Yojana (ABY). The eligibility for ABY is based on the Socio-Economic Caste Census (SECC) data. A lot of families would have been left out if Dr YSR Aarogyasri Yojana was to consider only SECC data.
  1. Implementation: The state government is far more experienced in terms of Dr YSR Aarogyasri Yojana as it has been running the scheme through highs and lows over 10+ years. The scheme has evolved after facing difficulties during the formation of Telangana. On the other hand, Aayushman Bharat Yojana is a fairly young project. Not a lot of families that need proper health care are enrolled under the scheme yet.

Andhra Pradesh Government’s Dr YSR Aarogyasri COVID-19 Coverage:

The COVID-19 pandemic has claimed thousands of lives around the world. This is a serious health condition that adversely affects the respiratory system of a person. He/she may have symptoms like dry cough, breathing problems, fever, etc. COVID-19 is also highly contagious and the patients are kept in quarantine. Considering this health condition, 15 new procedures are included in the Dr YSR Aarogyasri scheme. Here is a list of those treatments:

  1. Intensive care management of Septic Shock
  2. Medical Management of Acute Bronchitis with Pneumonia and Respiratory Failure
  3. Medical Management of Acute Respiratory Failure (With Ventilator)
  4. Medical Management of Acute Respiratory Failure (Without Ventilator)
  5. Medical Management of Acute Severe Asthma With Acute Respiratory Failure
  6. Medical Management of ARDS
  7. Medical Management of ARDS with DIC (Blood & Blood Products) (D65)
  8. Medical Management of ARDS with DIC (Blood & Blood Products) (D65) in Paediatrics
  9. Medical Management of ARDS with Multi-Organ failure (R65.1)
  10. Medical Management Of ARDS with multi-organ Failure in Paediatrics
  11. Medical Management of Confirmed COVID – 19 (Stable)
  12. Medical Management of Confirmed of COVID – 19 with Comorbidities – HTN, DM, COPD, HIV, Chr. Liver Disease, Chr. Renal Disease
  13. Medical Management of COPD with Respiratory Failure (Infective Exacerbation)
  14. Medical Management of Pneumonias
  15. Medical Management of suspected COVID – 19 (Stable)

Also, check: Corona Kavach and Corona Rakshak Insurance for COVID-19

How To Claim The YSR Aarogyasri Scheme?

The claim process of this scheme has become smooth due to the active functioning of the Dr. YSR Aarogyasri portal. The claim process for beneficiaries and hospitals is explained below:

Claim Process For Beneficiaries:

Unlike commercial health insurance, the beneficiaries of Dr.YSR Aarogyasri scheme do not have to carry out a lengthy claim process while availing medical treatment. Beneficiaries are given YSR Aarogyasri Health Cards at the time of enrolment. All they have to do, to avail treatment at an empaneled hospital is to give the health card to a Vaidya Mitra. He/she will collect the details present on the card and the treatment can start.

If a beneficiary does not have a physical card, he/she can pass on the YSR Aarogyasri Health Card number to the Vaidya Mitra. It would be a wise move to click a picture of the health card. In a rare case where no proof is available confirming that a patient is a beneficiary of the Dr.YSR Aarogyasri scheme, the details can be gathered by getting in touch with Aarogyasri Trust.

Claim Process For Hospitals:

The hospital should seek pre-authorization in case of planned surgical treatments. A claim can be fulfilled by the Dr.YSR Aarogyasri healthcare trust only if the following conditions are met by the hospital authorities:

  • The hospitals have pre-authorization for performing a treatment that is included in the list of approved treatments
  • The claim is intimated as early as possible
  • The claim amount is within the pre-authorization limit 
  • Photographic evidence of treatment is available for the settlement of claim

All claims are settled with the help of Dr.YSR Aarogyasri portal. This portal can also be used for the collection of claim documents, claim intimation, scrutiny of claim documents, etc. After a claim is received the following verifications are carried out:

  • Identity of the patient
  • Evidence of treatment
  • Claim amount in sync with the pre-authorized amount
  • Case management as per the pre-authorization

Dr.YSR Aarogyasri Health Care Trust Hospital List:

Many hospitals are empaneled under Dr YSR Aarogyasri Healthcare Trust. An empaneled hospital can offer cashless treatments to the beneficiaries in the time of a medical emergency. Here is a list of hospitals that offer treatment under Dr YSR Aarogyasri scheme:

Hospital NameArea
Aditya MultiCare HospitalVisakhapatnam
Amrutha Heart HospitalPrakasam
Apollo Drdo HospitalsRanga Reddy
Chandra Mohan’s Nursing HomeChittoor
Dr YSR Memorial HospitalsAnantapur
Gk HospitalAdilabad
Gowri Gopal Hospitals Pvt LtdKurnool
Indur Cancer HospitalNizamabad
Kamineni Institute Of Medical SciencesNalgonda
M N HospitalGuntur
Narayana Medical College HospitalNellore
Pushpagiri Eye HospitalVizianagaram
Pushpagiri Eye InstituteHyderabad
Raju Neuro And Multispeciality Hospital Private LimitedEast Godavari
Sentini Hospitals Private LimitedKrishna
Shree Balaji Multi Speciality HospitalMedak
Sindhura HospitalsSrikakulam
Sri Ram Kidney Infertility And Laparoscopic CentreKhammam
Sushruta Cancer HospitalKarimnagar
Susrutha Peoples HospitalMahabubnagar

Check here for the complete list of hospitals that are empaneled to Dr YSR Aarogyasri scheme.

Inclusion Of New Procedures At Government General Hospitals:

One of the biggest advantages of this health insurance scheme is that many new medical procedures are included in the list of coverages. This is helpful for the beneficiaries as they can now avail treatments like dengue haemorrhagic fever, plastic surgery for facial burns, rheumatic heart disease in children, acute hepatitis, etc. Here is a list for your reference:

ProcedureCode
Superficial Parotidectomy(Non-malignant)26.31
Laparoscopic HemiThyroidectomy06.2.2
Laparoscopic Surgical treatment for Epigastric Hernia repair with Mesh53.63 
Laparoscopic Surgical treatment for Duodenal Perforation44.42.1
Excision of Meckel’s Diverticulum45.33.1 
Rectovaginal fistula Management without Colostomy70.73.2
Rectopexy Open with Mesh for Rectal Prolapse48.75.1
Myringoplasty19.4.1 
Septorhinoplasty 21.84
Exenteration of Orbit16.5
Glaucoma Surgery 12.54.1 
Joint reconstruction/intra articular fractures81.96
Bone tumor surgery reconstruction with internal fixation(78.59)77.8
Coronary Balloon Angioplasty with Drug eluting stent(00.45)00.66.5 
Surgical management of Empyema Thoracis33.32 
Lumbar Hernia repair In Paediatric Patients53.9.2
Excision of Ureterocele with Ureteric Implantation56.41 
Open radical Prostatectomy60.5.2
Bladder neck reconstruction for Incontinence57.91.2 
Chemotherapy for Breast Cancer with Docetaxel 99.25.72

The complete list of new treatments included under Dr.YSR Aarogyasri scheme can be accessed here.

Also, read: Benefits of Buying Health Insurance Policy Online

Dr.YSR Aarogyasri Health Care Trust Toll-Free/Helpline Number And Address:

The Dr.YSR Aarogyasri Health Care Trust can be easily contacted by beneficiaries in case of any queries. Use the following contact details for the same:

Aarogyasri Helpline Number: 

  • 1800-599-1111
  • PAN India helpline number 104 can also be used to get a resolution for your queries.

Contact Number:

  • 0863 – 2222802 / 2259861

Dr.YSR Aarogyasri Address: 

  • D.No. 25-16-116/B, Chuttugunta,
  • Behind Gautam’s Hero Showroom,
  • Guntur – 522004.
  • Andhra Pradesh
  • India

Details for grievance resolution related to Dr.YSR Aarogyasri:

  • Contact number: 8333817424/23/20/07 (Office Timings)
  • Extension: 0863-2259861 (Ext:326)
  • Email address: [email protected]

Contact details related to medical reimbursement status and issues:

  • Contact number: 8333817363
  • Extension: 0863-2259861 (Ext:329)
  • Email address: [email protected]

Frequently Asked Questions:

Do I need to pay a premium for availing the Dr.YSR Aarogyasri health insurance scheme?

No, the premium for this scheme is borne by the Government of Andhra Pradesh. This makes it a highly beneficial health insurance programme.

Whom should I approach when I reach the hospital at the time of a medical emergency?

You should approach a Vaidya Mitra during a medical emergency. He/she will be located at a Kiosk in the hospital. Vaidya Mitra will help you through each step of hospitalization and claim.

What is a Network Hospital?

Network Hospital is any registered health care institution that is empaneled to provide services under Dr YSR Aarogyasri scheme.

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