Dr YSR Aarogyasri Health Scheme is a flagship health insurance/health care scheme by the Government of Andhra Pradesh. It aims to provide free/cashless secondary and tertiary healthcare services to eligible poor / lower‑income families, reducing their out‑of‑pocket spending for serious illnesses. The scheme operates through empanelled (network) hospitals, and has a dedicated trust, the Dr. YSR Aarogyasri Health Care Trust, to manage enrolment, authorisation, and payments.
Key Features:
- Free/cashless treatment for serious ailments (including surgeries, specialty care) in approved hospitals.
- Coverage limit up to ₹5 lakh per family per annum on a floater basis.
- Services include hospitalisation, diagnostics, pre‑ and post‑hospitalisation elements for eligible treatments.
Who is Eligible For Dr YSR Aarogyasri Health Scheme:
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To get benefits under Dr YSR Aarogyasri Health Scheme, you must satisfy certain eligibility criteria. These are:
- Residency: Must be a resident of Andhra Pradesh.
- Income Limit: Total family annual income should be less than or equal to ₹5 lakh.
- Ration Card / Specific Cards: Holding a White Ration Card is a key eligibility marker. Also, families with certain welfare/beneficiary cards like YSR Pension Kanuka, Jagananna Vidya Deevena / Vasathi Deevena are included.
- Land & Property Ownership: Restrictions on land: for example, less than 12 acres of wetland or less than 35 acres of dry land, or combined wet + dry land below a threshold. Also, property area less than some limit (e.g., less than 3000 sq ft) in a municipal area.
- Vehicle/Assets: Only one personal car in the family is allowed.
- Employment/Income Tax Returns: Even private sector/contract / part‑time employees are eligible, as long as their income is under the threshold. Permanent government employees/pensioners may have a different status depending on the rules.
Documents Required For Dr YSR Aarogyasri Health Scheme:
To enrol and get the Dr YSR Aarogyasri Health Scheme card (or to use the scheme), you generally need:
- Aadhaar Card (or other valid identity proof) for you and family members.
- Address proof (could be voter ID, utility bill, or other documents).
- Income certificate/proof of annual income (to show under ₹5 lakh).
- White Ration Card (in many cases) or other equivalent welfare card.
- Property/land documents, if applicable (for verifying land ownership).
- Vehicle registration/proof that you own a car.
Sometimes, medical reports are applied to or used for a serious disease requiring hospitalisation.
How to Apply For Dr YSR Aarogyasri Health Scheme:
Unlike some schemes where you apply at a specific office, many of the steps for Dr YSR Aarogyasri Health Scheme are integrated into government systems; some are automatic for eligible beneficiaries, others require minimal action. Here’s the typical process:
Check your eligibility using the criteria above. If you are in the income bracket, have the required ration card/welfare card, property, etc., you likely qualify.
Obtain required documents: Aadhaar, income proof, ration card / other welfare card, address proof, and any property/land documents if needed.
Visit local enrolment/help desk / Aarogya Mitra / Vaidya Mitra:
- These desks are found in government hospitals, Primary Health Centres (PHCs), Community Health Centres (CHCs), and Area / District Hospitals.
- There is an Aarogya Mitra (or Vaidya Mitra) who helps with registration, filling forms, checking eligibility, and guiding you.
Fill out the application/enrolment form: This may be done offline at a health facility or through a government portal (Navasakam / Sachivalayam, etc.) if available.
Verification of the documents by concerned officials (hospital help desk or scheme office).
Issuance of the Aarogyasri Health Card (or acknowledgement / unique health ID): After verification, you receive the card/card number. Use this when you go for treatment.
Availing treatment: Once you have the card, you can go to any empanelled hospital. Show your Aarogyasri card/number at the Aarogya Mitra desk in the hospital; they will process your case. If needed, pre‑authorisation is taken. Treatment (for covered ailments) is given in a cashless manner.
What Is Covered in Dr YSR Aarogyasri Health Scheme:
Here are the benefits and what the scheme covers, along with limits:
- Financial coverage up to ₹5 lakh per family per year on a floater basis.
- Secondary and tertiary care: Serious treatments/surgeries (cardiac, cancer, etc.), specialty hospital care.
- Empanelled/network hospitals: Both government and private hospitals that are part of the scheme are included. Treatment is cashless in those hospitals.
- Pre‑ and post‑hospitalisation costs as permitted for certain procedures. (Depends on what is specified in the guidelines.)
- Follow‑ups for certain treatments and other support as specified.
Exclusions In Dr YSR Aarogyasri Health Scheme:
- Not all diseases or procedures may be covered; there is a list of approved/identified procedures. If your condition is not in the list, you may need to pay.
- Some asset/income/land/vehicle ownership criteria must be met; if you exceed, you may not qualify.
- The card/scheme works primarily through network hospitals; going to a non‑empanelled hospital may not give cashless benefits.
- For emergencies, the process might have special provisions. But verification and authorisation need to be followed.
How To Avail Treatment Under Dr YSR Aarogyasri Health Scheme:
Here’s how to use the scheme when you or a family member needs treatment:
- Get your Aarogyasri Health Card or the number.
- Identify an empanelled hospital offering the required treatment.
- Go to the hospital and check in at the Aarogya Mitra / Vaidya Mitra / Aarogyasri helpdesk.
- Present your card/card number and required proof. The hospital staff will verify your eligibility.
- If required, request pre‑authorisation through the scheme for the specific treatment/procedure.
- Once approved, receive the treatment without paying for eligible parts (cashless).
- After treatment and discharge, the hospital sends bills/claims to the Aarogyasri trust, which settles payment with the hospital.
FAQ:
Q. What is the income limit for Dr YSR Aarogyasri Health Scheme?
A. The family’s annual income must be ≤ ₹5 lakh to be eligible under current guidelines.
Q. Do I need to pay any premiums or fees to enrol?
A. Typically, no premium for eligible families. The scheme is government‑funded. You may need to produce some certificates/documents, but no regular premium is charged.
Q. What if I own more land/property than the limit? Am I excluded?
A. Yes, owning land above the prescribed limits (like 12 acres wet wetland or 35 acres dry land, etc.) or a property beyond a certain size in municipal areas may make you ineligible under those criteria. You may need to check with local authorities if there are any exceptions.
Q. Can I use treatment in any hospital outside my district?
A. Yes, you can get treatment in any empanelled hospital in Andhra Pradesh, even if it is in another district. The card is valid across the state.
Q. What if I forget to carry the Dr YSR Aarogyasri Health Scheme card when going to the hospital?
A. If you have the card number, that may suffice in many cases (the hospital desk may verify data in the system). In emergencies, there may be ways to verify via the Trust.
Q. How long does the hospital claim settlement take?
A. The government hospital/trust aims to settle bills with empanelled hospitals within a certain period after discharge. Earlier guidelines mentioned up to six months.
Q. Are follow‑ups and post‑hospitalisation costs covered?
A. Some post‑hospitalisation costs/follow-ups are covered for certain treatments, depending on the guidelines. But not all post‑discharge expenses may be included. It depends on whether the procedure is in the specified list and what the policy says.
Q. If I am a government employee or pensioner, can I avail benefits?
A. Government employees/pensioners may have different eligibility: many permanent government employees/pensioners may not be eligible if their income is above the threshold. The scheme’s guidelines exclude permanent government employees or pensioners whose incomes are higher.
Q. What if my disease/surgery is not listed among the identified procedures?
A. If it’s not on the list, the scheme may not provide cashless coverage; you may need to pay out of pocket, unless the Trust has made special provisions. It is always good to check whether your required procedure is empanelled under the scheme.
Q. How do I know which hospitals are empanelled under Dr YSR Aarogyasri Health Scheme?
A. You can get a list of empanelled hospitals by:
- Visiting the Dr YSR Aarogyasri Health Scheme Trust website or the official Andhra Pradesh government health portals.
- Ask at the Aarogya Mitra / Vaidya Mitra help desk in your nearest government hospital.
- Checking local block/district hospital offices, which usually display a list.