Phase 1 a success, health insurance for poor to now cover entire state
A total of 50 lakh families in eight districts have availed benefits of the Rajiv Gandhi Jeevandayi health insurance scheme implemented by the state from July last year.
“A total of 22,100 surgeries worth Rs 59 crore have been conducted and the actual amount paid by the insurance company to the hospitals is Rs 38 crore,” Health Minister Suresh Shetty told The Indian Express.
He said efforts were now under way to extend the scheme to all parts of the state in the second phase.
The limited coverage of diseases and the income limit to avail the usual insurance schemes being restrictive were among the reasons for introducing the scheme for below poverty line and above poverty line families. The scheme implemented last year in collaboration with the National Insurance Company covers heart diseases, renal transplant, brain and spinal cord diseases as well as cancer.
The scheme has been introduced to provide cashless medical facilities to families coming under BPL and APL categories. Valid yellow and orange card holders will be included in the scheme under which patients can get admitted, operated upon and discharged without paying any money.
The entire premium per year per family is paid by the government and the sum insured is Rs 1.5 lakh per family.
“We will conduct health camps by the 147 empanelled hospitals to bring the beneficiaries into the system,” Shetty said.
A total of 972 procedures have been identified along with 121 follow-up packages in 30 specialised categories.
Under the system, several Arogyamitras and other facilitators will be appointed to assist the beneficiaries.
Health officials pointed out that the beneficiaries would have to approach the primary health centre or rural or district hospitals from where they would be referred under the scheme for preliminary diagnosis and basic tests. The pre-authorisation request is sent to the insurance company, which is required to approve it within 12 hours if all conditions are met. Under the scheme, the Rajiv Gandhi Jeevandayee Arogya Yojana Society will pay the insurance premium in installments on behalf of the insured beneficiary families to the insurance company.
In case of renal transplants, the immuno-suppressive therapy is required for a period of one year and here the upper ceiling for renal transplant has been kept at Rs 2.5 lakh.
At present, eight districts of Gadchiroli, Amravati, Nanded, Solapur, Dhule, Raigad, Mumbai and Mumbai (suburban) are implementing the scheme. In Pune, patients from outside the city are being treated under the scheme at Sassoon general hospital. However, the scheme is yet to be made fully functional for beneficiaries in Pune district.