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The Government of Karnataka has approved a Health Assurance Scheme vide Government order G.O. No. Akuka 343 CGE 2013, Bangalore, dated 23-11-2013, specially designed for the Above Poverty Line(APL), named “Rajiv Arogya Bahagya ”
Objectives :
To provide quality “Tertiary Health Care” for treatment of catastrophic illnesses involving hospitalization, surgery, and other therapies through an identified Network of Superspeciality Hospitals.
Coverage :
The “APL card holders” who are willing to make co-payment are eligible under “Rajiv Arogya Bhagya” Scheme". The beneficiaries possessing APL cards issued by the Food and Civil Supplies Department, GoK are valid beneficiaries.
Scheme Design :
The scheme shall get implemented in an “Assurance Mode” with a component of “Co-payment” payable by the APL beneficiary to the “Empanelled Network Treating Hospital”; in addition to the financial assurance by the Government through Suvarna Arogya Suraksha Trust, which shall be limited to Rs. 1.5 lakhs, also “on a sharing basis”; per household per year, wherein any one member or more than one member of the family can avail the treatment within the prescribed financial limit.
The scheme shall also allow a buffer of Rs. 50,000/-, which shall get sanctioned at the discretion of the Executive Director, Suvarna Arogya Suraksha Trust, primarily on the advice of the committee of doctors of Suvarna Arogya Suraksha Trust; on a case to case basis, demanding such excess sanction in circumstances extraordinaire.
Benefit Packages :
The scheme covers Tertiary treatment under 7 broad specialities viz Cardiology (includes cardiothoracic surgery, cardiovascular surgery and other cardiac procedures), Neurosurgery (includes Cranial, Spinal and peripheral neurosurgical procedures), Genitourinary Surgeries (includes renal and congenital genital malformations), Oncology (medical, surgical and radiation), Paediatric Surgeries (includes neonatal procedures), Polytrauma (includes injury with associated multi-organ involvement) and Burns (includes electrical shocks and scalds). It consists of “663 surgical procedures” pertains to and falls within the broad specialty groups stated above.
Co Payment Mechanism :
For General Ward :– The “Basic Package Rate” alone is admissible and it is shared between the Suvarna Arogya Suraksha Trust and the Beneficiary in the ratio of 70% : 30% and these warders are not entitled for any upgraded services.
For Semi-private and Private Wards :- The Hospitals shall “declare” their package rates which is termed as ‘Total Package Rate’; which shall be valid for a period of one year from the date of empanelment/renewal. The Suvarna Arogya Suraksha Trust shall be liable to pay 50% of the “Basic Package Rate” and the other 50% of “it”, along with the remaining balance portion of the ‘Total Package Rate” is liable to be “co-paid” by the Beneficiary to the Network Hospital.
