Rajiv Gandhi Jeevandayee Health Cards

Report
(A Joint Venture between
Govt. of Maharashtra and TCS)
Rajiv Gandhi Jeevandayee Arogya Yojana
Agenda
1.
Objective of the scheme
2.
Beneficiaries.
3.
Benefits
4.
Health card
5.
Family and Sum insured
6.
Package Details
7.
Cashless Transaction
8.
Process at Health Cards by VLE
9.
Aarogyamitra and its Process Flow (Arogyamitra)
10.
Pre-Printed Stationary
11.
Role of SCA’s VLE.
12.
Role of Directorate of Health Services
13.
Commercials for Health Cards Service
14.
Business Potential for SCA’s
15.
Contact us for Beneficiary
(A Joint Venture between
Govt. of Maharashtra and TCS)
Objective of the Scheme
•To improve access of Below Poverty Line (BPL) and
Above Poverty Line (APL) families.
•To provide Quality health care for identified
specialty services requiring hospitalization for
surgeries through Network hospitals.
•Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY)
would be implemented throughout the state of
Maharashtra in phased manner for a period of 3
years.The insurance policy/coverage under the
RGJAY for the eligible beneficiary families
(A Joint Venture between
Govt. of Maharashtra and TCS)
Beneficiaries
•Families holding
- Yellow Ration cards (BPL Families)
- Orange Ration cards (APL Families)
- Antyodaya Anna Yojana card and
- Annapurna card
• The families with white ration card
holding would not be covered under
the scheme.
• The beneficiary families would be
identified through the “ Rajiv Gandhi
Jeevandayee Health Card ” issued by
the Government of Maharashtra or
based on the Yellow and Orange ration
card issued by Civil Supplies
Department.
(A Joint Venture between
Govt. of Maharashtra and TCS)
Benefits
(A Joint Venture between
Govt. of Maharashtra and TCS)
Scheme would provide 971 surgeries/therapies/procedures along with121 follow up
packages in following 30 identified specialized categories
Sr. No.
Specialized Categories
Sr.No.
Specialized Categories
1
GENERAL SURGERY
16
POLY TRAUMA
2
ENT SURGERY
17
PROSTHESES
3
OPHTHALMOLOGY SURGERY
18
CRITICAL CARE
4
GYNAECOLOGY AND OBSTETRICS SURGERY
19
GENERAL MEDICINE
5
ORTHOPEDIC SURGERY AND PROCEDURES
20
INFECTIOUS DISEASES
6
SURGICAL GASTRO ENTEROLOGY
21
PEDIATRICS MEDICAL MANAGEMENT
7
CARDIAC AND CARDIOTHORACIC SURGERY
22
CARDIOLOGY
8
PEDIATRIC SURGERY
23
NEPHROLOGY
9
GENITOURINARY SYSTEM
24
NEUROLOGY
10
NEUROSURGERY
25
PULMONOLOGY
11
SURGICAL ONCOLOGY
26
DERMATOLOGY
12
MEDICAL ONCOLOGY
27
RHEUMATOLOGY
13
RADIATION ONCOLOGY
28
ENDOCRINOLOGY
14
PLASTIC SURGERY
29
GASTROENTEROLOGY
15
BURNS
30
INTERVENTIONAL RADIOLOGY
Health Cards
•
“ Rajiv Gandhi Jeevandayee Health
Cards ” will be issued to families
based on Yellow, Orange Ration
cards, Antyodaya Anna Yojana ,
Annapurna cards.
•
Health Cards will be used for
identification of Beneficiary in the
family under the Scheme.
•
Family Health Cards will be
prepared by using data from valid
Yellow or orange ration cards
coupled with Aadhaar numbers
issued by UID authorities
(A Joint Venture between
Govt. of Maharashtra and TCS)
Family and Sum Insured
•
•
•
•
Family means members as listed on the Rajiv
Gandhi Jeevandayee Arogya Yojana Health
Cards or holding valid Orange/Yellow Ration
Card
The Scheme shall provide coverage for meeting
all expenses relating to hospitalization of
beneficiary up to Rs.1,50,000/- per family per
year in any of the Empanelled Hospital subject
to Package Rates on cashless basis through
Health cards or valid Orange/Yellow Ration
Card.
The benefit shall be available to each and every
member of the family on floater basis i.e. the
total annual coverage of Rs.1.5 lakh can be
availed by one individual or collectively by all
members of the family.
Coverage up to INR 2, 50,000/- (for renal
transplants).
(A Joint Venture between
Govt. of Maharashtra and TCS)
Package details
The package rates will include
•
•
•
•
•
•
•
•
•
•
•
Bed charges in General ward,
Nursing and boarding charges,
Surgeons, Anesthetists,
Medical Practitioner, Consultants fees,
Anesthesia, Blood, Oxygen,
O.T. Charges,
Cost of Surgical Appliances,
Medicines and Drugs,
Cost of Prosthetic Devices, Implants, XRay and Diagnostic Tests,
Food to inpatient,
One time transport cost by State
Transport or second class rail fare (from
Hospital to residence of patient only)
(A Joint Venture between
Govt. of Maharashtra and TCS)
Cashless Transaction
• Transaction shall be cashless for
covered procedures at Network
hospitals.
• Beneficiary will go to hospital and
come out without making payment
to the hospital.
• When the beneficiary visits the
selected Empanelled hospital and
services of selected Empanelled
hospital should be made available
• The facility of cross referral to
nearest another Empanelled hospital
is to be made available
• Aarogyamitra will also provide the
beneficiary with the list of nearby
Empanelled hospitals.
(A Joint Venture between
Govt. of Maharashtra and TCS)
(A Joint Venture between
Govt. of Maharashtra and TCS)
Beneficiaries
will visit CSC
along with their
valid and
eligible Ration
cards
CSC VLE will
search Health Card
through
MahaOnline Portal
by any one method
from four options.
CSC VLE will
verify the details
as per the ration
card and asking
the beneficiaries
accordingly.
VLE will print
valid info on
pre-printed
stationary
provided to
VLE at free.
Aarogyamitra
• A friend and guide for patient
• Registration & Enrollment
• Counseling the patient
• Creating Awareness
• Assuring patients interest
• Help patient to avail the benefit
of the scheme
(A Joint Venture between
Govt. of Maharashtra and TCS)
Process Flow (Arogyamitra)
(A Joint Venture between
Govt. of Maharashtra and TCS)
Pre-Printed Stationary
• VLE will receive Pre-Printed stationary
from RGJAY society absolutely free, in
bunch of 500 Blank Health Cards.
• These Pre-Printed stationary will be
available to VLE at Taluka Health
Officer(THO) at taluka level.
• VLE will have to visit them with their VLE
identity proof, and collect Pre-Printed
stationary.
(A Joint Venture between
Govt. of Maharashtra and TCS)
Role of SCA’s VLE
•
SCA’s VLE will receive Pre-Printed stationary from RGJAY
society absolutely free.
•
SCA’s VLE will search the health cards through given 4
search option (Personal Details/Ration Card No/UID
No/Village Data).
•
SCA’s VLE will have confirm the details with the
beneficiary, along with the name of family manbers.
•
SCA’s VLE then print it on Pre-Printed stationary and
handover it to beneficiary.
•
SCA’s VLE should provide this services absolutely free and
should not charge any ₹ to beneficiary.
•
SCA’ VLE will be paid by Government of Maharashtra
RGJAY for each card printing, hence should not charge to
beneficiary.
•
SCA’s will generate INVOICE on No. of card printed and
forward it to Maha-Online, and received amount in 10
working days.
(A Joint Venture between
Govt. of Maharashtra and TCS)
Role of Directorate of Health Services
• DHS- Directorate of Health Services will
also ensuing printing of cards where
connectivity is low or No-Connectivity
through EXE file.
• DHS- Directorate of Health Services will
delivery the Pre-Printed Stationary via
Taluka Health Officer to VLE.
• DHS- Directorate of Health Services will
distribute Health cards at the location
where internet connectivity is low or no
existence of any VLE.
(A Joint Venture between
Govt. of Maharashtra and TCS)
Commercials for Health Cards Service
(A Joint Venture between
Govt. of Maharashtra and TCS)
Business Potential for SCA’s
Name of
SCA's
SCA's
Division
Name
Amravati
CMS
CMS
Aurangabad
Konkan
SPANCO
SPANCO
Pune
MOL
MOL
Nagpur
Basix
Basix
Nashik
Grand Total
Sum of Imported
Head of the Family
Count
14,96,712
(A Joint Venture between
Govt. of Maharashtra and TCS)
Total Count
Business
Potential (₹)
46,11,104
23,05,552
51,66,867
25,83,,433
23,09,434
11,54,717
31,14,392
13,78,319
37,88,548
19,42,325
23,09,434
1,40,29,730
Business Potential for SCA’s
Sr.
Division
District
1
Yavatmal (510)
2
Buldhana (500)
Amravati
3
Washim (502)
4
Akola (501)
5
Aurangabad (515)
6
Beed (523)
7
Latur (524)
8
Aurangabad
9
Osmanabad (525)
Parbhani (513)
10
Jalna (514)
11
Hingoli (512)
12
Nashik (516)
13
14
Nashik
Jalgaon (499)
Nandurbar (497)
Imported Head of
the Family Count
4,87,260
4,67,176
2,76,842
2,65,434
7,24,247
6,46,092
4,37,039
3,80,042
3,40,628
3,37,492
2,48,852
11,07,229
8,83,144
3,19,061
(A Joint Venture between
Govt. of Maharashtra and TCS)
Sr.
Division
15
16
District
Thane (517)
Konkan
Ratnagari (528)
17
Sindudurge (529)
18
Pune (521)
19
Kolhapur (530)
Pune
20
Satara (527)
21
Sangli (531)
22
Nagpur (505)
23
Chandrapur (509)
Nagpur
24
Wardha (504)
25
Gondia (507)
Imported Head of
the Family Count
7,43,974
4,08,465
2,25,880
16,88,508
8,16,200
6,50,951
6,32,889
9,93,104
4,52,391
2,59,260
2,37,570
Contact us for Beneficiary
•
For any assistance VLE should guide the
beneficiary and it’s family members with below
contact details.
Help-Line No: 18002332200
155388
email:
website : www.jeevandayee.gov.in
(A Joint Venture between
Govt. of Maharashtra and TCS)
(A Joint Venture between
Govt. of Maharashtra and TCS)

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