2Agenda Objective of the scheme Beneficiaries. Benefits Health card Family and Sum insuredPackage DetailsCashless TransactionProcess at Health Cards by VLEAarogyamitra and its Process Flow (Arogyamitra)Pre-Printed StationaryRole of SCA’s VLE.Role of Directorate of Health ServicesCommercials for Health Cards ServiceBusiness Potential for SCA’sContact us for Beneficiary
3Objective 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
4Beneficiaries Families holding - Yellow Ration cards (BPL Families) - Orange Ration cards (APL Families)- Antyodaya Anna Yojana card and- Annapurna cardThe 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.
5BenefitsScheme would provide 971 surgeries/therapies/procedures along with121 follow up packages in following 30 identified specialized categoriesSr. No.Specialized CategoriesSr.No.1GENERAL SURGERY16POLY TRAUMA2ENT SURGERY17PROSTHESES3OPHTHALMOLOGY SURGERY18CRITICAL CARE4GYNAECOLOGY AND OBSTETRICS SURGERY19GENERAL MEDICINE5ORTHOPEDIC SURGERY AND PROCEDURES20INFECTIOUS DISEASES6SURGICAL GASTRO ENTEROLOGY21PEDIATRICS MEDICAL MANAGEMENT7CARDIAC AND CARDIOTHORACIC SURGERY22CARDIOLOGY8PEDIATRIC SURGERY23NEPHROLOGY9GENITOURINARY SYSTEM24NEUROLOGY10NEUROSURGERY25PULMONOLOGY11SURGICAL ONCOLOGY26DERMATOLOGY12MEDICAL ONCOLOGY27RHEUMATOLOGY13RADIATION ONCOLOGY28ENDOCRINOLOGY14PLASTIC SURGERY29GASTROENTEROLOGY15BURNS30INTERVENTIONAL RADIOLOGY
6Health 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
7Family and Sum InsuredFamily means members as listed on the Rajiv Gandhi Jeevandayee Arogya Yojana Health Cards or holding valid Orange/Yellow Ration CardThe 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).
8The package rates will include Package detailsThe package rates will includeBed 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, X-Ray 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)
9Cashless TransactionTransaction 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 availableThe facility of cross referral to nearest another Empanelled hospital is to be made availableAarogyamitra will also provide the beneficiary with the list of nearby Empanelled hospitals.
10Process at Health Cards by VLE Beneficiaries will visit CSC along with their valid and eligible Ration cardsCSC VLE will verify the details as per the ration card and asking the beneficiaries accordingly.CSC VLE will search Health Card through MahaOnline Portal by any one method from four options.VLE will print valid info on pre-printed stationary provided to VLE at free.
11Aarogyamitra A friend and guide for patient Registration & Enrollment Counseling the patientCreating AwarenessAssuring patients interestHelp patient to avail the benefit of the scheme
13Pre-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.
14Role of SCA’s VLESCA’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.
15Role 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.
17Business Potential for SCA’s Name of SCA'sSCA'sDivision NameSum of Imported Head of the Family CountTotal CountBusiness Potential (₹)CMSAmravati14,96,71246,11,10423,05,552Aurangabad31,14,392SPANCOKonkan13,78,31951,66,86725,83,,433Pune37,88,548MOLNagpur19,42,325BasixNashik23,09,43411,54,717Grand Total1,40,29,730
18Imported Head of the Family Count Business Potential for SCA’sSr.DivisionDistrictImported Head of the Family Count1AmravatiYavatmal (510)4,87,26015KonkanThane (517)7,43,9742Buldhana (500)4,67,17616Ratnagari (528)4,08,4653Washim (502)2,76,84217Sindudurge (529)2,25,8804Akola (501)2,65,43418PunePune (521)16,88,5085AurangabadAurangabad (515)7,24,24719Kolhapur (530)8,16,2006Beed (523)6,46,09220Satara (527)6,50,9517Latur (524)4,37,03921Sangli (531)6,32,8898Osmanabad (525)3,80,04222NagpurNagpur (505)9,93,1049Parbhani (513)3,40,62823Chandrapur (509)4,52,39110Jalna (514)3,37,49224Wardha (504)2,59,26011Hingoli (512)2,48,85225Gondia (507)2,37,57012NashikNashik (516)11,07,22913Jalgaon (499)8,83,14414Nandurbar (497)3,19,061
19Contact us for Beneficiary For any assistance VLE should guide the beneficiary and it’s family members with below contact details.Help-Line No:155388website :