Rajiv Gandhi Jeevandayee Arogya Yojana

Agenda Objective of the scheme Beneficiaries. Benefits Health card Family and Sum insured Package Details Cashless Transaction Process at Health Cards by VLE Aarogyamitra and its Process Flow (Arogyamitra) Pre-Printed Stationary Role of SCA’s VLE. Role of Directorate of Health Services Commercials for Health Cards Service Business Potential for SCA’s Contact us for Beneficiary

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

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.

Benefits Scheme would provide 971 surgeries/therapies/procedures along with121 follow up packages in following 30 identified specialized categories Sr. No. Specialized Categories Sr.No. 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

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).

The package rates will include 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, 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)

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.

Process at Health Cards by VLE Beneficiaries will visit CSC along with their valid and eligible Ration cards CSC 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.

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

Process Flow (Arogyamitra)

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.

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.

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.

Commercials for Health Cards Service

Business Potential for SCA’s Name of SCA's SCA's Division Name Sum of Imported Head of the Family Count Total Count Business Potential (₹) CMS Amravati 14,96,712 46,11,104 23,05,552 Aurangabad 31,14,392 SPANCO Konkan 13,78,319 51,66,867 25,83,,433 Pune 37,88,548 MOL Nagpur 19,42,325   Basix Nashik 23,09,434 11,54,717 Grand Total 1,40,29,730

Imported Head of the Family Count Business Potential for SCA’s Sr. Division District Imported Head of the Family Count 1 Amravati Yavatmal (510) 4,87,260 15 Konkan Thane (517) 7,43,974 2 Buldhana (500) 4,67,176 16 Ratnagari (528) 4,08,465 3 Washim (502) 2,76,842 17 Sindudurge (529) 2,25,880 4 Akola (501) 2,65,434 18 Pune Pune (521) 16,88,508 5 Aurangabad Aurangabad (515) 7,24,247 19 Kolhapur (530) 8,16,200 6 Beed (523) 6,46,092 20 Satara (527) 6,50,951 7 Latur (524) 4,37,039 21 Sangli (531) 6,32,889 8 Osmanabad (525) 3,80,042 22 Nagpur Nagpur (505) 9,93,104 9 Parbhani (513) 3,40,628 23 Chandrapur (509) 4,52,391 10 Jalna (514) 3,37,492 24 Wardha (504) 2,59,260 11 Hingoli (512) 2,48,852 25 Gondia (507) 2,37,570 12 Nashik Nashik (516) 11,07,229   13 Jalgaon (499) 8,83,144 14 Nandurbar (497) 3,19,061

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

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