Dr.Nandamuri Taraka Rama Rao Vaidya Seva Health Insurance Scheme (Dr NTR Vaidya Seva Health Insurance Scheme) is sponsored by Govt. of AP.
This scheme is implemented in PPP model of Health Insurance and is shaped basing on the health needs of poor patients and provides cashless services for identified diseases under secondary and tertiary care through a network of service providers from Government and private sector.
Towards achievement of universal health coverage for BPL families whether defined in terms of financial protection or access to and effective use of health care.
- Members of Below Poverty Line (BPL) families’ having White Ration Card linked with Adhar card and available in Civil Supplies Department database will fall under this scheme.
- The scheme shall provide coverage for the services to the beneficiaries up to Rs.2.50 lakh per family per annum on floater basis. There shall be no co-payment under this scheme.
- Beneficiary will get primary care through free screening and outpatient consultation both in the health camps and in the network hospitals and coverage for the 1044 “Listed Therapies” for identified diseases in the 29 categories.
For list of diseases http://www.ntrvaidyaseva.ap.gov.in/web/guest/current-procedures
- End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a “listed therapies”.
- Free OP evaluation of patients for listed therapies who may not undergo treatment for “listed therapies”.
- All the pre-existing cases under listed therapies are covered under the scheme.
- Food and Transportation.
- Follow-up services for a period of one year through fixed packages to the patients whoever requires long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up package for consultation, investigations, drugs etc., for one year for listed therapies were formulated by Technical committee of the Trust in consultation with specialists.
Stakeholders in the scheme
- Beneficiaries of the scheme
- Vaidya Seva Health Care Trust
- Network Hospitals
- District Administration
- Software Company
- A beneficiary suffering from an ailment will approach ‘first point of contact’ for registration under the scheme. Biometric registration of the patient while registering online for the first time in a network hospital
First point of Contact are
- Vaidyamithra counters at PHC.
- At the NWH in case of emergencies or through referral from CMCO centers(104 and 108 services)
- Health Camp organized by the PHCs or NWHs
In case of emergency, patient should be admitted by a NWH and treated immediately. MEDCO or treating doctor shall obtain emergency telephonic pre-authrorisation through dedicated round the clock telephone lines of the Trust
- After initial scrutiny of the patient. The patient may be evaluated as an out-patient. After diagnosis and finalizing treatment mode if necessary will admitted and converted as “in-patient” in the online workflow.
- If the patient is found to be suffering from listed therapies, MEDCO shall submit the pre-authorization through the Trust portal within 24 hours.
If the patient is found to be suffering from diseases other than listed therapies, he shall be counseled and referred to nearest Govt. Hospital for further management.
- The NWH shall render complete treatment to the patient after obtaining pre-authorization.
- The NWH shall provide end to end cashless services within the package. However NWH may apply for enhancement of the package price in case of exigencies prior to discharge as per Trust guidelines.
- After complete recovery of the patient, NWH shall issue discharge summary, 10 days post-discharge medication, counsel the patient for follow-up.
- A letter of satisfactory services should be obtained from the beneficiary at the time of discharge by NWH
- The patient is reimbursed transport charges as per the scheme norms and obtains receipt.
- Follow-up Patient shall be provided follow-up services as per the standard medical norms duly counseling and recording the same in the discharge summary.
- The NWH will raise the claim after the 10 days of satisfactory discharge of the patient.
For other guideline click here
Source:-NTR vaidya seva