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Suvarna Arogya Suraksha

Health Scheme for the Poor


Objectives: To improve access of BPL families towards quality medical care for treatment of catastrophic illnesses involving hospitalization, surgery and therapies, through an identified network of Super Specialty care providers. The Scheme is envisaged to cover the following systemic diseases: Cardiovascular diseases Cancer Treatment a) Surgical Oncology b) Chemotherapy c) Radiation Oncology Neurological diseases Renal diseases Burns Poly trauma cases (Not covered by Motor vehicle insurance) Neo-Natal Beneficiaries: The scheme is intended to benefit below poverty line (BPL) families both in urban & rural areas of Karnataka in a phase wise manner. The pilot stage of the scheme will cover the following five Districts of Gulbarga Division: Bidar, Bellary, Gulbarga, Koppal & Raichur. Identification of these families will be based on BPL ration card issued by the Food and Civil Supplies Department, Government of Karnataka. The benefit will be restricted to only five members of a family. Benefit Package: Primarily, the Benefit Package will cover the identified tertiary care and catastrophic diseases that are not widely treatable in all Government Hospitals/ Institutions and are not covered under any other preexisting health programmes.
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Sum assured will be Rs.1,50,000/- on a family floater basis per year. Additional buffer of Rs.50,000/- per year for the entire family on a case to case basis will be available. Cashless Transaction: It is envisaged that for each hospitalization the transaction shall be cashless for covered procedures. Enrolled beneficiary will go to network hospital and come out without making any payment to the hospital subject to procedure provided under the Scheme. Pre-Existing Diseases: All diseases proposed under the Scheme shall be covered. A person suffering from any of the identified disease prior to the inception of the policy shall also be covered. Pre and Post Hospitalization: The package shall cover the entire cost of treatment of patient from the date of admission to his/her discharge from the Hospital and 10 days after discharge and complications while in hospital making the transaction truly cashless to the patient. Procedure for Enrollment of Hospitals: All the Public Hospitals (District Hospitals, Government/ Private Medical Colleges) and identified Private Hospitals/ Nursing Homes shall separately be empanelled. Private Hospitals/ Nursing Homes meaning, any institution in Karnataka established for in-patient surgical care and the Networked Hospital should comply with minimum criteria. Infrastructure and Manpower (General): Well equipped theatre Availability of trained paramedics Post-op facility with ventilator ICU care in concerned specialty Round the clock lab and imageology support Availability of specialists in support fields
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Quality of Services: Network Hospital agrees to provide separate and Free OPD consultation. However there will not be any discrimination to Suvarna Arogya Suraksha patients vis--vis other paying patients in regard to quality of services Network Hospital shall agree to provide free diagnostic tests and medical treatment required for beneficiaries irrespective of surgery. Memorandum of Understanding (MoU) between SAS Trust with Network Hospitals: MoU is between the SAST and Network Hospitals MoU is an agreement to provide services to pre-agreed set of benefit package and at pre-agreed PRICE. MoU will consist of pre-requisites including setting up of SAS Cell, Broadband Connectivity and using SAST web platform for all transaction processing Procedures will only be conducted on receipt of Pre-Authorization from Implementation Support Agency/ SAS Trust Claims Settlement: Suvarna Arogya Suraksha Trust shall settle the claims of the Hospitals within a set period of time after securitization and reviewed by the Trust, afterwards claims are duly processed by the Implementing Support Agency. Medical Camps: Health Camps will have to be conducted by Network Hospitals in predesignated areas and Districts. A fixed number of camps have to be held in the concerned districts in a year. They should ensure that free medical camp is conducted by each Network Hospital periodically at the place suggested by the Trust. The Network Hospitals must carry necessary screening equipment along with specialist and other Para-medical staff as suggested by the Trust. They should also work in close liaison with District Coordinator, District Health Officer in consultation with Deputy Commissioner.
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Hospitalization Period: The period for which the insured person is admitted in the hospital as inpatient and stays there for the sole purpose of receiving the necessary and reasonable treatment for the disease/ ailment contracted/ injuries sustained during the period of policy, the minimum period of stay shall be for at least 24 hours.