CHIEF MINISTER AROGYA ARUNACHAL YOJANA
Toll Free Number: 1800 233 5558

SALIENT FEATURES

  • Unit of Enrolment: A family will be the unit of enrolment and head of family can be either the husband or wife. Every family figuring in defined SECC Database will be entitled to claim benefit under the Ayushman Bharat-National Health Protection Mission.
  • Sum Assured: The schemes provide coverage for meeting expenses of hospitalization and surgical procedures of members of beneficiary family upto Rs 5 Lacs per family per year with capping of benefits for Secondary ailments at Rs 1 Lac per family per year and Rs 4 lacs per family per year for high cost tertiary ailments.
  • Benefits: The benefits to be provided on a cashless basis to the beneficiaries up to the limit of their annual coverage, package charges on specific procedures and subject to other terms and conditions outlined herein, are the following:
    • 1.  Risk Cover (RC) will include hospitalization / treatment expenses coverage including treatment for medical conditions and diseases requiring secondary and tertiary level of medical and surgical care treatment and follow up care along with cost for pre and post-hospitalization treatment as defined.
    • 2.  Pre-existing conditions/diseases are covered.
    • 3.  Benefit Package under the Risk Cover to be provided on a cashless basis up to the limit of their annual coverage and includes:
      • o Hospitalization expense benefits
      • o Follow-up care benefits
      • o Pre and post hospitalization expense benefits
      • o For the purpose of Hospitalization expenses as package rates shall include all the costs associated with the treatment, amongst other things:
        • 01.  Registration charges.
        • 02.  Bed charges (General Ward).
        • 03.  Nursing and boarding charges.
        • 04.  Surgeons, Anaesthetists, Medical Practitioner, Consultants fees etc.
        • 05.  Anaesthesia, Blood Transfusion, Oxygen, O.T. Charges, Cost of Surgical Appliances etc.
        • 06.  Medicines and drugs.
        • 07.  Cost of prosthetic devices, implants etc.
        • 08.  Pathology and radiology tests: radiology to include but not be limited to X-ray, MRI, CT Scan, etc.
        • 09.  Diagnosis and Tests, etc
        • 10.  Food to patient.
        • 11.  Pre and Post Hospitalisation expenses: Expenses incurred for consultation, diagnostic tests and medicines before the admission of the patient in the same hospital and cost of diagnostic tests and medicines and up to 10 days of the discharge from the hospital for the same ailment/ surgery.
        • 12.  Any other expenses related to the treatment of the patient in the hospital.
  • There will be approved list of procedures in the 23 specialties listed below:
    • #  Cardiology
    • #  Cardio-thoracic Surgery
    • #  Cardio-Vascular Surgery
    • #  Ophthalmology
    • #  ENT
    • #  Orthopedics
    • #  Poly trauma
    • #  Urology
    • #  Obstetrics & Gynaecology
    • #  General Surgery
    • #  Neuro-Surgery
    • #  Interventional Neuro-Radiology
    • #  Plastic and Reconstructive
    • #  Burns Management
    • #  Oral and Maxillofacial Surgery
    • #  Paediatrics Medical Management
    • #  Neo- Natal
    • #  Paediatrics Cancer
    • #  Paediatrics Surgery
    • #  Medical Packages
    • #  Oncology
    • #  Emergency Room Packages (Care requiring less than 12 hrs stay)
    • #  Mental Disorders Package