Schemes
 
 
  VAJPAYEE AROGYASHREE
  YESHASWINI
  RSBY (RASTRYA SWASTYA BHIMA YOJANA)

 

JANANI SHISHU SURAKSHA YOJANE
  SUVARNA AROGYA CHAITHANYA YOJANE
  CGHS (CENTRAL GOVERNMENT HEALTH SCHEME)
 

Dr.G.Y. Nagaraj (Insurance Implementing Officer/ consultant)
Former Joint Director, KHSDRP Department of health &family welfare, Gok
State programme officer for health insurance & PPP.
Implementing of universal health insurance scheme in the early later the present Vajpayee arogyashree scheme has been prepared TOR & other documents for effective implementation.
Under PPP state wide mobile health clinic’s & citizen help desks in various hospitals having 150 beds & above

 

VAJPAYEE AROGYSHREE SCHEME (VAS) :- FOR BPL CARD HOLDERS
VAS scheme is empanelled by SAST on 24/05/2013.

 
  • Since then the BPL Beneficiaries utilizing the surgical 447 procedures out of which our super specialty hospital (PMSSY) have been empanelled for various specialties like Cardiology, Neurosurgery, Plastic surgery, Pediatric surgery.
  • The details will be available on website : www.sast.gov.in
  • Till date about 75 beneficiaries have been enrolled
  • Till date 47 claims have been approved by SAST the total amount is15,92,000/-(Fifteen Lakhs Ninety Two Thousand Rupees Only) out of which 1,59,200 TDS have been detected .Hence the total amount credited to PMSSY SB account Bank Of Maharashtra city market branch rupees 14,34,800 (Fourteen Lakhs Thirty Four Thousand Eight Hundred Rupees Only )
  • All the beneficiaries having BPL card will be verified by Aarogyamithra(AM) & VAMCO in online
  • For all the beneficiaries, preauthorization approval has been taken before surgery from SAST.
  • Photo of the patient will be taken at the time of admission & counseling done before surgery has to be recorded along with VAMCO/AM & sent for preauth /claims settlements
  • In case of emergency cases we will take emergency approval from SAST
  • For preauthorization approval from SAST we have to upload all the documents pertaining to the benefit package, after validation by ISA IMPLEMENTING SUPPORT AGENCY (AHRL) it will be approved by SAST
  • Then the beneficiary will be conducted surgical procedures as per procedure code
  • At the time of discharge, Photo of the patient with post operative scar & discharge photo along with discharge card & TA amount along with VAMCO/AM is taken
  • After discharge of the patient within 15 days we have to submit all the Procedure claim documents like Xerox copy of Case sheet, typed copy of OT Notes, Discharge Summary, Procedure final Bill ,consolidated bill details, final bill, Feedback obtained from the beneficiary & also original investigation reports like MRI, CT scan, check X-ray & blood investigations etc will be submitted for the claim settlement to AHRL then finally SAST will approve the claims
  • Then the SAST will approve package amount according to the approved procedure code & claims
  • Then the same amount will be credited to our saving bank account :-Bank of Maharashtra, city market branch through ECS


YESHASHWINI :-
CO OPERATIVE FARMERS HEALTH CARE SCHEME

 
  • Yeshasvini scheme was empanelled to PMSSY-SSH by Health Insurance on 08/10/2012
  • Since then Yeshasvini beneficiaries utilizing the surgical of 805 procedures out of which our super specialty hospital (PMSSY) have been empanelled for various specialties like Cardiology, Neurosurgery, Plastic Gastro Enter logy and Pediatric surgery………….
  • The details will be available on web site:- www.MDINDIA.networx.com
  • Till date about 37 beneficiaries have been enrolled
  • Till date 36 beneficiaries have been approved by MDINDIA Ltd the total amount is Rs 5, 49,500/-(Five Lakh Forty Nine Thousand Rupees Only) has been credited to PMSSY SB account Bank Of Maharashtra City Market Branch, Fort Bangalore-02
  • All the beneficiaries having yeshasvini card with receipt will be verified by coordinator in the online
  • For preauthorization approval from MDINDIA we have to upload all the documents pertaining to the benefit package, after validation by ISA (IMPLEMENTING SUPPORT AGENCY it will be approved by MDINDIA
  • Photo of the patient has to be taken at the time of admission and before surgery for the approval.
  • For all the beneficiaries, preauthorization approval has been taken before surgery from MD INDIA(ISA)
  • In case of emergency we will take the emergency approval from MD India
  • Then the beneficiary will be conducted surgical procedures as per procedure code
  • After the discharge of the patient within 10 days we have to submit all the documents to MDindia for claim settlements. we should enclose all the documents pertaining to the surgery like yeshasvini ID, Premium receipt, admission receipt, approval copy, preauthorization copy, OT notes, Anesthesia notes and all investigations report related to the surgery.
  • After validation by MDINDIA claim settlement will be approved by yeshasvini c framers health care trust, package amount will be credited to the hospital SB account to the Bank Of Maharashtra, K.R market Branch, Bangalore through ECS.

 

CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) :-
FOR EMPLOYEES & RETIRED EMPLOYEES OF CENTRAL GOVERNMENT

 
  • The CGHS Central Government Health Scheme was empanelled to PMSSYSSH on 23/01/2013.
  • Since then CGHS Beneficiaries utilizing the services of various specialties like Cardiology, Neurosurgery, Plastic surgery, Gastro Enter logy and Pediatric surgery………….
  • The details will be available on website :www.mohfw.nic.in,cghsnew/index.asp
  • Till date about 13 beneficiaries have utilized the services at PMSSY-SSH
  • All the CGHS pensioner beneficiaries & serving employees are eligible for the treatment for cashless but they should produce employment ID card & referral slip from the CGHS health dispensaries later on we will claim the amount.
  • Till date 11 claims have been approved by CGHS the amount is Rs. 13,654/- out of this only 11,658/- and remaining 480/- will be done shortly.
  • Firstly we should take reference slip from the beneficiaries and the ID card and then they should register at OPD
  • They should approach the Insurance Wing to get signed and sealed from the insurance department and they can approach the concern specialist for the treatment.
  • After getting the treatment they should submit the Xerox copies for the concern document for the claim.
  • We should prepare the bill for the CGHS beneficiaries and take the signed from the hospital authority and we have to submit the claim to CGHS Department that is to Additional Director, 3rd Floor, E Wing, Kendriya Sadan, Kormanagala and Bangalore.
  • So within a month the claim amount will be credited to hospital SB account, Bank of Maharashtra, Bangalore

 

RASHTRIYA SWASTHYA BIMA YOJANA (RSBY)
UNORGANIZED SECTOR WORKERS BELONGING TO BPL CATEGORY

 
  • Rashtriya Swarthy Bima Yojana was empanelled to our hospital on 26/08/2013
  • The total number of patients with treatment done and given is 2 to till date
  • Totally 2 patients have been benefited from this hospital with the amount of Rs.25000/-
  • Two patients need to be approved and it will be credited to Bank of Maharashtra, City market Branch, Bangalore.
  • At present the scheme is stopped by central government and again it will be started by the month of February 2014


JANANI SHISHU SURAKSHA KARYAKRAMA (PROGRAME) :
PREGNANT WOMEN & NEW BORN CHILD WITHIN 1 YEAR

 
  • Under NRHM program all antenatal cases essentional services will be given for pre natal ,natal & post natal treatment
  • Also services will be given for new born babies up to 1 year for all BPL ,APL card holders, SC & ST free off cost

 

SUVARNA AROGYA CHAITANYA SCHEME:
SERVICES GIVEN TO ALL SUNDENTS STUDYING FROM FISRT TO TENTH STANDARDS IN GOVERNMENT, AIDED & UNAIDED SCHOOL
 
  • All the students are subjected to health checkups by the concerned PHC doctors if they detect any serious health problems (like Heart, Kidney , Eyes & Orthopedics ) they should refer to major hospitals with referral slip ,it should be counter signed by the concerned district surgeon then treatment will be given free off coast at super specialty hospital for the treatment.
 
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Bangalore Medical College and Research Institute Super Speciality Hospital , Bangalore - 560002, Karnataka, India
Phone: 091-080-2670 5883, Fax: 091-080-2670 5883, E-Mail: pmssysshospital@gmail.com
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