Assam
Atal Amrit Abhiyan Scheme
Main benefit
1.
Can you get this scheme?
Conditions at a glance
- Family income up to ₹5 lakh a year
- Has a BPL / Antyodaya card
About
The scheme "Atal Amrit Abhiyan Scheme” is a flagship scheme of the Government of Assam to provide cashless treatment and coverage of critical care targeted at the Below Poverty Line (BPL) population and Low-Income households. To address this key vulnerability faced by the BPL population and Low-Income households in the State, the Government of Assam has launched the health assurance scheme "Atal Amrit Abhiyan Scheme” which aims at making treatment more affordable and also to limit the disastrous financial impact that households often experience due to out of pocket spending. Under this scheme, treatment beneï¬ts up to ₹2.00 lakhs per individual annually towards approved procedures on a complete cashless basis is given. Beneficiaries can avail of cashless treatment under the scheme in the empanelled Government/Private Hospitals in six critical care specialities. Six specialities are-
1. Cancer
2. Heart disease
3. Kidney disease
4. Neurological disorder
5. Neonatal diseases
6. Burns
Vistarita Atal Amrit Abhiyan specialities are-
1. ICU Packages
2. Trauma
3. Critical Care Paediatrics
4. Paediatric Surgery
5. Japanese Encephalitis and Acute Encephalitic Syndrome
6. Supplementary Procedure (Bone Marrow Transplantation is also covered under AAA)Hospitals:
Hospitals, public, trust, and private-within and outside the state, have been empanelled under the Scheme. Empanelled hospitals are the only hospitals where the beneficiary is entitled to free cashless treatment (up to the eligible amount) under the Scheme.
Note 01: The Scheme is being implemented through one Implementation Support Agency (ISA) named Medi Assist Insurance TPA Pvt. Ltd., selected and engaged for the purpose.
Note 02: Each individual adult member of the eligible families will be enrolled for the purpose through the ISA and will be issued a laminated ID card having a unique identification number to facilitate a cashless treatment facility at the empanelled hospitals. Children below 18 years of age will be enrolled with the head of the family.
Benefits
- 1. The scheme will provide inpatient treatment facilities at the empanelled hospitals (Private and Public) up to a maximum limit of ₹2.00 lakh per individual member per annum within and outside the State of Assam covering 438 procedures.
- 2. The six diseases such as cardiovascular diseases, Cancer, Renal (Kidney) diseases, Neo-natal diseases, Neurological conditions & Burns will be covered under the scheme.
- 3. Cashless treatment and coverage of critical care targeted at the Below Poverty Line (BPL) population and Low-Income households.
- 4. The enrolled beneficiary is to be treated or can be admitted without making any payment to the hospital.
- 5. There will be no pre-existing condition exclusions. Pre-existing diseases are also covered from day one which means that any illness existing prior to the inception of the scheme shall also be covered.
- 6. The travel expenses of visiting people, treatment, and the daily allowance are also covered in this scheme.
- 7. For out of State treatment in empanelled hospitals in selected cities, patients and one attendant will be provided economy cheapest airfare on that route.
Who can apply
- The individual should be a permanent resident of Assam.
- All individuals from Below Poverty Line (BPL) families (up to an annual income of ₹ 1.2 lakhs) are eligible to enroll and avail of the benefits under this Scheme.
- All families (with annual income between ₹1.2 and ₹5 lakhs) are also eligible to enroll and avail of the benefits under this Scheme.
- The individual should possess a ration card issued by the Government of Assam under the National Food Security Act.
Documents needed
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How to apply
Offline
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Applicant can visit the official website and download the application form: https://nhm.assam.gov.in/schemes/detail/atal-amrit-abhiyan-0
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Fill out the application form completely and visit the nearest enrolment center. (All beneficiaries must be physically present at the enrollment center)
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The Verifying Officer scrutinizes all documents and verifies eligibility.
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Other than BPL family members receive a uniquely numbered challan for depositing the premium into the designated bank account.
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After verification (and payment of challan when applicable), the Operator takes a photograph of and also captures the fingerprints of each beneficiary.
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The operator issues the unique Atal Amrit Abhiyan Card (AAA ID card) along with the scheme hand-out to beneficiaries. Note 01: Enrollment under the scheme is totally free for members of the BPL families. Note 02: Members of other families having an annual family income of ₹5 lakhs or less are required to pay a nominal amount of ₹ 100/- per individual at the time of enrolment. Every year at the time of the yearly renewal ₹100 will be charged from such family members. Steps to be followed for availing treatment by beneficiaries In the empaneled Hospitals:
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Beneficiaries approach nearby Sub Divisional Civil Hospital/District Hospital/Medical College & Hospital/empaneled Hospital. Arogya Mitras would facilitate the beneficiary. If the beneficiary visits any other Government hospital other than the empaneled Hospital, the doctors will give him/her a referral card to the empaneled Hospital after the preliminary diagnosis.
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The Arogya Mitra engaged by the Implementation Support Agency examines the referral card and barcoded laminated card and facilitates the beneficiary to undergo preliminary diagnosis and basic tests.
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The empaneled Hospital, based on the diagnosis, admits the patient and sends a preauthorization request to the Implementation Support Agency.
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Doctors/Specialists of the Implementation Support Agency examine the preauthorization request and approve preauthorization within 24 hours of receiving the preauthorization request from the empaneled hospitals, if all the conditions are satisfied.
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The empaneled Hospital extends cashless treatment and surgery to the beneficiary subject to the limits prescribed under the scheme.
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Ernpaneled Hospital after discharge forwards the original bill, discharge summary with the signature of the patient, and other relevant documents to the Implementation Support Agency for processing and settlement of the claim within one week (7 days) from the date of discharge of the patient.
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Implementation Support Agency scrutinizes the bills and forwards the payment request of the bi to the State Nodal Cell (SNC) within fifteen days (15 days) of the receipt of bills from the empaneled Hospital.
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The State Nodal Cell (SNC) after verification of the bills in lieu of the services provided will directly make the payment by way of electronic transfer to the empaneled Hospital(s) within 30 days of receiving the bills from the Implementation Support Agency.
Common questions
What is the objective of the scheme?
The objective of the scheme is to provide cashless treatment and coverage of critical care targeted at the Below Poverty Line (BPL) population and Low-Income households. In addition, it aims at making treatment more affordable and also limits the disastrous financial impact that households often experience due to out-of- pocket spending.
How much amount of treatment will be covered under this scheme?
Under this scheme, treatment beneï¬ts up to ₹2.00 lakhs per individual member per annum within and outside the State of Assam covering.
Can an individual avail the benefits of the scheme also in a private hospital?
The beneficiary can avail of cashless treatment under the scheme in the empanelled Government as well as Private Hospitals.
What are the six critical care specialities covered under the scheme?
The six specialities are- cardiovascular diseases,
Cancer, Renal (Kidney) diseases, Neo-natal diseases, Neurological conditions & Burns Can an enrolled beneficiary be treated or admitted without making any payment to the hospital under the scheme?
Yes, the enrolled beneficiary is to be treated or can be admitted without making any payment to the hospital.
Are pre-existing diseases also covered under the scheme?
Yes, Pre-existing diseases are also covered from day one which means that any illness existing prior to the inception of the scheme shall also be covered.
Is this scheme also covering travel expense?
Yes, the travel expenses of visiting people, treatment, and the daily allowance are also covered in this scheme.
Will this scheme cover the travel expense out of the state of Assam?
For out of State treatment in empanelled hospitals in selected cities, patients and one attendant will be provided economy cheapest airfare on that route.
Is this scheme only for the resident of Assam?
Yes, the individual should be a permanent resident of Assam.
Who is eligible under the scheme?
All individuals from Below Poverty Line (BPL) families whose annual family income is upto ₹ 1.2 lakhs) and all other families whose annual income is between ₹1.2 and ₹5 lakhs are also eligible to enroll and avail of the benefits under this Scheme.
Is it mandatory to have a ration card while applying under the scheme?
Yes, the individual should possess a ration card issued by the Government of Assam under the National Food Security Act.
What is the enrolment fee for a member of the BPL families?
Enrollment under the scheme is totally free for members of the BPL families.
Official links
nhm.assam.gov.in/schemes/detail/atal-amrit-abhiyan-0Step