In these times of rising medical expenses and high costs, falling ill could mean landing into the debt trap. How then should the people Below the Poverty Line (BPL) and the Lower Income Group (LIG) meet healthcare expenses? Illness is not just a sickness for these people; it is a long-term threat to their income and livelihood.
Moreover, it also affects their earning capacity. This is because they do not attend to their illness immediately fearing high medical costs and postpone the treatment, till it’s almost too late. The root cause of such behaviour is lack of resources and loss of wages. To solve this problem, the State of Gujarat introduced the Mukhyamantri Amrutam “MA” Yojana. Mukhyamantri Amrutam was launched on 4th September 2012 by the Government of Gujarat.
In August 2014, this program was extended to the Lower Middle-Class families in the form of Mukhyamantri Amrutam Vatsalya Yojana. This was to provide free medical treatment to families, who did not fall under the definition of Below Poverty Line (BPL), and so couldn’t get free treatment for critical illnesses as they couldn’t afford the treatment.
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1. Facilities covered under MA Yojana and MA Vatsalya Yojana:
1. Cashless facilities provided to all beneficiaries under Mukhyamantri Amrutam Yojana and the Mukhyamantri Amrutam Vatsalya Yojana.
2. Cashless facilities are provided for medical treatment, surgical procedures and also critical illnesses. These can be Cancer, Neo-natal diseases, Knee and Hip Replacement, Cardiovascular diseases, Renal diseases, Neurological diseases, Burns, Poly-Trauma, Kidney, Liver and Kidney + Pancreas Transplantation.
3. About 698 defined procedures relating to the above treatment along with their follow-ups are also covered.
1. Beneficiaries are covered on family floater basis with sum assured up to Rs 3,00,000 per family per year.
2. Treatment relating to Kidney Transplant, Liver Transplant, Kidney + Pancreas Transplant procedures have a sum assured of up to Rs 5,00,000.
3. Treatment relating to Knee and Hip replacement procedures have capping of Rs 40,000 per replacement for a single replacement.
4. Transportation charges of Rs 300 are paid to beneficiaries to avail treatment at empanelled hospitals (network hospitals).
1. A family floater up to five members, that is, head of the family, spouse, and three dependents are covered under the schemes.
2. On a new birth, a newborn is covered as the 6th member during that financial year.
3. All costs of treatment, medicines, follow-up treatment, and transportation and so on are borne by the State.
4. Beneficiaries can enroll anytime during the year. Kiosks have been installed at Talukas and City Civic Centers for beneficiaries to enroll themselves. They can also get their card split, add or delete family members or even get a new card in case of a lost card.
5. Mobile kiosks are installed in every district.
6. No intermediaries are involved in any of the processes.
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4. Features of Mukhyamantri Amrutam and Mukhyamantri Amrutam Vatsalya Yojana:
1. These schemes are fully funded by the State of Gujarat. The funds directly go to the service providers.
2. Both public and private hospitals are enrolled in these schemes. This is to promote healthy competition while rendering services.
3. There is a bidding process wherein service providers take part in e-tendering and so, package rates are selected.
4. Implementation Support Agency is a critical part of the scheme. It provides pre-authorization cases, process claims and maintains a call centre for grievance redressal. It also screens hospitals for empanelment and hires key persons at hospital level like Regional Coordinator, District Coordinator and Arogya Mitras to manage the scheme.
5. To promote quality services, the scheme pays the hospitals, 10% over and above package rates to hospitals accredited by NABH, JCI and International Society for Quality in Healthcare. Be Wise, Get Rich.
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