Aarogyasri Community Health Insurance Scheme
Country of Operation
- Aarogyasri Health Care TrustGovernment
Target income level
- Bottom 20%
SummaryAarogyasri is state-financed and targets individuals living below the poverty line. Beneficiaries have access to numerous modern medical facilities and are navigated through the health care system by Aarogya Mithras, or patient advocates, hired to oversee each in-network hospital
Key program components
In order to facilitate effective implementation of the scheme, the government set up Aarogyasri Health Care Trust under the chairmanship of the Chief Minister of Andhra Pradesh. The Trust—in consultation with specialists in the field of insurance and other medical professionals— devised the tailor made Aarogyasri health insurance scheme. The Trust includes representatives from various government agencies and professional organizations. Aarogyasri is a state‐funded health insurance scheme for below‐the‐poverty‐line citizens in Andhra Pradesh, India. Catastrophic (inpatient) care is provided primarily by private providers (the network does include some public facilities, but the majority of the network providers remain private facilities), and administrative services are provided by a private insurer. Aarogyasri beneficiaries have access to facilities they would not otherwise be able to utilize due to the financial barriers to access. Aarogyasri is funded by general tax revenue generated by the state of Andhra Pradesh. The state subsidizes the full cost of the insurance premium for each beneficiary. The state chose to fully cover this cost as the administrative costs of collecting the premium would outweigh the total cost of the premium itself. In addition, the state wanted to ensure that the benefits of the scheme reached the poorest, who might otherwise be deterred from enrolling even if the premium to be paid out-of-pocket was nominal. For rollout of Aarogyasri, the State government engaged in an open, competitive bidding process to select a single insurer to implement the program. The insurer with the lowest premium bid (for the specified benefits package) won the contract to be the insurer for Aarogyasri. For the first phase of Aarogyasri, the premium was set at Rs.210 (US$4.50) per household annually, with each household entitled to claim all expenses in relation to a set of pre-specified critical diseases and surgeries up to a maximum of Rs.200,000 (USD4,440). The premium is the same across all districts in the state and the amount reimbursed per procedure to any network hospital is also the same. The scheme covers 65 million people.