What is the Maximum limit of Aarogyasri?

Aarogyasri Scheme Limit Increased – Up to ₹25 Lakh in Andhra Pradesh

Aarogyasri is a government-funded health insurance scheme that provides quality medical treatment to the economically weaker segments of society in Andhra Pradesh and Telangana. The scheme also plays a crucial role in alleviating the financial burden of healthcare expenses through cashless treatment at empanelled hospitals.

Its most distinctive feature is likely the annual maximum coverage limit, which defines the total financial coverage provided to every covered family each year. Continue reading to understand the maximum coverage available under the Aarogyasri scheme, along with its benefits and other details.

Maximum Limit of Aarogyasri Scheme

According to the latest information, the maximum monetary limit per family per year under the Aarogyasri scheme is ₹5 lakh. A beneficiary family can receive free medical care up to ₹500,000 within one year.

This ₹5 lakh coverage encompasses both inpatient hospitalisation and procedures for a wide range of health conditions, including:

• Cardiac surgeries
• Kidney transplants and dialysis
• Cancer treatments
• Neurosurgery
• Trauma care
• Organ transplants
• Burns and plastic surgeries
• And several other tertiary-level medical interventions
   

The scheme fully covers a fixed package price for each procedure without charging the patient out of pocket, provided the treatment is carried out at an empanelled hospital.

How does the ₹5 Lakh Limit Work?

This is how the ₹5 lakh limit under the Aarogyasri scheme operates:

• The limit applies per family, not per person.
• All eligible family members gain ₹5 lakh in yearly coverage.
• In special cases or emergencies where treatment costs exceed ₹5 lakh, the scheme may consider providing further assistance based on the recommendation of the medical board or hospital.
• If a family does not utilise the ₹5 lakh limit within a year, the unspent amount does not roll over to the following year.
   

For instance, if someone undergoes heart surgery costing ₹2.5 lakh, the other ₹2.5 lakh remains available for use by different family members within the same year.

Special Provisions and Additional Coverage of the Aarogyasri Scheme

In addition to the standard ₹5 lakh annual coverage, Aarogyasri also offers unrestricted emergency care for life-threatening conditions, including accidents, severe burns, and multiple organ failures. These cases are addressed individually, allowing expenses exceeding the ₹5 lakh limit to be approved for reimbursement or direct payment to hospitals.

The Trust has established procedures, such as district coordinators, network hospitals, and medical audit teams, to ensure that patients are not denied admission or charged for services covered under the scheme.

Inclusions Under the Aarogyasri Scheme

Aarogyasri offers over 2000 surgical and medical interventions across various specialities, including:

• Cardiology
• Nephrology
• Oncology
• Neurology
• Gastroenterology
• Orthopaedics
• Paediatrics
• ENT and General Surgery
   

Exclusions Under the Aarogyasri Scheme

Not every condition is included in this scheme. Some of the exclusions are:
 

• Cosmetic surgeries
• Organ failures due to alcohol/drug abuse (unless life-saving)
• Dental procedures (unless related to trauma)
• Certain chronic conditions that require ongoing outpatient care
   

Nevertheless, the Aarogyasri Trust can provide treatment under discretionary or extended cover in all emergencies and life-threatening situations.

How to Avail Aarogyasri Benefits?

To avail of the ₹5 lakh benefit under Aarogyasri, the following steps need to be taken:

• Proceed to a network hospital or health camp conducted under the scheme.
• The hospital will pre-authorise the case through online registration and obtain approval from the Aarogyasri Trust.
• The Trust pays the bill directly to the hospital after treatment.
   

Free transportation from home to the hospital and complimentary meals during hospitalisation are also provided to patients.
 

Benefits of the Aarogyasri Scheme

The Aarogyasri scheme offers comprehensive advantages across a broad spectrum of benefits for its beneficiaries:
 

• Comprehensive Medical Coverage:The plan covers over 1,672 medical procedures for various illnesses and ailments, including life-critical surgeries such as organ transplantation and cochlear implants.
• Pre-existing Diseases:Treating pre-existing diseases is included, relieving individuals with long-term conditions.
• Cashless Hospitalisation:Beneficiaries can utilise cashless hospitalisation facilities at empanelled hospitals, reducing the financial burden during medical emergencies.
• Coverage for High-Cost Treatment:The scheme offers coverage for high-cost treatments like organ transplantation, ensuring that financial constraints do not hinder access to life-saving procedures.
   

The Aarogyasri programme is a cornerstone of public health, providing essential financial protection and high-quality medical access to economically challenged families. The recent increases in coverage—up to ₹25 lakh in Andhra Pradesh and ₹10 lakh in Telangana—testify to both state governments' commitment to enhancing healthcare access.

By meeting the eligibility criteria and following a simple application process, families can significantly ease the burden of medical expenses and concentrate on recovery and well-being.

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