Jyothi Sanjeevini Scheme(JSS)
The Government of Karnataka has approved a Health Assurance Scheme vide Government order No. DPAR/14/SMR/2013 dated 18/08/2014, specially designed for the Government Employees, named “Jyothi Sanjeevini”. It is a comprehensive health care to the Government employees, wherein the Scheme provides cashless treatment to all the Government Employees and their dependants through an empanelled Network of Hospitals for Tertiary Care .
To provide quality “tertiary health care” for the treatment of catastrophic illnesses involving hospitalization, surgery, and other therapies through an identified Network of Super Speciality Hospitals.
The scheme covers tertiary treatment of 7 broad specialities viz Cardiology, Oncology, Genito Urinary Surgery, Neurology , Burns, Poly-Trauma cases (excluding medico legal cases) and Neo-Natal & Paediatric Surgery.
Beneficiaries & Coverage :
“Beneficiary” means and relates to all State Government Employees and their dependant family members defined by the Government of Karnataka from time to time; and as such all of them are covered under this Scheme.
Beneficiaries Identification :
The beneficiary is identified by virtue of Karnataka Government Insurance Department’s Policy Number which get interacted with the HRMS data base of the Department of Personnel and Administrative Reforms of the Government of Karnataka. The Government has allowed Suvarna Arogya Suraksha Trust to access the data base of the Government Servants for the purpose of identifying the Government Servants and their dependants. The dependant family members of a Government Servant includes as defined under Rule 2(1) of clause (i) (ii) & (iii) of Karnataka Government Servants (Medical Attendant) Rules, 1963 which defines as under:
(i) The wife or husband of the Government Servant.
(ii) The father and mother (including step-mother) if they ordinarily reside with the Government Servant and their total monthly income does not exceed Rs. 6,000 and
(iii) Children including adopted children and step children, of a Government Servant who are wholly dependent on such Government servant. The above details shall be declared and certified by the Government Servant.
The Government Servants will not be eligible, if the benefits are already availed “in any of the other” Government sponsored health schemes;
The scheme is implemented in an “Assurance Mode” through Suvarna Arogya Suraksha Trust to the “State Government Employees and their dependants” by a network of “Empanelled Hospitals” with no financial cap. The process of identification and empanelment is a continuous one from “time to time”. Only such of those Network Hospitals who are already empanelled and gets empanelled for “Vajpayee Arogyashree Scheme”, alone are empanelled under “Jyothi Sanjeevini Scheme”. It is “cashless” to the beneficiaries except in following cases;
(i) where the beneficiary opts/desires an higher implants, stents, prosthesis etc., which are costlier than the ones included in the benefit package and
(ii) where the beneficiary opts for superior wards other than the one for which he/she is entitled. In the aforesaid circumstances, the beneficiaries shall bear the additional cost.
Implementing Support Agency (ISA):
The Suvarna Arogya Suraksha Trust has hired the services of an Implementing Support Agency for the implementation of the said scheme. The ISA provides such services to cover the activities including IEC; empanelment of hospitals and accrediting the service providers; establishing provider payment mechanism; training and placement of Arogyamitras in each of the Network Hospitals to assist patients; conducting camps as and when required; establishment of call centres, pre-authorisation and claims processing units; and monitoring & evaluation of service providers.
The scheme covers tertiary treatment of 7 broad specialities viz cardio-vascular diseases, cancer, renal diseases, neurological diseases, burns, poly-trauma cases* and neo-natal cases. It includes “449 procedures“ pertaining to seven specialities stated above. The package includes consultation, diagnostics, procedure cost, food, hospital charges and post hospitalization services up-to 10 days include medicines. Upper limit is fixed for those procedures requiring implants, stents etc., exceeding which the difference of cost will be borne by the beneficiaries. In addition, the scheme covers “60 defined follow-up packages” that include post hospitalization care for a subset of covered procedures, including consultations, diagnostics and drugs.
Entitlement of Wards :
Jyothi Sanjeevini Scheme