Biju Swasthya Kalyana Yojana

Updated on April 25, 2022, 12:10 p.m.

Biju Swasthya Kalyana Yojana is the brain child of the Chief Minister of Odisha Shri. Naveen Patnaik. This scheme was introduced in memory of his father Late Shri. Biju Patnaik on 15th August 2018.

There is an age old saying by a noted scholar that “A healthy nation they say is a wealthy nation”. Healthcare is significant to the society because people get ill, accidents and emergencies arises and the hospitals are required to diagnose, treat and manage different types of ailments and diseases in Odisha.

All over the world, the healthcare industry continues to flourish and breed as long as there is the existence of man on earth and hence forms a massive part of any nation’s economy.

Let us understand the term “Healthcare”. It is defined as the diagnosis, treatment, prevention and management of illness, injury, disease, and the preservation of physical and mental well-being in the humans. Healthcare services are provided by medical practitioners and allied health professionals.

VISION OF THE BIJU SWASTHYA KALYANA YOJANA

Providing authenticated technical inputs for policy formulation and programme execution. Academics and training, Research and Development, in Public Health, Health Care including Emergency Preparedness and Response/Medical Education to the Government of Odisha for achieving maximum standard of health for the people of Odisha.

MISSION OF THE BIJU SWASTHYA KALYANA YOJANA

“Every life is precious” has always been the guiding principle of the Government of Odisha under this scheme.

OBJECTIVES OF THEBIJU SWASTHYA KALYANAYOJANA

The Government of Odisha has introduced the high-spirited Biju Swasthya Kalyana Yojana to achieve objectives given below as follows:

ToofferaWide-ranging, AccessibleandAcceptable healthcare for the people of Odisha free of cost.
To encourage and commence Operational Research for better understanding and execution of State Health Programs and other health Care undertakings.
To simplify the prevention, mitigation, and control of public health emergencies due to Chemical, Biological, Radiological and Nuclear Hazards in disastrous circumstances.

FEATURES OF THE BIJU SWASTHYA KALYANA YOJANA

The Biju Swasthya Kalyana Yojana was started with the resolve to boost the healthcare in the state of Odisha. The features of the policies are given below as follows.

To strengthen Regional Offices of Health and Family Welfare, for ensuring application of Health Programs and connection between hospitals in Odisha for activities related to health.
The duration of coverage under the Biju Swasthya Kalyana Yojana is one year.
State Government will take complete expenses of all health services delivered to all patients, irrespective of income, position, residence in all State Government health care zones starting from Village level to District Head Quarters, Government Hospitals and Medical College.
200 private hospitals are presently recognised within and outside the State to assist the patients getting admitted under the Biju Swasthya Kalyana Yojana.
To lay down precise standards and rules for safety and quality assurance of all phases of health care including Patient Safety, Hospital Attained Infection and Resistance development.
To facilitate transparency and maintenance of standards in counselling for depressed people.
State Government will bear the expense of healthcare provided in recognised hospitals for over 98 lakh economically weak families in Odisha, with an Annual Health Coverage of INR 5 lakh per family.
To provide technical support to the Department of Health and Family Welfare for achieving Universal Health Care available to all citizens and to prioritise special groups.
Assistance will be given to the inpatients getting enrolled under this Scheme.
To ensure delivery of state-of-the-art Emergency Care Services, including surgical medical, Trauma, Burn Care Paediatric and obstetric emergency care for all the people of Odisha under the Biju Swasthya Kalyana Yojana.
To facilitate management of digital data related to health infrastructure, health Services and health status of the population.
Encouraging the community contribution through society using the Community, Civil Society Groups, taking responsibility for their wellbeing and good health under the Biju Swasthya Kalyana Yojana.
People can get the cashless treatment in leading hospitals in Odisha.
Additional INR 5 lakh for the women members of the family is offered exhausting the initial limit under the Biju Swasthya Kalyana Yojana.

ELIGIBILITY CRITERIA FOR AVAILING SERVICES OF THE BIJU SWASTHYA KALYANA YOJANA

There are certain eligible criteria’s for the people to become the member of theBijuSwasthyaKalyanaYojana given below as follows:

All the citizens of Odisha are eligible for cashless health care services at all Government of Odisha recognised health care institutes from Village to District Head Quarters Hospital and Government Medical College Hospital.
All those families whose annual income is below INR 50000 in rural areas and below INR 60000 in urban areas.
Caste certificate attested for verification purpose.
The beneficiary must have the SFSS (Odisha State Food Security Scheme) and the NFSA (National Food Security Act) cards to avail the cashless health care coverage of INR 5 Lakhs per family.

PROCEDURE FOR APPLYING FOR THE SERVICES OF THE BIJU SWASTHYA KALYANA YOJANA

The technique introduced by the Government of Odisha to enrol in the Biju Swasthya Kalyana Yojana is given below as follows.

The applicant needs to go to the local Grama Panchayats, Village, and District Government Hospital and submit all the documents.
The technical review committee will scrutinise the documents and give reply within 7 business days.
Pending documents must be submitted within 7 business days.
If you are the member of the Annatodaya Anna Yojana (AAY),the same details will be used to enrol the applicant under the Biju Swasthya Kalyana Yojana.
The applicant will receive the message in his/her mobile number.
IncomecertificateiscompulsoryforthefamilieswillingtogetbenefitsundertheBijuSwasthyaKalyanaYojana.

DOCUMENTS REQUIRED FOR APPLYING FOR THE SERVICES OF THE BIJU SWASTHYA KALYANA YOJANA

To be the recipient of the Biju Swasthya Kalyana Yojana, you must furnish the below mentioned documents, givenbelow.

Birth Certificate attested by Gazetted officer.
Self Help Group Certificate.
Passport Size Photos.
Address Proof documents attested by Gazetted Officer.
Certificate for Differently-abled, Ex-Serviceman and others.
Nativity Certificate Xerox copy signed by the gazetted officer of the government.
Voter Id, Aadhar Card, PAN Card, Ration Card Xerox copies signed by the gazetted officer of the government.
Affidavit of the notary if any major change has been done like the name change and others.

RESERVED PACKAGE SERVICESOFFEREDUNDER THE BIJU SWASTHYA KALYANA YOJANA

The Reserved Package Services offered by the government hospitals under the Biju Swasthya Kalyana Yojana are given below as follows. The below mentioned charges will be borne by the Government of Odisha.

Registration Charges.
BedandtheICU charges.
Free diagnostic isdoneinthefieldofRadiology, Ultrasound, Pathology, related charges.
Nursing and Boarding charges.
Doctor/Surgeon/ Medical Consultants/Anaesthetist/ fees.
Charges for Anaesthesia/ Blood Transfusion/ Oxygen/ OperationTheatrecosts, Medicines and Drugs costs.
Daily food and diet patterns of the patients.
Treatment of Gastroenteritis, Dysentery, Heat stroke and Surgeries for Hydrocele, Typhoid, Fever, Diarrhoea, Tuberculosis, Urinary Tract Infection, Abscess drainage, Lymphoma and cyst formation and procedures like Dilatation and Curettage is under theReserved Package Services.
Pre (charges for consultation, diagnostic tests and prescriptions).
Post (medicine cost for 5 days on discharge and follow up consultation) hospitalisation expenses and any other expenses related to the treatment.
Apart from the package cost the Government also bears the cost of Devices/ implants utilised during hospitalisation.
Covers In-patient treatment packages only.
Post-discharge diagnostics and post-discharge medicines up to 15 days are covered under this scheme.
OPD case in private hospital is not covered the Biju Swasthya Kalyana Yojana.

REFERRAL PACKAGE SERVICES OFFERED UNDER THE BIJU SWASTHYA KALYANA YOJANA

The Referral Package Services offered by the government hospitals under the Biju Swasthya Kalyana Yojana are given below as follows.

The patient will be referred to the hospital if the treatment is not available in the hospital where the patient approaches for treatment.
Cases will be referred to another hospital, if it takes longer time than usual to carry out the consultation, treatment, surgery at the designated Government Hospital in Odisha.
Emergency situations, wherein the chosen Government Hospital in Odisha is not able to attend to the patient.
Under this scenario, the patient in Odisha will have to choose the hospital very carefully, because if certain implants and treatments are not available in the hospital, the cost of the treatment can only be claimed with prior-preauthorisation.
Actual cost of medicines, and diagnostics, ICU charges will be added to the existing package, if the patient produces the original invoices within 15 days.

HOW TO SETTLE THE CLAIMS UNDER THE BIJU SWASTHYA KALYANA YOJANA?

There are certain rules followed while settling the claims under the Biju Swasthya Kalyana Yojana given below as follows:

After the patient is discharged, all the documents must be submitted to the hospital within 7 days.
The payment will get reimbursed to the account of the patient by Net Enabled Funds Transfer (NEFT), within a month.
If the patient’s needs to have more than 1 surgery in the Operation Theatre, then surgical process with the highest rate is considered and amount is reimbursed.
If the documents are not submitted within 7 days of discharge, thepatient tends to lose the concession under the Biju Swasthya Kalyana Yojana.

COMPONENTS UNDERTHE BIJU SWASTHYA KALYANA YOJANA

There are three mechanisms available under the Biju Swasthya Kalyana Yojana.

Coordinators:

State Health Assurance Society (SHAS), selects the co-ordinators in Odisha in all districts where there are private empanelled hospitals.
District Coordinator along with the District Kiosk monitors the execution of the Biju Swasthya Kalyana Yojana and offer valuable assistance.

Healthcare Kiosks:

It is the nominated IT partner of State Health Assurance Society (SHAS), in Odisha.
These kiosks can hasten patient check-in and check-out without involving staff.
The whole process for patient becomes quicker and efficient and in turn their frustration is eliminated.
Patients can spend their time effectively by knowing how much longer they should wait.
They also offer solutions to the hospitals under this scheme and make sure that the software is upgraded from time to time.
In addition, simple transactions like submitting insurance, paying for services can be handled through this kiosk.

Swasthya Mitras:

They are like the Customer Support Representatives to assist the beneficiaries at hospitals in Odisha.
Swasthya Mitras, act like a bridge between SHAS and hospitals and are the first contact point for the patients.
They also play a major role in asking for missing documents/forms while the patients apply for reimbursements.
They look after processes such as facilitation of beneficiaries, amount to be credited, with the hospital management and the co-ordinators of the hospital.
Swasthya Mitras also facilitate officers appointed by hospitals in uploading of pre-authorisation forms and claims documents.
They look after grievances of hospitals regarding claim settlement and pre-authorisation approval.

Biju Swasthya Kalyana Yojana

COMPONENTS UNDERTHE BIJU SWASTHYA KALYANA YOJANA

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