Role of NGO

We associate with NGOs/ MFIs and Cooperatives registered under one of the following Acts:-
       * Societies Act of various states.
       * Trust Act.
       * Under Section 25 of companies Act.
       * Cooperative Societies registered under the state / Central cooperative Acts / Model Acts.
       * Nonbanking financial companies.

The role of the partner organization is to explain the details of the scheme to their beneficiaries and to encourage them to voluntarily become members. The membership fee is collected by the NGO and deposited in the Health Benefit Fund account maintained by the Health Trust. NGO keeps in touch with recognized hospitals and members. NGO recommends for payment of special benefits such as due to death of member etc. directly payable to the members. NGO gives feedback and suggestions to SAS from time to time about the smooth implementation of the scheme.

Role of Hospitals

The hospitals provide healthcare services to members who visit the hospitals as per the terms and conditions contained in the agreement signed between SAS and the hospitals. They may also conduct free health camps in association with voluntary and other organizations.

Management of the Health Benefit fund

'HEALTH BENEFIT FUND' is created to receive and manage the membership fee collected from the health card holders. The amount is used to take care of the processing and administrative costs incurred by SAS and the NGO and for reimbursing the cost of providing health services incurred by the recognized hospitals. At the end of the year the surplus from the Health Benefit Fund is used for building new hospitals and conducting preventive healthcare programs.

Membership Eligibility

       * She/he is a present beneficiary or likely to be beneficiary of the NGO/MFI.
       * His/her age is between 6 months to 65 years.
       * He/she does not have any disease/ deformity by birth and • She/he has understood the scheme details and is voluntarily agreeable to pay the membership fee per year.

Persons not eligible to be members:

       * The diagnosis shows that he/she is HIV/AIDs positive and has related opportunistic disease.
       * The diagnosis shows that the treatment sought is birth related.
       * Persons (members) affected in large scale due to natural calamities and other unforeseen calamities.

Membership fee and healthcare benefits

Poor families are encouraged to make their family members, persons related by blood /marriage to the family members. The benefits are available even if one of the family members becomes member of the scheme. Family members are defined as those share food from a common kitchen and / those related by blood or marriage.

The upper limits to which healthcare expenses will be reimbursed are given in the following table.

Membership Fee and Healthcare Expense Limit
No of members of one family registered under the scheme	Membership Fee per member	Membership Fee collected	Upper limit of healthcare expenses
1	190	190	5,000
2	190	380	10,000
3	190	570	15,000
4	180	750	20,000
5	170	920	25,000
6	160	1,080	30,000
7	150	1,230	35,000
8	150	1,380	40,000
9	150	1,530	45,000
10	150	1,680	50,000

Any one of the family member or all of the family members having membership of the scheme can utilize the amount of eligibility of all members put together on floater basis.

Additional Benefits

Period of healthcare benefit

The limit is available for one year from the date of becoming member of the scheme. The membership can be renewed before one month of the date of expiry of the membership.

Free Health Camps

SAS conducts a minimum of two free health camps in a year in selected districts. The camps reach out to members as well as non-members in the districts covered by the beneficiary organizations. The camps enable the members to avail of basic health check-up at their doorstep and identify health issues in a timely fashion.

Healthcare benefits provided

The Card Holders will visit the recognized network hospitals in the event of ill-health. They will be received by the Help Desk Executives, appointed by the company, who will help them obtain timely and qualitative healthcare services. When only a single person of a family becomes a member he/she will receive free health services costing up to ₹5000/- during the year. As the number of registered members in a family increases the limit up to which free health services provided increases as multiples of ₹5000/. For example, if in a family 3 have become members, any member of the family or all the three members put together can receive free healthcare services costing up to ₹15000/- during one year.

The benefit is provided subject the card holder producing the health card to the Help Desk Executive and the Help Desk Executive confirming the membership from the details available in the Web based software by matching the details given by the card holder and pre-sanction being approved by the BPO at Mysore.

The healthcare benefits are of two types – In-patient and Out-Patient.

Free Health Camps

SAS conducts a minimum of two free health camps in a year in selected districts. The camps reach out to members as well as non-members in the districts covered by the beneficiary organizations. The camps enable the members to avail of basic health check-up at their doorstep and identify health issues in a timely fashion.

Healthcare benefits provided

The Card Holders will visit the recognized network hospitals in the event of ill-health. They will be received by the Help Desk Executives, appointed by the company, who will help them obtain timely and qualitative healthcare services. When only a single person of a family becomes a member he/she will receive free health services costing up to ₹5000/- during the year. As the number of registered members in a family increases the limit up to which free health services provided increases as multiples of ₹5000/. For example, if in a family 3 have become members, any member of the family or all the three members put together can receive free healthcare services costing up to Rs.15000/- during one year.

The benefit is provided subject the card holder producing the health card to the Help Desk Executive and the Help Desk Executive confirming the membership from the details available in the Web based software by matching the details given by the card holder and pre-sanction being approved by the BPO at Mysore.

The healthcare benefits are of two types – In–patient and Out–Patient.

What is Not Covered

     « Congenital diseases
     « Plastic surgery and other cosmetic treatments except treatment related to accidents.
     « Spectacles, hearing aids, health related Belts and other artificial limbs and aids.
     « Dental related diseases and surgery except when there is a need for hospitalization due to accidents etc.
     « Disease caused by alcoholism, consumption of drugs
     « Venereal diseases, HIV, self-attempted damages to the body, attempt to suicide.
     « Dialysis, chemotherapy
     « Prenatal and Post-natal diseases, abortions, IUD
     « Naturopathy, and treatment related to sterility
     « Cost of transport in ambulance, cost of food, travel, telephone expenses incurred by the card holder in connection with the treatment.
     « Dog bite, immunization, debility, and anemia.
     « Treatment taken as inpatient for diseases which could have been treated as outpatient.
     « Expenses incurred for X-Ray, CT scan, MRI, angiogram and other investigations to diagnose the diseases.
     « Contagious diseases and diseases/ injury to health caused in masses due to war, communal violence, earth quake, floods, typhoon, tsunami etc.

Scheme Flow Chart

The diagram below provides a graphical representation of the structure of the program with respect to the various entities involved.