The Deen Dayal Swasthya Seva Yojana (DDSSY) is a comprehensive health insurance initiative launched by the Government of Goa to provide cashless medical care and treatment to Goan residents through both government and private hospitals. With DDSSY, beneficiaries can avail of cashless hospitalization, surgeries, and medical procedures within the set annual coverage limits.
Benefits
- Coverage Limit
- Families with up to three members: Coverage up to ₹2,50,000/- per year.
- Families with four or more members: Coverage up to ₹4,00,000/- per year.
- The maximum total claim per family per year will not exceed ₹4,00,000/-.
- Cashless Facility
- Beneficiaries can avail cashless treatment up to their coverage limit at Empanelled Health Care Providers (EHCPs).
- Additional Coverage
- Individuals are free to opt for higher coverage by paying extra premium without affecting the government-provided benefits.
- Wide Range of Procedures
- 447 medical procedures are covered under the scheme.
Eligibility
- Resident of Goa
- Must have resided in Goa continuously for at least five years or more.
- Family Composition
- Coverage applies to the entire family based on the ration card or supporting documents.
Application Process
There is no specific application form for the scheme. Below are the steps to use the scheme benefits:
Offline & Online
- Visit an Empanelled Health Care Provider (EHCP)
- Consult the official DDSSY website or the list provided to find an EHCP near you.
- Consult the Doctor
- If the required surgery/treatment is covered under DDSSY, approach the DDSSY Sahayak at the hospital with the DDSSY card.
- Pre-Authorization
- The Sahayak will request pre-authorization from the ISA pre-authorization doctor.
- Once approved, the beneficiary will receive cashless treatment.
Alternatively:
- If you know the required procedure, check the website for EHCPs offering that procedure. Visit the hospital of your choice from the empanelled list.
Documents Required
- Aadhaar Card/Enrollment Slip (compulsory for every family member above 5 years)
- Residence Proof: Document showing at least 5 years of residency in Goa (passport, old driving license, older election card, etc.)
- Caste Certificates (if applicable): SC/ST certificate from Director of Tribal Welfare/Deputy Collector, or OBC (non-creamy layer) with income certificate showing income < ₹6,00,000/- per annum.
- Differently Abled Certificate (if applicable): Issued by Medical Board.
- Ration Card (to define the family). In its absence, attach the following:
- Marriage Certificate (for spouse).
- Birth Certificate/School Leaving Certificate (for dependent children).
- Declaration stating the dependent parents are not employed.
Frequently Asked Questions (FAQs)
What is the objective of the DDSSY scheme?
The scheme aims to provide quality medical care, covering hospitalization and surgeries for Goan residents, entirely on a cashless basis within the defined coverage.
Who is eligible for the DDSSY scheme?
All Goa residents, who have continuously lived in Goa for five years or more, are eligible along with their families.
What is the insurance coverage provided under DDSSY?
Families of up to three members receive ₹2,50,000 in annual coverage; larger families can get ₹4,00,000 per year, with no total claims exceeding ₹4,00,000.
What documents are required to avail of the DDSSY scheme?
Aadhaar card, residence proof showing at least five years in Goa, ration card or alternate family proofs, and relevant certificates for specific cases (SC/ST/OBC/differently abled).
How can a beneficiary avail of the benefits under the DDSSY scheme?
Beneficiaries can visit an empanelled hospital. After doctor consultation, the DDSSY Sahayak will handle the pre-authorization process, enabling cashless treatment.
Can a beneficiary opt for higher insurance coverage?
Yes, they can purchase additional coverage from the insurance provider at their own expense without affecting the scheme.
How many medical procedures are covered under the DDSSY scheme?
A total of 447 procedures are covered, including major surgeries and treatments.
What should a beneficiary do if they are aware of the required procedure?
They can check the DDSSY website to find a hospital offering that procedure, then visit that hospital for pre-authorization.
Where can applications for the DDSSY scheme be submitted?
Beneficiaries do not need to submit a formal application. They simply approach the empanelled hospital with the required documents.
Who should be contacted for more information about the DDSSY scheme?
For detailed queries, contact the Nodal Officers or the addresses/phone numbers provided in the official guidelines.