Support for Marginalized Individuals for Livelihood and Enterprise (SMILE): Composite Medical Health for Transgender Persons

Description
Launched on 12th February 2022, “Composite Medical Health for Transgender Persons” is a component of the “Comprehensive Rehabilitation for Welfare of Transgender Persons” sub-scheme of the “Support for Marginalized Individuals for Livelihood and Enterprise SMILE ” scheme. The scheme was launched by the Ministry of Social Justice and Empowerment, Government of India. The scheme aims to provide health Insurance coverage to all Transgender persons living in India to improve their health condition through proper treatment including sex re-assignment surgeries as well as medical support. The scheme provides health insurance in the form of Ayushman Bharat Plus, inclusive of gender reaffirmation surgery and comprehensive transition-related healthcare, covering hormone therapy and post-operation formalities, redeemable at all private and government healthcare facilities.

Benefits
• Health insurance cover of ₹5,00,000/- (Five Lakh Rupees) per year.
• Coverage is provided in the form of Ayushman Bharat Plus health insurance.
• Coverage is inclusive of gender reaffirmation surgery within the health benefit package under Ayushman Bharat Yojana.
• The comprehensive package covers all aspects of transition related healthcare for Transgender persons.
• Coverage specifically includes hormone therapy and Sex Re-assignment surgery inclusive of post operation formalities.
• Treatment for the beneficiary shall be cashless. The Government of India provides for 100% of the approved expenditure.

Eligibility Criteria
1. - The applicant should be Transgender.
2. - The applicant should not be availing similar benefits from any other schemes of the Central Government or State Government.
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Application Process
Step 1: Step 1: Ensure Possession of Mandatory Identification
Online
The applicant must possess the Transgender Certificate issued by the "National Portal for Transgender Persons", as this document is mandatory to avail the health insurance package.
Beneficiaries who have already received their certificates from the National Portal are automatically eligible to receive the insurance.

Step 2: Step 2: Access the Benefits at an Empanelled Facility or Service Centre
Online
The Transgender beneficiary or applicant possessing the Transgender Certificate should visit an empanelled hospital or a Common Service Centre (CSE).
These empanelled hospitals are identified from the list of institutions already approved under the Ayushman Bharat Scheme.

Step 3: Step 3: Verification of Certificate Details on the System
Online
The applicant is required to present their registration Identification/Transgender person’s certificate serial number from the National Portal to the staff at the facility or centre.
The beneficiary's details will then be entered and verified on a real-time basis, adhering to the current Beneficiary Identification System procedure utilized for Pradhan Mantri Jan Arogya Yojana beneficiaries.

Step 4: Step 4: Obtain the Ayushman Transgender Health Card
Online
If an individual does not possess the mandatory Transgender Certificate, they shall be redirected to the National Portal website to obtain the required document.
After successful verification of the Transgender Certificate, the eligible applicant will subsequently be issued the specific Ayushman Transgender Health card.
Contact Us
For General Queries: 011-20893988, [email protected]
For Technical Queries: +91 79 23268279, [email protected]
Working Hours: 10:00 AM to 17:00 PM, Monday to Friday

Required Documents
• Transgender Certificate And Identity Card Issued By The National Portal For Transgender Persons (Mandatory Document To Avail Health Insurance Package).
• Registration Identification/Transgender Person’s Certificate Serial Number (Required From The National Portal For Transgender Persons To Access Benefits).

Frequently Asked Questions
Q: Following the successful completion of the verification procedure, what official document is then issued to the eligible Transgender applicant?
A: After successful verification of the Transgender Certificate and eligibility, the applicant will subsequently be issued the specific Ayushman Transgender Health card.
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Q: Are there any limitations regarding other governmental financial or healthcare support that might disqualify an applicant from receiving these services?
A: Yes, the beneficiary must not be currently receiving similar health or financial benefits from any other schemes provided by either the Central Government or a State Government.
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Q: When receiving treatment at an authorized medical facility, will the individual typically be required to pay for the services upfront or is the process fully managed?
A: The treatment provided to the beneficiary under this composite medical health scheme shall be entirely cashless. The hospitals submit the bills directly to the National Health Authority.
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Q: Does the insurance coverage provided specifically include procedures necessary for gender transition, such as gender affirmation surgeries?
A: Yes, the provided health insurance, known as Ayushman Bharat Plus, is inclusive of gender reaffirmation surgery within the health benefit package under the Ayushman Bharat Yojana.
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Q: What specific certification documents must an individual hold to prove their status as a Transgender person eligible for this benefit?
A: The applicant must be a Transgender person as officially notified by the Government of India and must possess the mandatory Transgender Certificate and Identity Card issued by the National Portal for Transgender Persons.
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Q: If a Transgender person wishes to avail of the medical health package but does not currently hold the required certificate, what action should they take?
A: Such Transgender persons who do not possess the necessary certificate issued by the National Portal shall be redirected to the website to first obtain the certificate so as to become eligible for the health package.
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Q: What is the total maximum financial coverage value provided annually to each eligible beneficiary under this specific health care offering?
A: Each eligible Transgender person receives an insurance cover of ₹5,00,000/- (Five Lakh Rupees) per year under the scheme, provided in the form of Ayushman Bharat Plus health insurance.
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Q: What percentage of the total approved expenditure for the medical services provided to the beneficiaries is funded by the Government?
A: The Government of India fully funds the scheme by providing 100% of the total approved expenditure incurred for providing the Composite Medical Health services to Transgender persons.
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Q: Can you detail the comprehensive scope of healthcare services covered, ensuring that transition-related needs are fully addressed?
A: The Comprehensive Package covers all aspects of transition-related healthcare for Transgender persons. This coverage specifically includes essential treatments like hormone therapy and Sex Re-assignment Surgery.
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Q: If I have already successfully obtained the official identity documentation, am I automatically considered eligible to enroll for the associated insurance policy?
A: Yes, Transgender persons who have already received their official certificates from the National Portal for Transgender Persons would be automatically eligible to receive the health insurance.
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Q: At which types of medical institutions, including both public and private, can an eligible beneficiary redeem the transition-related health services?
A: The services offered under the comprehensive package can be redeemed for treatment and care at all recognized private and government healthcare facilities.
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Q: Is the Transgender Certificate issued via the National Portal an absolute prerequisite document for gaining access to the health insurance benefits package?
A: Yes, the Transgender person certificate issued by the National Portal for Transgender Persons is an absolute mandatory document required to successfully avail the health insurance package.
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Q: Does the comprehensive package extend its coverage to include follow-up consultations and necessary procedures after a sex reassignment surgery has been performed?
A: Yes, the comprehensive package explicitly includes coverage for Sex Re-assignment Surgery, and this inclusion extends to covering necessary post operation formalities.
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Q: Once certification is confirmed, what is the primary physical location or administrative center where an applicant can initiate the process of accessing the benefits?
A: The beneficiary possessing the Transgender Certificate from the National Portal can visit an empanelled hospital or a Common Service Centre (CSC) to initiate the entry and verification of their details.
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