Ayushman Bharat Yojana Rajasthan

The Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY) is a government healthcare scheme introduced on August 30, 2019, under Chief Minister Ashok Gehlot’s government in Rajasthan. This healthcare scheme is an amalgamation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the Bhamashah Swasthya Bima Yojana, it is deemed useful to the beneficiaries of both schemes. The new scheme covers various expenses like hospitalisation costs, daycare treatment, pre and post hospitalisation expenses and more.

Key Features and Benefits of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

Let’s understand the features and benefits of the Ayushman Bharat Rajasthan Swasthya Bima Yojana:

• Health Coverage for Families from Lower-Income Groups

The AB-MGRSBY scheme provides health coverage for RSBY families from Rajasthan, i.e. people that belong to the lower-income group as well as those under the National Food Security Act and Socio-Economic Caste Census 2011.

• Cashless Hospitalisation

With the Ayushman Bharat Yojana Rajasthan, you can avail the benefits of cashless hospitalisation. To put it simply, if you get the treatment done from an empanelled hospital, you do not have to spend a single rupee.

• High Sum Insured

The Ayushman Bharat Rajasthan Swasthya Bima Yojana provides a high sum insured of up to ₹5 Lakhs, which is bifurcated into 2 parts:

1. ₹50,000 is for common health conditions

2. The remaining ₹4.5 Lakhs is dedicated to serious or critical illnesses

• Insurance Cover for the Whole Family

This health insurance scheme is like a family floater policy, where the whole family (even a newborn child) is covered under a single plan. This helps you ensure that all your loved ones are protected under a medical insurance plan.

• No Cap on Family Members and Age

Unlike most health insurance policies, the Ayushman Bharat Rajasthan Swasthya Bima Yojana has no limits on the number of family members that can be enrolled under the plan. Moreover, there is no limit on the age as well.

• Variety of Medical Packages

The AB-MGRSBY scheme provides around 1576 medical packages to the policyholders.

What is Covered Under the Ayushman Bharat Rajasthan Swasthya Bima Yojana?

Here’s what is covered under the AB-MGRSBY scheme:

• In-patient hospitalisation

• Newborn baby coverage

• daycare treatment

• Pre-hospitalisation costs for up to 5 days before being admitted

• Post-hospitalisation costs for up to 15 days after being discharged

What is Not Covered Under the Ayushman Bharat Rajasthan Swasthya Bima Yojana?

Check out the below list to know a few things that are not covered under the Ayushman Bharat Yojana Rajasthan:

• Minor health conditions that do not require hospitalisation (unless stipulated in the package list).

• Dental treatments undergone to enhance aesthetics.

• Expenses incurred against tonics and vitamins (unless it is included in the treatment).

• Vaccinations.

• Procedures to resemble the opposite sex, which also includes hormone replacement therapy.

• Circumcision is not covered unless it is medically needed due to an accident.

• Plastic surgery (unless it is required to correct a deformity related to some injury).

• Suicide or attempt to suicide.

• Medical treatments due to the overuse of an intoxicating substance.

• The persistent vegetative state caused by brain damage.

• Anomalies, congenital external diseases, or defects.

Eligibility Criteria for the Ayushman Bharat Rajasthan Swasthya Bima Yojana

Wondering if you are eligible for the AB-MGRSBY scheme? The following points highlight the eligibility conditions to apply for this health insurance plan:

• Individuals who are the permanent citizens of Rajasthan

• People who belong to the lower-income group

• Families eligible under the National Food Security Act (NFSA)

• Members of PMJAY

• Families under Socio Economic Caste Census (SECC) 2011

How to Register for the Ayushman Bharat Rajasthan Swasthya Bima Yojana Online

Anyone who is eligible under the PMJAY and BSBY schemes are also eligible for the Ayushman Bharat Yojana Rajasthan. Here’s how you can apply for the AB-MGRSBY scheme online:

 

• Step 1: Visit the official website of this healthcare scheme.

• Step 2: On the home page, click on the link to apply online.

• Step 3: After this, an application form will open in front of you.

• Step 4: You have to enter all the important information asked in this application form.

• Step 5: Attach all the important documents and click on the ‘Submit’ button.

 

And that’s all. It’s that easy to apply for the Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana.

Documents Needed to Avail the Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana

Just like the BSBY scheme, beneficiaries need to make use of the Bhamashah card at all partner hospitals. However, along with the Bhamashah card, you might have to furnish a few more documents. And they are:

• Bhamashah card / Bhamashah acknowledgement slip for families mentioned in the National Food Security Act (NFSA)

• Registration card number

• Aadhaar card

• 23 digital HHID number

• Ayushman Bharat Scheme eligibility letter

Note: It is mandatory to link your ration card and Aadhaar card number to the Bhamashah card by visiting your nearest e-Mitra centre.

BSBY Phase 2

Let’s explore the aim of BSBY phase 2:

• To offer cashless treatments for ailments related to the packages included under the scheme

• To ascertain that the beneficiaries do not have to pay for the medical expenses out of their own pockets

• To offer quality healthcare services

BSBY Phase 2 Features

BSBY phase 2 offers multiple key features. And they are:

1. This scheme provides cashless medical services to the families eligible under the Food Safety Act in Rajasthan.

2. To make use of the benefits of this scheme, it is mandatory to connect the Bhamashah card with NFSA.

3. It offers ₹30,000 p.a. for minor diseases, whereas, ₹3 Lakhs for chronic diseases

4. The scheme offers 1401 kinds of medical packages under the scheme. Out of these 1401 packages, 738 fall in secondary and 663 in tertiary categories. Moreover, 14 packages are for private hospitals and 46 packages are for government hospitals.

5. Expenses related to the medication, from the date of being admitted to up to 10 days post discharge, are included in the package.

AB-MGRSBY Swasthya Marg Darshak

A “Marg Darshak” is an individual who guides you through things you aren’t certain about. For the Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana, a Swasthya Marg Darshak means a person available in the hospital to help you make use of the benefits offered under the scheme.

Qualification and Skills Required to Become the Swasthya Marg Darshak

If you are interested in becoming the Swasthya Marg Darshak, you must have the following skills and qualifications:

• A graduate from a recognised university

• Ability to communicate efficiently

• Basic computer skills

• Must be residing somewhere near the healthcare institution assigned to them

Roles and Responsibility

Here’s a list of roles and responsibilities of the Swasthya Marg Darshak in AB-MGRSBY:

• Swasthya Marg Darshak will provide assistance in the medical treatment or procedure of the patients visiting the healthcare institution with this health insurance scheme.

• According to the guidelines mentioned in the scheme, you must do the identification process of the beneficiary family as well as of the patient, and other miscellaneous admission and discharge-related work.

• As the Swasthya Marg Darshak, you are responsible for generating and submitting claims, requesting queries, sending pre-authorisation requests, guiding beneficiaries, and more.

• The Marg Darshak must also upload documents to the software provided by the concerned hospital//doctor/beneficiary/nurse.

How to Raise a Claim under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

Follow the below steps to raise a claim under the Ayushman Bharat Rajasthan Swasthya Bima Yojana:

• Step 1: Visit the nearest empanelled hospital, where you can consult the doctor and get a treatment

• Step 2: Carry all the necessary documents to the hospital

• Step 3: Contact the Swasthya Marg Darshak available in the hospital

• Step 4: The Swasthya Marg Darshak will help you manage the formalities and verify your documents

• Step 5: Undergo the treatment for your illness

• Step 6: Get discharged without paying the bill because it will be taken care of by the AB-MGRSBY scheme

List of Packages under the AB-MGRSBY Scheme

Let’s checkout the list of medical packages offered under the AB-MGRSBY scheme:

Note: The entire list can be viewed on the government website.

Claim Process for the AB-MGRSBY Scheme

The claim process for secondary and tertiary care packages are a tad different. Let’s understand them in brief:

• Secondary Care Packages

Empanelled medical institutions and hospitals do not require pre-authorisation. However, it is important to note that claims must be submitted only after 3 days of a beneficiary being discharged. Documents such as the photo of the patient with a timestamp must be submitted to process the claim. Documents may be examined by an RSHAA representative. Moreover, hospitals must ensure they do not delay the process of submitting important documents. Late submissions could cost a penalty of 50% of the package.

• Tertiary Care Packages

Hospitals and healthcare institutions must send pre-authorisation requests to RSHAA and inform them about the claim. However, if they are dealing with a life-threatening situation, the hospital is allowed to complete the formality later. Insurance companies should approve the claim within 24 hours of getting all the important documents. The claim shall be deemed approved if the insurance provider does not send any approval. Hospitals must note that the treatment or procedure can begin after the pre-authorisation for treatments falling under the tertiary package. The next steps of the claim process are similar to the secondary care packages.

List of Hospitals under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

The AB-MGRSBY healthcare scheme is associated with a multitude of hospitals and medical institutions. The below table of government, as well as private medical institutions partnered with this Ayushman Bharat scheme, will help you identify the nearest hospital for you.

Government Hospitals Under the Ayushman Bharat Rajasthan Swasthya Bima Yojana:

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana Contact Details

It is important to know how you can contact an Ayushman Bharat Yojana Rajasthan representative whenever needed. It will help you deal with issues that may arise during hospitalisation.

 

Toll-Free Helpline Numbers: 1800 180 6127, 14555, 1800-111-565

Nodal Officer of Department

Name: Dr. Ashutosh Garg

Dy. Dir(Plan)DMHS

Mob. No: +91 9414310649

Ph. No: 01412223179

E-Mail: drashutoshgarg@hotmail.com

Health Insurance Plans Available at Bajaj Markets