Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana Overview

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY) is a government scheme introduced on August 30, 2019, under Chief Minister Ashok Gehlot’s government. Since this healthcare scheme is an amalgamation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Bhamashah Swasthya Bima Yojana, it is deemed useful to the beneficiaries. Both AB-PMJAY and BSBY were merged together to broaden the eligibility criteria and offer better medical assistance.

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 expenses

  • 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:

Package

Specialty

Code

Prolapse Uterus LeFort's

Obstetrics & Gynaecology

39040001

Appendicectomy

General Surgery

39010001

Lensectomy + Vitrectomy

Ophthalmology

39070001

Septoplasty + FESS

ENT

39020001

Pneumonectomy

Chest Surgery

29140002A

Pacemaker implantation Temporary

Cardiology & CTVS

19120001A

Chelation Therapy for Thalassemia Major

General Medicine

19100001A

Fistulectomy

Dentistry

19110001A

Pemetrexed

Medical Oncology

29160020A

Colonoscopy with Biopsy

Gastrology

29190001A

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:

Name of the Hospital

Name of the Doctor

Contact Details

Email Address

Govt Amritkaur Hospital Beawar

Dr. M. K. Jain

9214559618

Pmoakh@Rediff.Com

Rajkiya Mahila Chikitsalaya

Dr. Ajay Sharma

9414314845

Dr.Ajayshama.80@Gmail.Com

JawaharLal Nehru Hospital

Dr. Shyam Bhutra

9414355761

Supdtjlnhospitalajmer@Gmail.Com

Government Sub Division Hospital Kekri

Dr. Ramavtar Swarnkar

146729701

Pmokekri@Yahoo.Com

Govt Satellite Hospital

Dr. B. D. Heda

1452268024

Pmosatelliteajmer@Gmail.Com

Government General Hospital Nasirabad

Dr. R. N. Mathur

8764318505

Pmonasirabad@Yahoo.Com

Bhinai

Dr. Navratanmal Jain

9414550704

Chc_bhinai@Yahoo.In

Yagya Narayan Hospital Ajmer

Dr. Naresh Chandra Mittal

146324560

Ynhksg123@Gmail.Com

Arain

Nodal Officer

1463281124

Chcarain@Yahoo.In

Pushkar

Dr. M. D. Kalra

9414364051

Moicpushkar@Gmail.Com

Masuda

Gurubachan Singh

9414550704

Chcmasuda@Gmail.Com

Pisangan

Dr. Ravindra Kaushik

9414252733

Chcpisn@Yahoo.Com

Akbarpur

Dr. Gaurav Agrwal

9610780105

Phcakbarpur@Rediffmail.Com

Srinagar

Dr. Yashwant Gurubakshani

9462510091

Chcsrinagar@Gmail.Com

Vijaynagar Ajmer

Dr. Gopal Joshi

9414144446

Bjnrghb1956@Gmail.Com

Rajiv Gandhi General Hospital Alwar

Dr. Bhagwan Sahay

9414374319

Pmo_alw@Rediffmail.Com

Baroda Mev

Dr. Alok Sharma

9828128287

Mobarodamev@Gmail.Com

Badaud

Dr. Sapna Godara

9785618722

Chcbarrod@Gmail.Com

Behror

Dr. Suresh Chand

9414200744

Chc_beh@Rediffmail.Com

Satellite Hospital Kala Kuan

Dr. Pramod Mathur

9829120505

Hospitalsatelite@Gmail.Com

Name of the Hospital

Name of the Doctor

Contact Details

Email Address

Jmd Hospital N Research Centre

Dr. Asha Khanna

9829071475

Drykkhanna@Rediff.Com

Anand Multispeciality Hospital And Research Center

Dr. Narendra Anandani

9460316977

Anandmhospital@Gmail.Com

Ajmer ENT Hospital

Dr. Sikandar Singh

9414424411

Sikandersingh82@Gmail.Com

Deepmala Pagarani Hospital And Research

Dr. J. L. Gargiya

9414444491

Info@Deepmalahospitalajmer.Com

Chandak Eye Hospital

Dr. Vinit Chandak

9352994557

Chandak.Eye.Hospital@Gmail.Com

Dr Nand Lal Hospital And Research Center

Dr. Preeti Batra

9461304108

Drnandlalhospital@Gmail.Com

Dr Vijay ENT Hospital

Dr. Vijay Gakhar

9982147067

Drvijaygakhar@Gmail.Com

Gheesibai Memorial Mittal Hospital And Research Centre

Shyam Kumar Somani

9314390005

Shyam@Mittalhospital.Com

Jai Clinic And Nursing Home

Dr. C. P. Singhal

9571749915

Jaiclinichospital@Gmail.Com Empanelled

Pkv Hospital And Research Center

Dr. Himanshu Pandey

9166347554

Himanshupandaybds@Yahoo.Com

Kshetrapal Hospital Multispeciality Research Centre

Alok Sharma

9100109409

Tpa.Kshetrapal@Gmail.Com

Mewar Hospital Pvt Ltd

Dr. Nitin Sanadhya

1452970188

Cashless@Mewarhospitals.Com

Shree Parshwanath Jain Hospital N R C

Dr. N M Singhvi

9414277764

Parashvanath2002@Gmail.Com

Pushpa Chandak Memorial Multispeciality

Dr. Sudha Chandak

9829087032

Drsudhachandak@Yahoo.In

Rathi Hospital

Dr. Sanjay Rathi

9829071299

Mmgranites@Gmail.Com

Rishi Ortho Hospital

Dr. Govind Natani

9829088135

Drgovindnatani@Yahoo.Co.Uk

Saran Hospital

Ramniwas Saran

9166845959

Hospitalsaran@Gmail.Com

T J Mayani Hospital And Research Centre

Dr. Ratna Tharani

9783928171

Mayanihospital@Rediffmail.Com

 

St. Francis Hospital

Dr. Sunita Antony

9829506740

Gracesunita@Gmail.Com

Swastik Hospital And Research Centre

Dr. Ashish Bakliwal

9252032162

Swastikhospitalkekri@Gmail.Com

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

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FAQs Related to Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

  • ✔️How much coverage does the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana offer for minor diseases?

    The Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana offers ₹50,000 for minor diseases.

  • ✔️How much coverage does the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana offer for serious diseases?

    The Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana offers ₹4.5 Lakhs for serious diseases.

  • ✔️Is a newborn child covered under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?

    Yes. Newborn children are covered under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana.

  • ✔️What is the eligibility criteria to apply for the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?

    The eligibility criteria to apply for the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana is:

    • 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

  • ✔️As per the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana, what are secondary and tertiary diseases?

    According to the AB-MGRSBY scheme (Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana), secondary diseases are general health problems and tertiary diseases are basically conditions related to critical illnesses like thyroplasty, lung injury repair, colonoscopy, and more.