Team AckoNov 25, 2021
The Indian state of Rajasthan is one of the most beautiful states in the country. It is rich in folk culture and tradition with a humble population of 6 crore people. The main occupation of people here is agriculture, followed by trade and business. According to the World Bank, Rajasthan also is one of the lowest-income states of India.
People belonging to low-income groups, unfortunately, cannot avail facilities like salaried jobs or health care. However, the government is striving hard to eliminate challenges related to availing medical facilities. Schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana are being introduced for providing quality health care services.
In this article we will focus on Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana for scheme related details:
Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana is a health insurance scheme introduced under Chief Minister Ashok Gehlot’s government. It was announced on 30th of August 2019. The AB-MGRSBY is expected to be very helpful for the beneficiaries because it is an integration of AB-PMJAY and BSBY schemes. These two schemes were merged to include more number of eligible families into one scheme and provide quality health care services.
AB-MGRSBY is a beneficial health insurance plan that has the following features and benefits:
The beneficiaries of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana can avail cashless hospitalization in a network/empanelled hospital. This list is available in this article under the heading “List of Hospitals That Cover under AB-MGRSBY”. As the name suggests, a cashless treatment means that the beneficiary does not have to bear the cost of a medical treatment. These costs will be borne by the government.
AB-MGRSBY offers holistic coverage that pays for the entire cycle of a medical emergency, including follow-up care. Here is a list of medical facilities that are covered under the scheme:
Hospitalization expense benefits
Daycare treatment benefits if applicable
Follow-up care benefits
Pre and post hospitalization expense benefits
Newborn child/children benefits
AB-MGRSBY offers a very good amount of sum insured to the beneficiary family. The main sum insured is Rs. 5 lakh per year for each family covered under the scheme. It is segmented as the following:
Rs. 50,000 for secondary illnesses
Rs. 4,50,000 for tertiary illness
More the number of hospitals empanelled under the scheme, the more it is beneficial at the time of a medical emergency. If an empanelled hospital is present in the vicinity of the beneficiary, he/she can reach there faster and treatment can begin. The AB-MGRSBY has many hospitals registered to treat patients under the scheme.
A health insurance plan can be of many types. The most common types are Individual, family floater, and group health insurance plans. Among these, the AB-MGRSBY scheme is a family-floater plan where the sum insured can be used by all members of the family. This is beneficial as compared to other plans because a balance can be created while making claims. For example, individual members of a family can require treatment at different times. A family floater plan can ensure that all members can avail proper medical facilities.
Things that are not covered under an insurance policy are called exclusions of the policy. An insurance company will not be liable to settle a claim raised against the exclusion of the policy. Here are the things that are not covered under AB-MGRSBY:
Minor conditions that do not require hospitalization, unless mentioned in the package list.
Cost of vitamins and tonics unless part of the required treatment.
Dental treatments carried out for enhancing aesthetics.
Surgical procedures for resembling the opposite sex including hormone replacement therapy.
Vaccinations are not covered.
Plastic surgery unless required to correct an injury-related deformity.
Circumcision unless medically required due to an accidental injury.
Attempted suicide and suicide.
The persistent vegetative state as a result of brain damage.
Expenses related to medical treatments due to overuse of any intoxicating substance.
Congenital external diseases, anomalies, or defects.
The scheme is meant for families that belong to lower-income groups and do not have access to quality health care. Considering this fact, the eligibility of AB-MGRSBY is constrained to accommodate certain families from the state of Rajasthan. Here are the eligibility criteria of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana:
Members of the eligible beneficiary family based on SECCO that rely on economic, social and caste census. Family members falling under the National Food Security Act (NFSA)
Families must be Rajasthani natives
Beneficiaries must have Aadhaar card, Bhamashah card/Acknowledgement Slip
Members of Ayushman Bharat Scheme
A family of beneficiaries do not need to carry out a separate enrolment process to enter Mahatma Gandhi Rajasthan Swasthya Bima Yojana. Since this scheme has not yet received a full-fledged launch, a specific process for registration of AB-MGRSBY has not been rolled out. However, the beneficiaries can identify themselves under the scheme by checking the relevant information from the Jan soochna portal.
Like the Bhamashah Health Insurance Scheme, the benefit of this scheme will be given through Bhamashah Card (Jan Aadhaar Card) in all registered hospitals. The following documents are required for the identification of the beneficiary family to avail the scheme:
Bhamashah Card (Jan Aadhaar Card) / Bhamashah Acknowledgement Slip for families falling under the National Food Security Act (NFSA)
Ration Card Number
Eligibility letter of Ayushman Bharat Scheme written by Hon’ble Prime Minister is required
23 digit HHID number
Note that it is necessary to get the Aadhaar card and ration card number connected to Bhamashah card (Jan Aadhaar card) by visiting the nearest e-Mitra centre.
Following are the objectives of BSBY Phase 2:
To provide cashless treatment for diseases related to packages mentioned in the scheme for eligible families.
Reducing Out of Pocket Expenditure on medical emergencies of eligible families.
To provide quality medical facilities to eligible families through state-owned hospitals as well as the empaneled private hospitals under the scheme.
Reduction in a load of patients in 4 state hospitals.
This scheme is applicable to provide cashless medical facilities to the eligible beneficiary families under the Food Safety Act of the state.
To avail the benefit of the scheme, the Bhamashah card of the beneficiary family must be connected to the NFSA.
The scheme pays Rs. 30,000 / – per annum for general diseases and Rs. 3.00 lakhs for serious diseases on a per-year basis
1401 types of disease-packages are available under the scheme, out of which 663 fall in tertiary and 738 secondary categories. Out of these, 46 packages are reserved for government hospitals and 14 packages are reserved for private hospitals.
The expenditure for medicines, from the date of admission of the patient up to 10 days after discharge, is included in the package.
Also, read: Arogya Sanjeevani Policy
A “Marg Darshak” is a person who guides you about certain things when you are in need. Concerning AB-MGRSBY, a Swasthya Marg Darshak or “Health Guide” is a person present at a hospital that will help you to avail the benefits of AB-MGRSBY.
An interested person should bear the following set of skills and qualifications to become a Swasthya Marg Darshak:
A holder of a graduate degree from an accredited university
Has good communication skills
Basic knowledge of operating a computer
Should reside near the hospital where he/she will be working
Swasthya Marg Darshak will help in the treatment of the patient coming to the medical institute under the scheme.
As per the guidelines of the plan, identification of the beneficiary family, identification of the patient and all the work related to the admission and discharge of the patient.
The Swasthya Marg Darshak will be responsible for all the work related to generating, submitting claims, sending pre-authorization requests, requesting queries, etc.
Uploading related documents from the concerned doctor/nursing worker/medical institute/beneficiary to the software.
Separate registration is not required for enrolling under AB-MGRSBY. The beneficiary family needs to use the documents listed under “How To Enroll in AB-MGRSBY” in this article, at the time of a medical emergency. This is how the family can avail cashless medical treatment under AB-MGRSBY.
The beneficiary of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana needs to carry a few documents along with them during medical treatment. These documents can help them claim secondary care packages or Tertiary care packages. The claim will be settled between the hospital and the insurance company after the verification of documents. Here is the list of documents required to claim against the Mahatma Gandhi Rajasthan Swasthya Bima Yojana:
Bhamashah Card (Jan Aadhaar Card)
Aadhaar card of the patient
The Bhamashah Card of the patient should also be linked to the Aadhaar card. The HHID Number of the family may also be required at the time of claim. Note that after verification, the patient or other beneficiaries do not have to worry about claim settlement. No further intervention is required. The beneficiary should focus on availing proper medical facilities and improving their health.
The rate for each medical package is different depending upon the complexity of the surgery. Here is a list of packages available under the scheme:
The complete list of packages can be viewed on the website of the Rajasthan Government.
|Septoplasty + FESS||ENT||39020001|
|Prolapse Uterus LeFort's||Obstetrics & Gynecology||39040001|
|Lensectomy + Vitrectomy||Ophthalmology||39070001|
|Pacemaker implantation Temporary||Cardiology & CTVS||19120001A|
|Colonoscopy with Biopsy||Gastrology||29190001A|
|Chelation Therapy for Thalassemia Major||General Medicine||19100001A|
The claim process will be carried out after the patient is discharged from the hospital. Here are the details:
For secondary care packages: An empanelled hospital does not need pre-authorisation. However, the claim needs to be submitted after 3 days of a patient’s discharge. Documents like a patient’s photo with a timestamp will be required for the claim process. Documents may be verified by RSHAA representative. Note that late submissions may attract a penalty of 50% of the package.
For Tertiary care packages: A preauthorization request must be sent to RSHAA to intimate a claim. However, in case of a life-threatening event, the hospital will be allowed to carry out this formality later. The insurance company should send the approval within 24 hours of receiving all the required documents. In the case of no communication from the insurance company, the claim is deemed to be approved. The treatment is supposed to begin only after pre-authorization for a Tertiary care package. The next process of claim is similar to that of secondary care packages.
A large number of hospitals are empanelled under this health insurance scheme. Note that a long hospital list is more beneficial for the policyholder as they do not have to spend time looking for an empanelled hospital in the time of a medical emergency. Here are the lists of both government and private hospitals:
View the complete list of government hospitals here.
|Hospital Name||Doctor||Contact||Email Address|
|JawaharLal Nehru Hospital||Dr Shyam Bhutra||9414355761||[email protected]|
|Rajkiya Mahila Chikitsalaya||Dr Ajay Sharma||9414314845||[email protected]|
|Govt Amritkaur Hospital Beawer||Dr M K Jain||9214559618||[email protected]|
|Govt Satellite Hospital||Dr.B.D.Heda||1452268024||[email protected]|
|Government General Hospital Nasirabad||Dr. R. N. Mathur||8764318505||[email protected]|
|Government Sub Division Hospital Kekri||Dr. Ramavtar Swarnkar||146729701||[email protected]|
|Yagya Narayan Hospital Ajmer||Dr Naresh Chandra Mittal||146324560||[email protected]|
|Arain||Nodal Officer||1463281124||[email protected]|
|Bhinai||Dr Navratanmal Jain||9414550704||[email protected]|
|Masuda||Gurubachan Singh||9414550704||[email protected]|
|Pisangan||Dr Ravindra Kaushik||9414252733||[email protected]|
|Pushkar||Dr M.D Kalra||9414364051||[email protected]|
|Srinagar||Dr. Yashwant Gurubakshani||9462510091||Chcsri[email protected]|
|Vijaynagar Ajmer||Dr. Gopal Joshi||9414144446||[email protected]|
|Rajeev Gandhi General Hospital Alwar||Dr. Bhagwan Sahay||9414374319||[email protected]|
|Satellite Hospital Kala Kuwa||Dr. Pramod Mathur||9829120505||[email protected]|
|Akbarpur||Dr. Gaurav Agrwal||9610780105||[email protected]|
|Badaud||Dr. Sapna Godara||9785618722||[email protected]|
|Bahror||Dr. Suresh Chand||9414200744||[email protected]|
|Badoda Mev||Dr. Alok Sharma||9828128287||[email protected]|
|Hospital Name||Doctor||Contact||Email Address|
|Ajmer ENT Hospital||Dr Sikandar Singh||9414424411||[email protected]|
|Anand Multispeciality Hospital And Research Center||Dr Narendra Anandani||9460316977||[email protected]|
|Chandak Eye Hospital||Dr.Vinit Chandak||9352994557||[email protected]|
|Deepmala Pagarani Hospital And Research||Dr J L Gargiya||9414444491||[email protected]|
|Dr Nand Lal Hospital And Research Center||Dr Preeti Batra||9461304108||[email protected]|
|Dr Vijay ENT Hospital||Dr.Vijay Gakhar||9982147067||[email protected]|
|Gheesibai Memorial Mittal Hospital And Research Centre||Shyam Kumar Somani||9314390005||[email protected]|
|Jai Clinic And Nursing Home||Dr C P Singhal||9571749915||[email protected] Empanelled|
|Jmd Hospital N Research Centre||Dr Asha Khanna||9829071475||[email protected]|
|Kshetrapal Hospital Multispeciality Research Centre||Alok Sharma||9100109409||[email protected]|
|Mewar Hospital Pvt Ltd||Dr Nitin Sanadhya||1452970188||[email protected]|
|Pkv Hospital And Research Center||Dr Himanshu Pandey||9166347554||[email protected]|
|Pushpa Chandak Memorial Multispeciality||Dr Sudha Chandak||9829087032||[email protected]|
|Rathi Hospital||Dr Sanjay Rathi||9829071299||[email protected]|
|Rishi Ortho Hospital||Dr Govind Natani||9829088135||[email protected]|
|Saran Hospital||Ramniwas Saran||9166845959||[email protected]|
|Shree Parashavnath Jain Hospital N R C||Dr N M Singhvi||9414277764||[email protected]|
|St. Francis Hospital||Dr Sunita Antony||9829506740||[email protected]|
|Swastik Hospital And Research Centre||Dr Ashish Bakliwal||9252032162||[email protected]|
|T J Mayani Hospital And Research Centre||Dr Ratna Tharani||9783928171||[email protected]|
The following contact numbers can be used for getting your queries resolved:
Nodal Officer of Department:
Dr Ashutosh Garg
Ph. No: 01412223179
Mob No: +91 9414310649
E-Mail: [email protected]
Are daycare treatments covered under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?
Yes, various daycare treatments as listed in the AB-MGRSBY package are covered under the scheme.
What is the meaning of secondary and tertiary diseases in terms of AB-MGRSBY?
Secondary diseases are general health ailments like extraction of a tooth, fractures, tonsillectomy, etc. while tertiary diseases could be conditions related to critical illnesses, for example, Lung Injury repair, Thyroplasty, Colonoscopy, etc.
What is the policy period of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?
The policy period of AB-MGRSBY is 12 months from the date of commencement or any time period as stipulated by RSHAA.
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