AB-MGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

The AB-MGRSBY is an integration of Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Bhamashah Swasthya Bima Yojana (BSBY). As a result, it will benefit about 1.10 crore families in Rajasthan.

Key Highlights of Ayushman Bharat Mahatma Gandhi Rajasthan Health Insurance Scheme 

The Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana was previously known as Bhamashah Swasthya Bima Yojana. However, this scheme was launched again in January 2021 after combining with the AB-PMJAY.

Take a look at the key highlights of the Ayushman Bharat Mahatma Gandhi Rajasthan health insuranc scheme 2021: 

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana 2021 Eligibility Criteria 

The eligibility criteria for the Ayushman Bharat Mahatma Gandhi Rajasthan health insurance scheme 2021 is as follows:

• People who are permanent citizens of Rajasthan and belong to lower-income groups
• Families under Socio Economic Caste Census (SECC) 2011
• Eligible families under the National Food Security Act (NFSA)
• Members of the Ayushman Bharat (PMJAY) scheme

Salient Features of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana 2021

Check out the salient features of Ayushman Bharat Rajasthan Swasthya Bima Yojana 2021:

• Coverage for Lower Income Groups - It offers health insurance coverageto RSBY Rajasthan families belonging to lower-income groups and those under National Food Security Act and Socio-Economic Caste Census 2011.
• High Sum Insured - The scheme offers a high sum insured of Rs 5 lakh to all beneficiaries, out of which Rs 50,000 is for coverage of common ailments and Rs 4.5 lakh is for critical illnesses coverage.
• Cashless Hospitalization Treatment - It provides cashless hospitalization treatment to the beneficiary across all empanelled government and private hospitals in Rajasthan.
• Coverage for the Entire Family - The Ayushman Bharat Mahatma Gandhi Yojana Rajasthan is a family floater scheme where a single policy provides coverage to the entire family, including a newborn baby.
• Wide Range of Medical Packages - The scheme offers a total of 1576 medical packages to the beneficiaries.
• No Limit on Age or Family Members - It does not come with any age limit for the family members or any limit for the number of family members that can be covered.

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana 2021 Benefits 

The following are the coverage benefits of Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana Rajasthan:

• In-patient hospitalization expenses
• Pre-hospitalization expenses for up to 5 days before getting admitted
• Post-hospitalization expenses for up 15 days after getting discharged from the hospital
• Day care treatment expenses
• Newborn baby coverage

Exclusions of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?

Medical expenses resulting from the following are not covered by the Ayushman Bharat Mahatma Gandhi Yojana Rajasthan:

• Unnecessary hospitalization
• Vitamins and tonics, which are not part of the treatment
• Vaccinations
• Cosmetic dental treatment
• Plastic surgery unless part of the treatment
• Overuse of intoxicants
• Suicide or an attempt of suicide
• Congenital external defects, anomalies or diseases
• Sex change operation, including hormone replacement therapy
• Circumcision unless required medically
• Persistent vegetative state due to brain damage

How to Register for Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana 2021? 

The eligible families under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana do not have to register themselves separately to avail the benefits of the scheme. If they are eligible under the PMJAY and BSBY schemes, they are eligible under the Ayushman Bharat Rajasthan Swasthya Bima Yojana. Besides, a specific registration process for this scheme has not been rolled out yet as a full-fledged launch has not taken place.

However, eligible families can check relevant information related to the scheme on the Jan Soochna portal.

How to Raise a Claim Under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana?

To raise a claim under Ayushman Bharat Rajasthan Swasthya Bima Yojana, you need to follow the steps given below:

• Visit the network hospital where you want to get medical treatment
• Carry the required documents to the hospital
• Contact the Swasthya Marg Darshak at the hospital
• The Swasthya Marg Darshak will help you with all the formalities and verify your documents
• Take treatment for your illness
• Get discharged without paying the bill as it will be covered under the AB-MGRSBY scheme

Documents Required for Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana 

The following documents are required to avail the benefits of the Ayushman Bharat Mahatma Gandhi Rajasthan health insurance scheme:

• Jan Aadhaar Card or Bhamashah Card/ Bhamashah acknowledgement slip
• Eligibility letter of Ayushman Bharat scheme
• Aadhaar Card
• Ration card number
• 23-Digit HHID number

Make sure to get your Aadhaar Card and ration card number interlinked to Jan Aadhaar Card/ Bhamashah Card as it is mandatory under AB-MGRSBY 2021. You can get it interlinked by visiting the nearest e-Mitra centre.

Ayushman Bharat Mahatma Gandhi Yojana Rajasthan Swasthya Marg Darshak  

Under the Ayushman Bharat Mahatma Gandhi Rajasthan health insurance scheme, a Swasthya Marg Darshak is a person who guides the beneficiary of the AB-MGRSBY 2021 to avail the benefits of the scheme. He/she is basically a health guide who is present at the network hospital to help the patients with all the formalities and ensure that they receive the treatment without any hassles.

Role & Responsibilities of a Swathya Marg Darshak:

The following is the role and responsibilities of a Swasthya Marg Darshak:

• To help a patient coming to the network hospital under the AB-MGRSBY scheme to avail medical treatment
• To identify the beneficiary family and the patient as per the guidelines of the scheme
• To carry out all documentation work related to the patient’s admission and discharge from the hospital
• To raise and submit claims, request for a pre-authorization letter, etc. on behalf of the patient
• To upload documents by the patient/ doctor/ hospital to the software

Who Can Apply for Swasthya Marg Darshak? 

People interested in applying for Swathya Marg Darshak should have the following qualifications and skills:

• A graduate from an accredited university
• Basic knowledge of operating computers
• Good communication skills
• Should stay near the network hospital where he/ she would be posted

List of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana Medical Packages

Ayushman Bharat Mahatma Gandhi Rajasthan health insurance scheme offers 1576 medical packages to the beneficiaries. Each package comes with a unique code. The rate for the package depends on the disease and the complexity of the treatment/ surgery. Take a look at some of the packages available under the Ayushman Bharat Swasthya Bima Yojana Rajasthan: 

The complete list of medical packages available under the scheme can be found on the official website of the Government of Rajasthan.