Launched during Chief Minister Ashok Gehlot’s administration on August 30, 2019, the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana amalgamates the AB-PMJAY and BSBY initiatives. This beneficial program offers eligible households access to top-notch healthcare services including daycare treatments, hospitalisation costs, pre and post-hospitalisation care, expenses related to newborns, and more. In this article, we will discuss in detail the benefits, coverage, inclusions, exclusions, and more about the AB-MGRSBY scheme.
AB-MGRSBY: An overview
Given below are a few details about the scheme:
Scheme name |
Ayushman Bharat – Mahatma Gandhi Rajasthan Swasthaya Bima Yojana (AB-MGRSBY) |
Objective |
AB-MGRSBY aims to reduce out-of-pocket hospitalisation costs, decrease unfulfilled medical needs, and enhance the accessibility of quality inpatient care and day care surgeries for treating illnesses and medical conditions among identified families. |
Official website |
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Sum insured |
Rs. 5 lakh* per family/ per year |
Eligibility criteria for AB-MGRSBY
The eligibility requirements for the Ayushman Bharat Mahatma Gandhi Rajasthan health insurance scheme are outlined below:
- Residents of Rajasthan with permanent citizenship status and belonging to lower-income brackets.
- Households identified under the Socio-Economic Caste Census (SECC) 2011.
- Families meeting the eligibility criteria of the National Food Security Act (NFSA).
- Individuals enrolled in the Ayushman Bharat (PMJAY) scheme.
Features and benefits of AB-MGRSBY
Discussed below are the key features of the Ayushman Bharat Mahatma Gnadhi Rajasthan health insurance scheme:
Cashless hospitalisation:
- Beneficiaries can access cashless hospitalisation in network/empanelled hospitals.
- The government bears the medical treatment costs, relieving the beneficiary of financial burdens.
Coverage for medical needs:
- Comprehensive coverage includes hospitalisation, daycare treatments, follow-up care, and pre and post-hospitalisation expenses.
- Newborn child/children benefits are also included.
High sum insured:
- Offers a substantial sum insured of Rs. 5 lakh per year for each family.
- Segmented into Rs. 50,000 for secondary illnesses and Rs. 4.5 lakh for tertiary illnesses.
Large number of empanelled hospitals:
- Increased number of empanelled hospitals enhances accessibility during medical emergencies.
- Availability of nearby empanelled hospitals ensures prompt treatment initiation.
Health insurance on family floater basis:
- Family-floater plan enables all family members to utilise the sum insured.
- Ensures equitable distribution of benefits among family members, accommodating varying medical needs over time.
Exclusions under AB-MGRSBY
Exclusions within an insurance policy delineate what is not covered by the policy. Any claims raised against these exclusions will not be entertained by the insurance company. Here are the exclusions under AB-MGRSBY:
- Minor ailments not necessitating hospitalisation, unless specified in the package list.
- Expenses for vitamins and tonics unless integral to the treatment.
- Dental procedures for cosmetic purposes.
- Surgeries for gender reassignment, including hormone therapy.
- Vaccinations are excluded from coverage.
- Plastic surgery unless medically necessary to correct injury-induced deformities.
- Circumcision unless medically necessary due to accidental injury.
- Suicidal attempts or suicide.
- Persistent vegetative state resulting from brain damage.
- Costs associated with medical treatment due to substance abuse.
- Congenital external diseases, anomalies, or defects.
Read more: Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)
AB-MGRSBY: Registration process
A family of beneficiaries is not required to undergo a separate enrollment process to participate in the Mahatma Gandhi Rajasthan Swasthya Bima Yojana. As this scheme has not been fully launched yet, a specific registration process for AB-MGRSBY has not been implemented. However, beneficiaries can register themselves under the scheme by accessing pertinent information from the Jan Soochna portal.
Claim process under AB-MGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana
You can follow the steps given below to claim benefits under AB-MGRSBY:
Step 1: Visit the nearest hospital for medical treatment.
Step 2: Bring along the necessary documents.
Step 3: Engage with the Swasthya Marg Darshak stationed at the hospital.
Step 4: The Swasthya Marg Darshak will assist with formalities and document verification.
Step 5: Receive the required medical treatment for your condition.
Step 6: If admitted to a cashless hospital, discharge without payment of medical bills is facilitated.
Also, read: Gram Suvidha
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 acknowledement slip
- Eligibility letter of Ayushman Bharat scheme
- Aadhaar Card
- Ration card number
- 23-Digit HHID number
The beneficiaries must ensure that they get their 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.
Read more: Aarogyasri Telangana - Overview, How to apply & Eligibility
Roles and responsibilities of a Swasthya Marg Darshak
Below are the duties and responsibilities of a Swasthya Marg Darshak:
- Assist patients visiting the hospital in accessing benefits provided by the AB-MGRSBY scheme.
- Identify eligible beneficiary families and patients according to scheme protocols.
- Complete necessary documentation, including patient records and discharge procedures.
- Initiate and file claim forms accurately.
- Upload all required claim documents.
In summary, the AB-MGRSBY program is a vital lifeline for countless families, offering crucial support for their healthcare needs. It simplifies access to medical services and eases the burden of expenses, ensuring that nobody is left behind due to financial constraints.
Related government scheme |
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