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

The Ayushman Bharat Mahatma Gandhi Yojana is a health insurance scheme introduced by the State Government of Rajasthan on 30th January’2021. This public health insurance scheme was launched by Chief Minister of Rajasthan, Ashok Ghelot, to provide cashless medical treatment to low-income citizens of Rajasthan. The scheme will benefit 1.10 crore families in the state of Rajasthan. The scheme is an integration of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Bhamashah Swasthya Bima Yojana.The two schemes were integrated to extend health coverage to maximum eligible families and provide quality healthcare services.

Given below are the features of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

• Cover for lower income groups: Under the scheme, health insurance coverage is offered to families belonging to lower income groups and those which are a part of the National Food Security Act and Socio-Economic Caste Census 2011.

• High sum insured: High coverage amount of 5 lakh is offered to all the beneficiaries out of which 50,000 is for common ailments and remaining 4.5 lakh is for critical illness cover.

• Cashless hospitalization: Cashless treatment service is offered to all beneficiaries across all government and private hospitals in the state of Rajasthan.

• Extend coverage to family: Entire family including a newborn baby is covered under the AB-MGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

• Access to wellness packages: Overall beneficiaries get access to 1576 medical packages

• No limit on age or family members: There is no limit on the entry age of the family members and nor any limit on the number of family members covered

The below individuals are eligible to receive coverage under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

• Individuals who are permanent residents of the state of Rajasthan
• Individuals belonging to lower income groups
• Families that are a part of the socio economic caste census SECC (2011)
• Ayushman Bharat Scheme members

Given below are the benefits of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima

• Pre-hospitalization expenses up to 5 days
• Post-hospitalization expenses up to 15 days
• In-patient hospitalization
• Day care treatment expenses
• Newborn coverage

Given below is the list of exclusions of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima scheme

• Vaccination
• Cosmetic dental treatment
• Hospitalization for treatment that was not necessary
• Cosmetic treatment
• Dental treatment
• Plastic surgery
• Overuse of intoxicants
• Suicide or attempt to suicide
• Sex change operation
• Hormone replacement therapy
• Circumcision
• Persistent vegetative state due to brain damage

Separate registration is not required for families that are already covered under the PMJAY and BSBY schemes. A full-fledged launch of the scheme has not been done yet, due to which the registration process for this scheme has not been rolled out.

However, to get coverage, the eligible members can check for the relevant information on the Jan Soochna portal.

Process of raising claim under AB-MGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

• Visit the nearest hospital to get the medical treatment
• Carry the required documents to the hospital
• Connect with the Swasthya Marg Darshak at the hospital
• The Swasthya Marg Darshak will help you with the formalities and verification of the documents
• Get the required treatment for your medical condition
• If hospitalized at a cashless hospital, you can get discharged without having to pay off the medical bills

The below documents are required to be submitted to avail benefits under AB-MGRSBY scheme

• Eligibility letter of the Ayushman Bharat scheme
• Ration card number
• 23 digit HHID number
• Aadhar card number
• Jan Dhan Card or Bhamashah card

Given below are the roles and responsibilities of a Swasthya Marg Darshak

• Help the patient who has visited the hospital to avail the benefits under the AB-MGRSBY scheme
• Identifying the beneficiary family and patient as per the guidelines of the scheme
• Carry out the documentation process including patient documentation and discharge
• Raise and submit claim forms
• Upload the claim documents

The following skills and qualifications are required to become a Swasthya Marg Darshak

• A graduate from accredited university
• Basic knowledge of operating computers
• Good communication skills
• Residing near the network hospital