Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY)

The Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana (AB-PMJAY) or the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana is a government scheme for the lower section of people living in Rajasthan. The scheme is expected to benefit a whopping 1.10 crore families in the State of Rajasthan. The AB MGRSBY was earlier known as the BSBY as mentioned and was relaunched in a new avatar in January 2021.

Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana Details

Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana Eligibility Criteria

The Ayushman Card eligibility criteria include the following:

• Those who are permanent Rajasthan citizens while hailing from lower-income groups
• Those under the SECC (Socio-Economic Caste Census) 2011 as per the Ayushman Bharat Yojana eligibility guidelines
• Families eligible under NFSA (National Food Security Act)
• Members under the PMJAY or Ayushman Bharat Yojana Rajasthan scheme

Features of the Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana

• The Ayushman Bharat Bima Yojana in the new avatar offers health insurance to RSBY families in the LIG (lower-income group) categories and those under the SECC 2011 or NFSA
• The Mahatma Gandhi Ayushman Bharat Yojana will now offer the sum insured of Rs. 5 lakh to beneficiaries and Rs. 50,000 will be allotted out of this amount for covering common diseases while Rs. 4.5 lakh will be allotted for covering critical illnesses
• Beneficiaries will be able to get cashless treatment throughout all public and private empanelled hospitals
• The whole family will be covered under the scheme, including newborn babies
• There is no age limit for any family member or any limit for the number of family members covered under the scheme

Ayushman Bharat Mahatma Gandhi Swasthya Bima Yojana Benefits

• Coverage for in-patient hospitalization costs
• Coverage for post-hospitalization costs up to 15 days
• Pre-hospitalization cost coverage for up to 5 days before admission
• Coverage for daycare treatment costs 
• Coverage for newborn babies
• Completely cashless treatment at empanelled hospitals

Ayushman Bharat Mahatma Gandhi Swasthya Bima Scheme Exclusions

• Vaccination
• Over-usage of intoxicants
• Tonics and vitamins not included in treatment
• Unnecessary admission to hospital
• Suicide or attempt to suicide
• Cosmetic dental procedures 
• Plastic surgery unless included in treatment
• Operations for sex change, inclusive of hormone replacement therapies 
• Congenital ailments or defects
• Remaining in a vegetative state owing to brain damage
• Circumcision, unless medically needed

Ayushman Bharat Mahatma Gandhi Swasthya Bima Scheme Registration Procedure

• There is no separate registration required for families eligible under the scheme if they are already eligible under the BSBY or PMJAY plans
• The Jan Soochna portal offers more information for citizens

Ayushman Bharat Mahatma Gandhi Swasthya Bima Scheme Claim Procedure

• Go to the network hospital empanelled under the scheme
• Carry all vital documents
• Contact your Swasthya Marg Darshak here
• You will get assistance with all the verification procedures and formalities thereafter
• You can get treated and will be discharged without having to pay any bills afterwards 

Ayushman Bharat Mahatma Gandhi Swasthya Bima Scheme Vital Documents

• Bhamashah Card or Jan Aadhar Card or the Bhamashah acknowledgment slip
• Aadhar Card
• Eligibility Letter for the Ayushman Bharat Scheme 
• Ration Card Number
• HHID Number (23 Digits)

You should ensure that your ration and Aadhar card numbers are linked to the Bhamashah or Jan Aadhar Cards. This is compulsory under the new scheme. You can get this process done at your nearest eMitra service provider. A Swasthya Marg Darshak will be stationed at all network hospitals for helping people get all their formalities done in a hassle-free manner. This professional will have responsibility for helping patients get medical treatment seamlessly while identifying the beneficiary household and patients based on scheme guidelines. 

He or she will also help with all verification and documentation procedures linked to the discharge and admission of patients. Patients will also get help in submitting and raising claims along with requesting their pre-authorization letters alongside. They can also upload their documents to the software with ease. Those who are graduates from recognized universities with basic information about running computers, communication skills and residences near network hospitals or places of posting are eligible for applying. 

Available Medical Packages

There are more than 1,576 medical or health packages available for eligible beneficiaries under this scheme. There is a unique code allotted for every package. The rate will depend on the type of ailment and the overall complexity of surgical treatment. Here are some of the available packages under the plan: 

You will find the full list at the official portal of the Rajasthan State Government. 

Conclusion

The AB-MGRSBY scheme offers immense benefits to citizens looking to avail themselves of a variety of health and medical treatments for valid reasons. There is a vast network of empanelled hospitals with professionals present to help citizens with documentation, verification, and admission. This is one of the best possible options for Rajasthan citizens in terms of universal healthcare coverage.