Health Insurance

ABMGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

Rajasthan is one of the most beautiful cities in India. About 60 million people live there, and the population's main occupation here is agriculture, trade and business. According to the World Bank,…

Rajasthan is one of the most beautiful cities in India. About 60 million people live there, and the population's main occupation here is agriculture, trade and business. According to the World Bank, Rajasthan is reportedly one of the lowest-income states in India.

Unfortunately, people from the low-income group are unable to avail services like good health care facilities. However, the government of Tamil Nadu is making significant efforts to remove the barriers to access to medical facilities. Schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat Mahatma Gandhi Rajasthan Health Insurance Scheme (ABMGRSBY) are being launched in the state to provide high-quality medical services.

What is Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY?

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY is a government health insurance scheme launched by Chief Minister Shri Ashok Gehlot. It was launched on 30 January 2021 to provide health insurance cover to 1.10 crore families of Rajasthan. ABMGRSBY is a combination of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and Bhamashah Swasthya Bima Yojana. The main objective of this merger of these health insurance schemes is to expand the health insurance coverage to maximum eligible families and provide the best health services to the state's people.

Key Specifications of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY?

Below mentioned are the key specifications of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

Scheme Name

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY

Launched on 

30 january 2021 

Launched by

Government of Rajasthan

Beneficiary 

People of Rajasthan

Health Insurance Sum Insured

INR 5 Lakh

Plan Type

Family floater Health Insurance

Policy Tenure

1 Year

Number of Medical Packages

1576

Network Hospitals

Government and Private

Official Website

health.rajasthan.gov.in

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY Eligibility Criteria

Below mentioned are the eligibility criteria for Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

  • Any Individual who is a permanent resident of Rajasthan.
  • Any Individual belongs to a low-income group.
  • PMJAY or Ayushman Bharat Yojana Scheme members.
  • Families come under Social Economic Caste Census (SECC) 2011.
  • Eligible Families come under the National Food Security Act (NFSA).

Key Features and Benefits of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY

Below mentioned are the key features of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

  • Health Cover for Low-Income People: Ayushman Bharat Rajasthan Swasthya Bima Yojana offers health insurance to families living in Rajasthan who belong to low-income groups and those who come under National Food Security Act (NFSA) or Social Economic Caste Census (SECC) 2011.
  • High Sum Insured Amount: ABMGRSBY offers a higher sum insured of INR 5 Lakh to all the beneficiaries, of which INR 50K is for common diseases/treatments and INR 4.5 Lakh for critical illnesses.
  • Cashless Hospitalization: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana offers cashless treatment to all the beneficiaries across all the network hospitals in Rajasthan.
  • Covers Entire Family: Ayushman Bharat Mahatma Gandhi Yojana is a family floater health plan where you get a health cover for your entire family.
  • Medical Packages: Ayushman Bharat Mahatma Gandhi Yojana or ABMGRSBY offers 1576 medical packages to the beneficiaries.
  • Age Limit: There is no age limit for family members in ABMGRSBY. That means the family member of any age can be covered under this scheme.

Coverage Benefits of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY

Below-mentioned is the Coverage Benefits of Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

Coverage Feature

Coverage Benefit

In-patient Hospitalization

Covered

Pre-Hospitalization

Covered for up to 5 Days

Post-Hospitalization

Covered for up to 15 Days

Daycare Treatment 

Covered

Newborn baby expenses

Covered

Exclusions Under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY

Below mentioned are the treatments or situations that are not covered under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

  • Minor Treatment that does not require hospitalization
  • Vaccinations
  • Vitamins and tonics
  • Plastic surgery 
  • Overuse of intoxicants
  • Cosmetic dental treatment
  • Suicide or an attempt of suicide
  • Congenital external defects, anomalies or diseases
  • Sex change operation
  • Hormone Replace therapy
  • Circumcision 
  • Persistent vegetative state due to brain damage

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana Registration

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY does not require the eligible families to register individually to avail of the benefits of the scheme. If they are eligible for PMJAY and BSBY schemes, then they are also eligible for Ayushman Bharat Rajasthan Health Insurance Scheme. But, the beneficiary can check the scheme information and identify themselves from the Jan Soochna Portal.

Claim Process Under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY 

To file a claim under ABMGRSBY, you need to follow the below-mentioned steps:

  • Visit the nearest network hospital.
  • Carry the required documents with yourself
  • Contact the “Swasthya Marg Darshak” at the network hospital.
  • Swasthya marg darshak will verify your documents and help you with the other necessary formalities.
  • Get medical treatment for your illness.
  • Get discharge from the hospital and you don’t have to pay the bill amount as it is covered under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY.

Required Documents for Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY

Below mentioned are the documents required to avail the coverage of the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

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

Who is Swasthya Marg Darshak and its Roles and Responsibilities?

A Swasthya Marg Darshak is a person at the network hospital who guides the beneficiary of the scheme regarding the benefits, key features and claim process. A Swasthya Marg Darshak is a health guide who works in a network hospital to assist the beneficiary with the documents and ensure that they receive healthcare without any problems.

Roles and Responsibilities

Following are the roles and responsibilities of the swasthya marg darshak:

  • Helping the beneficiaries at the hospital
  • Verifying the documents
  • Helping in raising and submitting the claim
  • Uploading the documents by the doctor/ patient/ hospitals to the software.

Who can Apply for Swasthya Marg Darshak?

Below-mentioned is the skills and qualifications that are required to become a swasthya marg darshak:

  • Graduation from an accredited university
  • Basic knowledge computers
  • Good communication skills
  • Residing near the network hospital

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY Package List

Below mentioned are some of the packages under Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY:

PACKAGE

SPACILITY

CODE

Prolapse Uterus LeFort's

Obstetrics & Gynecology

39040001

Pacemaker implantation Temporary

Cardiology & CTVS

19120001A

Appendicectomy

General Surgery

39010001

Septoplasty + FESS

ENT

39020001

Lensectomy + Vitrectomy

Ophthalmology

39070001

Fistulectomy

Dentistry

19110001A

Pneumonectomy

Chest Surgery

29140002A

Chelation Therapy for Thalassemia Major

General Medicine

19100001A

Pemetrexed

Medical Oncology

29160020A

Colonoscopy with Biopsy

Gastrology

29190001A

List of Government Hospitals and Private Empanelled under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana scheme or ABMGRSBY 

Below mentioned is the list of Government Hospitals and Private Empanelled under the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana scheme or ABMGRSBY:

Government Hospitals

HOSPITAL NAME

DOCTOR

JawaharLal Nehru Hospital

Dr Shyam Bhutra

Rajkiya Mahila Chikitsalaya

Dr Ajay Sharma

Govt Amritkaur Hospital Beawer

Dr M K Jain

Govt Satellite Hospital

Dr.B.D.Heda

Government General Hospital Nasirabad

Dr. R. N. Mathur

Government Sub Division Hospital Kekri

Dr. Ramavtar Swarnkar

Yagya Narayan Hospital Ajmer

Dr Naresh Chandra Mittal

Arain

Nodal Officer

Bhinai

Dr Navratanmal Jain

Masuda

Gurubachan Singh

Pisangan

Dr Ravindra Kaushik

Pushkar

Dr M.D Kalra

Srinagar

Dr. Yashwant Gurubakshani

Vijaynagar Ajmer

Dr. Gopal Joshi

Rajeev Gandhi General Hospital Alwar

Dr. Bhagwan Sahay

Satellite Hospital Kala Kuwa

Dr. Pramod Mathur

Akbarpur

Dr. Gaurav Agrwal

Badaud

Dr. Sapna Godara

Bahror

Dr. Suresh Chand

Badoda Mev

Dr. Alok Sharma

Private Hospitals

HOSPITAL NAME

DOCTOR

Ajmer ENT Hospital

Dr Sikandar Singh

Anand Multispeciality Hospital And Research Center

Dr Narendra Anandani

Chandak Eye Hospital

Dr.Vinit Chandak

Deepmala Pagarani Hospital And Research

Dr J L Gargiya

Dr Nand Lal Hospital And Research Center

Dr Preeti Batra

Dr Vijay ENT Hospital

Dr.Vijay Gakhar

Gheesibai Memorial Mittal Hospital And Research Centre

Dr Shyam Kumar Somani

Jai Clinic And Nursing Home

Dr C P Singhal

Jmd Hospital N Research Centre

Dr Asha Khanna

Kshetrapal Hospital Multispeciality Research Centre

Alok Sharma

Mewar Hospital Pvt Ltd

Dr Nitin Sanadhya

Pkv Hospital And Research Center

Dr Himanshu Pandey

Pushpa Chandak Memorial Multispeciality

Dr Sudha Chandak

Rathi Hospital

Dr Sanjay Rathi

Rishi Ortho Hospital

Dr Govind Natani

Saran Hospital

Ramniwas Saran

Shree Parashavnath Jain Hospital N R C

Dr N M Singhvi

St. Francis Hospital

Dr Sunita Antony

Swastik Hospital And Research Centre

Dr Ashish Bakliwal

T J Mayani Hospital And Research Centre

Dr Ratna Tharani

ABMGRSBY Contact Details:

Below-mentioned contact numbers can be used to get your queries resolved:

  • 14555 (Toll-Free)
  • 1800-111-565 (Toll-Free)
  • 1800-180-6127 (Toll-Free)

Nodal Officer of Department:

  • Dr Ashutosh Garg
    • Dy.Dir(Plan)DMHS
    • Ph. No: 01412223179
    • Contact No: +91 9414310649
    • E-Mail ID: drashutoshgarg@hotmail.com

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana or ABMGRSBY FAQs

  1. What is Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (ABMGRSBY)?

Ans. Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (ABMGRSBY) is a health insurance scheme implemented by the Government of Rajasthan, India. It aims to financially protect eligible families by offering cashless healthcare services for certain medical treatments and hospitalizations.

  1. Who is eligible for ABMGRSBY?

Ans. The eligibility criteria for ABMGRSBY include the following:

  • Residence: The scheme is available to residents of Rajasthan, India.
  • Socio-Economic Categorization: Families falling under the categories of Below Poverty Line (BPL), Socio-Economic Caste Census (SECC), or identified as Deprived Rural Families by the government are eligible.
  • Family Size: Families with up to five members can be covered. Families with up to seven members may also be eligible in certain cases.
  • Age: There are no specific age restrictions for eligibility. However, the scheme primarily targets vulnerable populations, including the elderly, women, and children.
  1. What are the benefits of ABMGRSBY?

Ans. The ABMGRSBY scheme provides the following benefits:

  • Health Coverage
  • Cashless Treatment
  • Financial Protection
  • Comprehensive Coverage
  • Transport Allowance
  • No Cap on Family Size
  1. How can one apply for ABMGRSBY?

Ans. The application process for ABMGRSBY typically involves the following steps:

  • Registration: Eligible families must register for the scheme through the designated registration process. This may involve providing necessary details, such as family information, identification documents, and proof of eligibility criteria.
  • Verification: The authorities will verify the provided information and documents to determine the family's eligibility for the scheme.
  • Issuance of Health Card: Once the eligibility is confirmed, a health card is issued to the eligible family members. This card provides cashless treatment at empanelled hospitals and healthcare facilities.

The specific application process and required documentation may vary. It is recommended to refer to the official guidelines or contact the relevant authorities for precise instructions on applying for ABMGRSBY.

  1. Are there any costs associated with ABMGRSBY?

Ans. Eligible families under ABMGRSBY are entitled to receive healthcare services free of cost at empanelled hospitals and healthcare facilities. The scheme covers the treatment expenses up to the defined limits. However, it's important to note that there may be certain exclusions or co-payment requirements for specific procedures or services, as outlined in the scheme guidelines.

  1. How can one find empanelled hospitals under ABMGRSBY?

Ans. The list of empanelled hospitals under ABMGRSBY is typically available on the scheme's official website or through the designated authorities. Beneficiaries can refer to these sources to find the hospitals that are equipped to provide cashless treatment under the scheme.

  1. Can one avail treatment at non-empanelled hospitals under ABMGRSBY?

Ans. Generally, the ABMGRSBY scheme is designed to provide cashless treatment at empanelled hospitals and healthcare facilities. However, in certain emergencies or when empanelled hospitals are unavailable nearby, beneficiaries may be allowed to seek treatment at non-empanelled hospitals. In such cases, the reimbursement process would apply, where the beneficiary would need to pay for the treatment initially and then claim reimbursement from the scheme authorities as per the defined procedures.

 

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