ABMGRSBY: Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana

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:

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:

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:

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

Private Hospitals