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 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: [email protected]

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.

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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.