Summary
The Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY), launched in 2021, combines the state’s Bhamashah Swasthya Bima Yojana and Ayushman Bharat (PMJAY). It provides free health insurance of up to ₹5 lakh per year to over 1.1 crore low-income families in Rajasthan, covering hospitalisation, pre- and post-treatment, daycare procedures, and newborn care. Beneficiaries can access services at empanelled private and government hospitals. While it offers significant financial protection, the coverage may not fully meet the rising costs of healthcare, making private insurance a recommended supplement for broader, pan-India coverage and higher sum insured options.
Launched on January 30, 2021, by the Government of Rajasthan, the Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana (AB-MGRSBY) combines two existing schemes, namely the Bhamashah Swasthya Bima Yojana (BSBY), a state-level scheme, and Ayushman Bharat (PMJAY), a central government scheme. AB-MGRSBY aims to provide healthcare facilities to lower-income families. Since its launch, the scheme has offered benefits to over 1.1 crore families.
When you enroll in the Ayushman Bharat Bima Yojana Rajasthan, you get access to the following benefits:
Once enrolled under AB-MGRSBY, you can receive a cashless healthcare facility without paying anything from your pocket up to the sum insured amount.
The scheme offers medical coverage of up to ₹5 lakhs. Of this, you can use ₹4.5 lakhs for tertiary illness and the balance for secondary illness.
The scheme covers pre and post-hospitalisation charges, in-patient expenses, daycare treatment, and more. It also covers newborns and children who belong to the enrolled family members.
The scheme is available as an individual plan, a family floater plan, and a group health cover. If you opt for a family floater, the sum insured is shared among all the covered members of your family.
You can access scheme benefits at both private and government hospitals in Rajasthan.
Under AB-MGRSBY, beneficiaries have access to 1,576 medical packages.
To qualify for Ayushman Bharat Mahatma Gandhi Rajasthan Bima Yojana, you must satisfy the following criteria:
• The scheme covers post-hospitalisation expenses necessary for recovery for up to 15 days from the date of discharge from the healthcare centre.
• Medical expenses necessary before admission to hospitalisation are covered for up to 5 days.
• The scheme covers both daycare and inpatient hospitalization.
• The coverage also extends to newborn babies.
To apply for the AB-MGRSBY scheme, follow the steps outlined below:
Visit the e-Mitra kiosk. You can also visit the nearby government hospital in the Rajasthan state.
Submit your identity and address proof along with your Jan Aadhar or Bhamashah ID.
The officials will verify your documents and biometric data. Once approved, you will be provided with a digital health card.
You can use the card to receive health treatment at an empanelled hospital.
AB-MGRSBY health insurance covers the following list of expenses:
• The scheme covers post-hospitalisation expenses necessary for recovery for up to 15 days from the date of getting discharged from the healthcare centre.
• Medical expenses necessary before getting admitted to hospitalisation are covered for up to 5 days.
• The scheme covers both daycare and in-patient hospitalisation.
• The coverage also extends to new born babies.
Note: The policy excludes expenses related to vaccination, plastic surgery, treatment of conditions arising out of intoxication, suicide attempts, gender change procedures, and a few more.
Parameters | AB-MGRSBY | Private Health Insurance |
|---|---|---|
Eligibility | Available to NFSA beneficiaries, BPL families, and SECC-listed households in Rajasthan. | Any individual or family that can afford to pay the premium can get health cover. |
Premium | Free | The premium varies based on age, geographical location, lifestyle, and existing health conditions. |
Coverage | Rs. 5 lakh per family for tertiary and secondary care. | Depending on the budget, coverage can be as high as a few crores. |
Portability | Limited to Rajasthan | Pan-India coverage |
Regulatory Oversight | State Health Assurance Agency | Insurance Regulatory and Development Authority (IRDA) |
The AB-MGRSBY offers health insurance to vulnerable families in Rajasthan. By merging central and state schemes, it offers eligible families cashless treatment of up to ₹5 lakh per year, without putting any restriction on age or family size. However, considering the surge in the cost of quality healthcare facilities, the coverage offered under this scheme may not always be sufficient. This is where it is recommended to get health insurance for a family from private insurers. The coverage offered by them comes with a flexible sum insured ranging from a few lakhs to up to a few crores. Not only that, there is no state-specific restriction, and you can avail cashless medical treatment across India at your insurer’s empanelled hospitals.
FAQs
The scheme provides coverage up to ₹5 lakhs per year per family for tertiary and secondary care hospitalisation. The scheme also pays for general illnesses up to ₹50,000 and ₹4.5 lakhs for serious ailments.
The scheme reimburses expenses for OPD consultations, diagnostics, and medications incurred five days before getting admitted to the hospital and 15 days after getting discharged from the hospital.
For enrolment, you need to submit identity proof such as an Aadhaar Card, a residence certificate, a BPL card, and an SECC and NFSA listing confirmation.
Swasthya Marg Darshak assists beneficiaries with the hospital process, document verification, and queries related to claims.
If you want to raise a concern, you can call the toll-free number mentioned on the AB-MGRSBY portal or visit the State Health Assurance Agency (SHAA) office in Jaipur.
Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.
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