Rajasthan’s Ayushman Bharat-Mahatma Gandhi Rajasthan Swasthya Bima Yojana health insurance to be in full force by November

• Rajasthan’s health department guarantees a revised health insurance scheme would be out soon
• 160 hospitals have already been impaneled
• IMA-Rajasthan complains over unpaid dues

THD NewsDesk, Rajasthan: Driven towards restoring the faith of antagonized citizens in the government health insurance scheme, the Rajasthan government has assured the revised plan’s beneficiaries. Addressing their complaints, the state health department reported the fresh Ayushman Bharat-Mahatma Gandhi Rajasthan Swasthya Bima Yojna (AB-MGRSBY) would be in full force by November this year. Till now, more than a hundred hospitals have already confirmed to be a part of the government scheme. 

“We are finalising things such as software and the process of empanelling of hospitals. So far, 160 hospitals have been impaneled,” said a senior health department official.

However, Dr. Thareja, President of the Indian Medical Association-Rajasthan-branch) on behalf of state-run hospitals of Rajasthan said,

“Since a lot of hospitals dues have not been cleared, they are not showing interest in the scheme.”

Until the state government does not clear the dues, there is a considerable probability that the hospitals would not agree to be a part of the scheme.

Of the many citizens failing to avail of the benefits of the scheme for their treatment, Rubina (30) said, “Till last year, I was getting the benefit under the scheme. The coverage under the scheme was Rs 3 lakh but that amount exhausted in November-December last year and since then I have been paying for dialysis. I tried a lot of times but my coverage has not been increased. My husband has disowned me and I have two daughters. My dialysis is possible only because some relatives are helping me.”

Considering the ailing kidney patient’s financial condition, the hospital has provided discounts for her dialysis to ease the burden.

A similar story of a disappointed citizen undergoing dialysis treatment, Rajesh Saini, comes from Tonk. Though earlier, a large chunk of his medical expenses was covered by the insurance scheme, the insurance amount has been thoroughly utilized, and Rajesh is on his own for the last six months. Complaining of the health insurance scheme, he alleged that his coverage had not been enhanced despite repeated requests.

Contrary to his complaint, health department officials claim the coverage of beneficiaries whose Rs 3 lakh have exhausted is being raised regularly.

Ayushman Bharat Mahatma Gandhi Rajasthan Swasthya Bima Yojana is a health insurance scheme introduced under CM Ashok Gehlot’s government in 2019. It is a family floater plan for people belonging to the Below all family members can use the Poverty Line (BPL) section of the society wherein the sum insured.

Eligibility criteria for availing of the AB-MGRSBY scheme

• Family members falling under the National Food Security Act (NFSA)
• Families must be Rajasthani natives
• Members of Ayushman Bharat Scheme

To apply for the insurance scheme, beneficiaries must also produce documents such as the Aadhaar card, Ration card and Bhamashah card/Acknowledgement Slip.

Benefits covered under the scheme

• The beneficiaries can avail of cashless hospitalization in a network/impaneled hospital.
• The principal sum insured is Rs. 5 lakh per year for each family covered under the scheme that provides Rs. 50,000 for secondary illnesses and Rs. 4,50,000 for tertiary diseases.
• AB-MGRSBY offers coverage for the entire cycle of a medical emergency, pre-hospitalization, and hospitalization rates, including follow-up care.
• Pre-Natal and post-natal care/daycare facilities for children are also covered under the scheme.

Such health insurance schemes are introduced by the government to guarantee primary health care facilities to all the citizens, regardless of their income. However, the proper implementation of projects must be assured so that the target audience benefits from them.

Source: ET Healthworld