Bhamashah Swasthya Bima Yojana Scheme: Application, Eligibility and Benefits

Posted on: May 22, 2024 | 3 mins | Written by: HDFC ERGO Team

Bhamashah Swasthya Bima Yojana Scheme: Application, Eligibility and Benefits

Bhamashah Swasthya Bima Yojana is a family floater health insurance scheme designed and launched by the government of Rajasthan to ensure comprehensive health insurance coverage, especially for the economically weaker section of society.

What is the Bhamashah Swasthya Bima Yojana scheme?

This is an initiative introduced by the Rajasthan State Government. It was launched back in 2015 for the benefit of the people of the state. However, the current name of this initiative is Ayushman Bharat Mahatma Gandhi (ABMG) Health Insurance Scheme. The scope of this scheme has been enhanced with the inclusion of the families of the socio-economic census.

This scheme is noted for offering cashless health insurance facilities allowing coverage of up to INR 5 lakhs for generic health ailments and INR 5 lakhs for critical illnesses for the beneficiaries. To enjoy uninterrupted family floater health insurance coverage, you must ensure to pay a fixed premium every year.

Eligibility criteria for Bhamashah Swasthya Bima Yojana

To get enrolled under Bhamashah Swasthya Bima Yojana, you need to fulfill the following criteria:

• The beneficiary must be a permanent citizen of Rajasthan.

• The concerned beneficiary must be a holder of Jan's Aadhaar card and Aadhaar card.

• The beneficiary must be included in the Socio-economic Survey of 2011 for eligible families under NFS.

• The beneficiaries must belong to the economically weaker section of the society.

Features of the BSBY Health Insurance Scheme:

As designed for the BPL families of Rajasthan, some of the salient features of the BSBY include:

• Pre-hospitalisation as well as post-hospitalisation coverage:

BSBY allows pre- and post-hospitalisation expenses of up to 7 and 15 days respectively.

• Cashless facility:

BSBY allows cashless treatment facilities across a wide network of listed and impanelled hospitals.

• Zero age limit:

There are no age criteria for enrolling under this scheme.

• Single family floater plan:

This offers family floater coverage allowing hospitalization cost coverage for all the family members who are enrolled.

• Multiple types of treatments covered:

It covers several types of treatments, medical packages, and surgical procedures.

• Includes miscellaneous hospital expenses:

It also covers hospitalization expenses like meals, supplies, devices, etc.

Benefits of the Bhamashah Swasthya Bima Yojana Scheme

Some of the most highlighting benefits of the Bhamashah Swasthya Bima Yojana include:

• Direct transfer:

The benefits are directly transferred to ensure optimum transparency and eventually reduce the possibility of degradation of the fund that is allocated.

• Rewards:

Qualified applicants receive a reward of INR 2000 in two parts.

• Women-special:

There is a special biometric card identity verification for the women beneficiaries. It allows them to acquire rations from qualified PDS outlets.

• Additional payment:

BSBY pays an additional INR 100 for every family member in a family holds an active and genuine Aadhaar card.

• Comprehensive financial protection:

This scheme allows comprehensive medical insurance coverage for the economically backward section of society.

• Distribution:

This scheme has distributed over INR 2600 crores to its eligible beneficiaries.

Objectives of Bhamashah Swasthya Bima Yojana Scheme:

BSBY was launched with certain clear motives and objectives. Some of the most intriguing objectives of this scheme include:

• Health insurance coverage:

The principal objective of BSBY is to offer comprehensive health insurance coverage for economically weaker people across Rajasthan. The beneficiaries can avail of free medical treatment up to INR 5 lakhs.

• Cashless treatment facility:

BSBY allows quality healthcare treatment for a variety of ailments, eventually reducing OUP expenses to an extent, especially for the BPL people.

• Ensuring quality in-patient services:

This scheme allows easy accessibility to quality healthcare services across the state for financially backward people. It is targeted to uplift the treatment standards across the state for the common people.

What’s covered and what’s not covered in the Bhamashah Swasthya Bima Yojana Scheme:

A. What is covered?

BSBY covers the following medical expenses:

▪ Pre- and post-hospitalization expenses of up to 7 and 15 days respectively

▪ Transportation allowance of up to INR 100- INR 500 for polytrauma and cardiac cases

▪ Cashless facility for secondary and tertiary medical treatment

▪ OPD coverage

▪ Allows PED coverage

▪ Allows INR 3 lakh coverage for critical ailments

▪ Allows INR 30000 coverage for general ailments

▪ Allows coverage for room rent, nursing charges, food for the concerned beneficiary, consultation charges, etc.

B. What is not covered?

Some of the typical exclusions of the BSBY scheme are:

▪ Any individual who is not a member of the NFSA and BSBY is not covered.

▪ Non-family members of the concerned scheme do not get any coverage.

BSBY application process

You can avail of BSBY coverage using both online and offline methods:

A. Online Process:

◦ First, visit the official BSBY website.

◦ Click on the “Apply online” tab present on the home page.

◦ Fill out the application form that opens with relevant and true information as necessary.

◦ Attach all the relevant documents.

◦ The “Submit” tab needs to be clicked to complete the transaction.

B. Offline Process:

◦ Physically visit the health department office of the district to collect the relevant scheme form.

◦ Duly fill in the form with relevant information.

◦ Attach all the necessary papers.

◦ Submit all the documents to the health department to complete the application procedure.

How to download a BSBY card?

If you need to download a genuine BSBY card, you need to first complete registration under the SSO portal of Rajasthan. You must follow these simple steps:

• Log in to the designated SSO account to find the link to the Citizen App on the extreme left.

• Select the Bahamashah option in your mobile application and the option of the BSBY e-card will appear.

• Enter all the relevant details to download the card.

What is the process of activating the BSBY Health Insurance card:

To activate the health insurance card under the BSBY scheme, you must follow these steps:

• Fill out the online form for registration and enrolment under the scheme.

• After this, seek the citizen enrolment option to enter the reference ID to acquire the details.

• You need to first verify and then submit relevant information as required on the enrolment form.

• Note the auto-generated number of the enrolment receipt for your future reference.

How to edit a BSBY card online?

To edit a Bhamashah Swasthya Bima Yojana card online, you must:

• Visit the official Rajasthan SSO portal.

• Log in using your designated SSO ID and password.

• Select the “edit” option.

• Make the necessary alterations and then save.

How do I update my BSBY card bank account?

You can easily update a BSBY card bank account using a valid eMitra account:

• Log in to the relevant eMitra account.

• Select the “bank details” option.

• Enter the BSBY receipt number and the details of the bank account will be displayed.

• Make the relevant alterations and save.

How to claim under the Bhamashah Swasthya Bima Yojana?

BSBY claim settlement process is easy:

• Show your ID proof and Bhamashah Swasthya Bima Yojana card to the network hospital.

• The insurer will authorise the designated amount.

• The concerned hospital will share all the bills and reports with the insurer.

• The company will directly settle the claim.

Medical packages list of BSBY

The list of medical packages under BSBY includes:

• FESS+septoplasty

• Appendicectomy

• LeFort’s uterus prolapse

• Vitrectomy+lensectomy

• Temporary pacemaker implantation

• Pneumonectomy

• Fistulectomy

• Colonoscopy with biopsy

• Pemetrexed

• Chelation therapy for major thalassemia.

Contact details

1. Dr. Vikram Singh bsbyraj@yahoo.com | 9529963867

2. Ms. Achu Agarwal, Programme Officer, BSBY bsbyraj@yahoo.com | 8764848541

Conclusion

Bhamashah Swasthya Bima Yojana has been launched to relieve the financial pressure on poor people while getting quality medical treatment. This comprehensive health insurance scheme acts as a boon for economically weaker people.

FAQs

1. Who is eligible for the BSBY scheme?

Rajasthan’s permanent residents with valid Jan Aadhaar cards and Aadhaar cards belonging to the background of low-income groups are eligible for this scheme.

2. Are there any camps for BSBY enrolment?

Yes, respective Gram Panchayats hold these temporary camps while Panchayat Samitis and Raj Sampark Bharat Nirman Seva Kendra hold permanent centres.

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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