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Rajasthan Government Health Scheme

 

Introduction

 

The Rajasthan Government has been providing medical facilities to Honourable Members of the Government, MLAs, Ex-MLAs, as well as the State Government officials and pensioners with provisions under the various Laws, Schemes, and Medical Insurance Policies. Private bodies/boards/companies provide medical institutions with their own regulations. Key rules/schemes are as follows:

  • Rules of Members of the Rajasthan Legislative Council (Medical Services) Laws, 1964

  • Rules of Members of the Rajasthan Provincial Council Former Members and Family Pensioners (Medical Equipment), 2010

  • Rules of Rajasthan Civil Services (Medical Attendance), 2013

  • Rajasthan State Pensioners' Medical Concession Scheme, 2014

  • Raj Mediclaim Policy

In addition to the above, Ministers, Justice Officials, All Indian Authorities also receive medical facilities under the following rules:

  • Rules of the Minister of Rajasthan (Medical Attendance), 1961

  • Rules of Rajasthan Judicial Officers (Medical Facilities), 2008

  • All Laws of India Services (Medical Attendance), 1954

About Scheme:


All state-run hospitals accredited by the State Government and Private-Public Hospitals will be eligible to provide treatment facilities under this program in accordance with the terms and conditions. In the event of a serious emergency, treatment will be allowed in referral hospitals after appropriate referral by the appropriate authority.

The scheme relies on CGHS prices and surgeries otherwise it may be not amended under this program to provide emergency medical treatment in intensive care hospitals.

This program will provide:

  • Investigations at Government Institutions and Diagnostic Canters

  • OPD treatment

  • Non-revenue area for IPD / day-care services.

  • Family Welfare, Obstetrics, and Child Health Services.

Beneficiaries and Scheme Coverage:

 

Sub-Category

Beneficiary Category

Rules / Scheme presently applicable

RGHS Coverage

RGHS-1

Ministers

Medical facilities as per The Rajasthan Ministers (Medical Attendance) Rules, 1961

Availability in terms of applicable laws

RGHS-2

Members of Rajasthan Legislative Assembly

Medical facilities as per The Rajasthan Legislative Assembly Members (Medical Facilities) Rules, 1964

Availability in terms of applicable laws

RGHS-3

Ex-Members of Rajasthan Legislative Assembly

Medical facilities as per Rajasthan Legislative Assembly Ex-Members and Family Pensioners (Medical Facilities) Rules, 2010

Availability in terms of applicable laws

RGHS-4

Serving and Retired Judicial Officers

Medical facilities as per Rajasthan Judicial Officers (Medical Facilities) Rules, 2008

Availability in terms of applicable laws

RGHS-5

Serving AIS Officers

Medical facilities as per All India Services (Medical Attendance) Rules, 1954, and also various orders issued by DOP in this regard.

Availability in terms of applicable laws

RGHS-6

Retired AIS


Availability in terms of applicable laws

RGHS-7

Serving State Government employees appointed prior to 01-01-2004

Medical facilities as per RCS(MA) Rules, 2013

Availability in terms of applicable laws

RGHS-8

Pensioners and family pensioners under RCS (Pension) Rules, 1996

Medical facility as per Rajasthan State Pensioners Medical Concession Scheme, 2014

Availability in terms of applicable laws

RGHS-9

Serving State Government employees appointed on or after 01-01-2004

Medical facilities up to the extent of Raj Mediclaim Policy (i.e. up to the limit of Rs 3.00 lacs only for indoor patients.)

  • IPD / Day-care, OPD (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lakhs per family in flat.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations.

  • Ambulance fees.

RGHS-10

Pensioners of State Government covered under NPS

No medical facility available at present

  • IPD / DAY- care, OPD without cash (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lacs for a family on floater-basis.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations

  • Ambulance fees

RGHS-11

Serving employees of State Autonomous Bodies (SAB) including Boards, Corporation, etc. who were appointed prior to 01.01.2004

As per applicable Scheme of concerned Board/corporation etc.

  • IPD / DAY- care, OPD without cash (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lacs for a family on floater-basis.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations

  • Ambulance fees.

RGHS-12

Serving employees of State Autonomous Bodies (SAB) including Boards, Corporation, etc. who were appointed on or after 01.01.2004

Presently under Raj Mediclaim Scheme.

  • IPD / DAY- care, OPD without cash (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lacs for a family on floater-basis.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations

  • Ambulance fees

RGHS-13

Pensioners of State Autonomous Bodies (SAB) including Boards, Corporation, etc. who were appointed prior to 01.01.2004

As per applicable Scheme of concerned Board/corporation etc.

  • IPD / DAY- care, OPD without cash (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lacs for a family on floater-basis.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations

  • Ambulance fees

RGHS-14

Pensioners of State Autonomous Bodies (SAB) including Boards, Corporation, etc. who were appointed on or after 01.01.2004

No medical facilities.

  • IPD / DAY- care, OPD without cash (up to Rs.20,000), medical care facilities in accordance with CGHS standards or other rates as determined by the competent authority.

  • Treatment up to INR 5 lacs for a family on floater-basis.

  • Additional costs related to traumatic illness up to Rs 5 lacs per family.

  • Travel allowance for medical treatment as applicable TA Rules & Regulations

  • Ambulance fees

 

In case of Grave Illness - RGHS Coverage:

 

Cases of Vascular Surgery, Coronary Artery Surgery, Hodgkin's Disease, Urinary Tract Survival for More Than 24 Hours, Acute Myocardial Infarction, Acute Pneumonitis, Acute Respiratory Distress, Cancer, Kidney Failure, Stroke, Multiple Sclerosis, Meningitis, Transplantation of Major Organs such as Kidney, Lungs, Pneumonia, Heart, Liver or Bone Marrow, Injuries, Delivery, Pregnancy Tuberculosis and related complications, swine flu, dengue fever, Appendicitis, Pancreatitis, etc. can be treated in case of emergency.

RGHS: Fully Online and Automated system:

 

  • HBEC Hospital Strengthening (Apply and approve the program) on the RGHS web portal: Online and color process

  • Identified database of family beneficiary status (Jan Aadhar)

  • Pre-authorization at hospital level only

  • Payment through Online System in Hospitals

RGHS - Claim Settlement:

 

The claim payment process will be on the RGHS IT Platform via the RGHS portal and the electronic medical record (EMR) of each beneficiary will be kept with the RGHS cardholder in an electronic Wallet.

Grievance Redressal:

 

Any dispute between the SIPF and the beneficiary, the SIPF and the affiliated impaneled hospitals, and the beneficiary hospital which is unable to operate during or after the scheme period in connection with the validity, interpretation, operation, or alleged violation of any provision of the scheme shall be District Level Grievance Redressal Committee (DGRC), State Level Grievance Redressal Committee (SLGRC) and Appeal Authority.

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