Bhamashah Swasthya Bima Yojana

• Enjoy options to cover yourself, your spouse, kids and even your parents
• Enjoy access to 10,000+ hospitals for cashless treatment
• Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

Bhamashah Swasthya Bima Yojana is a health insurance scheme developed by the Government of Rajasthan to provide quality healthcare for the state’s citizens. This is a cashless scheme that provides financial security against various medical threats faced by poor families in Rajasthan. This scheme is primarily designed for the benefit of people living in rural areas. This cover ensures that the overall health status of the state is improved through effective measures. Moreover, the data collected from schemes like this can be used to implement policy level changes in the government’s healthcare initiatives.

Eligibility for Bhamashah Swasthya Bima Yojana

Members must meet the following eligibility criteria to avail benefits under this medical insurance scheme:

• Members who are covered under National Food Security Act (NFSA) and Rashtriya Swasthya Bima Yojana (RSBY) are eligible for this scheme.
• There is no age limit for members enrolling in this cover. Families of members can also be covered under this scheme.

Features of Bhamashah Swasthya Bima Yojana

Some of the notable features of Bhamashah Swasthya Bima Yojana can be listed as follows:

• This is a complete cashless treatment scheme that pays for all hospitalisation expenses incurred by the insured.
• The insured can obtain treatment benefits up to Rs.30,000 for general illnesses and Rs.3 lakh for critical illnesses.
• Treatment for members is provided through government hospitals and private network hospitals.
• This scheme provides stimulus for private hospitals to open their facilities in rural areas, thereby reducing the pressure of government hospitals.
• For secondary and tertiary illnesses, beneficiaries will be covered as per the pre decided packaged rates.
• All pre-existing conditions will be covered from the beginning of this scheme.
• Pre hospitalisation medical expenses are covered for up to 7 days before admission in a hospital.
• Post hospitalisation medical expenses are covered for up to 15 days after discharge from the hospital.
• This scheme was originally intended only for in-patient expenses, but the coverage has been extended later to include OPD medical expenses.
• Coverage related information can be obtained from the call center associated with this plan. A mobile application is also available to track the status of this policy.

Benefits of Bhamashah Swasthya Bima Yojana

Though the exclusions are not directly outlined under this policy cover, this scheme is limited to medical emergencies and necessary treatments. Cosmetic or aesthetic treatments are not covered under thisExclusions of Bhamashah Swasthya Bima Yojana scheme. Moreover, certain conditions may not be covered under this policy unless there is a medical emergency.

Claim Procedure

Since this is a cashless treatment scheme, all medical expenses incurred by the members are paid directly to the network hospital within the approved package limit. The insured must provide the policy card and other personal identification proof during the time of admission in a network hospital. During the time of admission, the network hospital will seek authorisation from the insurer regarding the patient’s admission.

The cashless treatment will begin after the authorisation is obtained. Once the treatment is over, the network hospital will send the medical bills, diagnostic reports, discharge summary, physical certificate, and other relevant documents to the insurer. The insurer will verify these documents and transfer the claim amount to the network facility.