Rajasthan Government Health Scheme

Scheme Introduction: A Brief Overview

The Rajasthan Government Health Scheme (RGHS) is a cashless health benefit scheme of the Government of Rajasthan for state government employees, pensioners, public representatives, and other notified categories. The Finance (Insurance) Department introduced the scheme on 9 April 2021. Currently, it is implemented by the Rajasthan State Health Assurance Agency (RSHAA) under the Medical and Health Department. RGHS covers indoor (IPD) treatment, specified day-care procedures, outdoor (OPD) treatment, investigations, and treatment under Ayurveda, Homeopathy and Unani, along with other treatments that the state government specifies from time to time.

Before RGHS, medical facilities for different groups ran under separate rules, such as the Rajasthan Civil Services (Medical Attendance) Rules, 2013, the Rajasthan State Pensioners' Medical Concession Scheme, 2014, the medical rules for Ministers, MLAs, ex-MLAs, judicial officers and All India Services officers, and the Raj Mediclaim Policy. The government launched RGHS to bring these categories under one cashless system. The objective of the scheme is to give eligible beneficiaries and their dependent family members quality medical treatment without paying upfront at the hospital or pharmacy, while each category keeps the facilities allowed under its own rules.

The scheme compulsorily covers  Ministers, All India Services officers, MLAs and ex-MLAs, serving and retired judicial officers, serving government employees (under both the old and new pension schemes) and pensioners/family pensioners. It also applies to employees and pensioners of  Autonomous Bodies, Boards and Corporations. Under the scheme, new beneficiaries get treatment of up to ₹5 lakh per year on a family floater basis, and it also covers expenses above ₹5 lakh for catastrophic illnesses in government or empanelled private hospitals. For State Autonomous Body (SAB) employees and pensioners, a sum insured of ₹5 lakh per family per year (including ₹20,000 for OPD) plus an additional ₹5 lakh for specified catastrophic illnesses is provided.

Rajasthan Government Health Scheme runs fully online. Beneficiaries register through the Rajasthan SSO portal using their  Jan Aadhaar details, and each eligible family gets a single  RGHS e-card number that every registered member can use. Treatment is available at government hospitals, empanelled private hospitals, PPP hospitals, and referral hospitals, while OPD medicines are available at  CONFED stores and empanelled pharmacies. Hospitals receive payment as per RGHS rates, which follow CGHS rates until the state notifies its own rates. Reimbursement is allowed only where cashless treatment is not available, such as treatment in a grave emergency at an unapproved hospital, and the claim must be filed on the RGHS portal.

Like RGHS, the Rajasthan government is also running three other schemes to provide health facilities to the people. The Chief Minister Ayushman Accidental Insurance Scheme offers free accidental insurance cover of up to ₹5-10 lakh in case of death or disability for enrolled families. The Mukhyamantri Nishulk Nirogi Rajasthan Yojana provides free medicines and diagnostic tests in government hospitals. The Chief Minister Ayushman Arogya Scheme (MAA-Yojana) offers cashless treatment of up to ₹25 lakh per family per year to eligible families. You can check the complete details of these schemes here.

Scheme Benefits

RGHS gives eligible beneficiaries the following medical benefits, subject to their category rules, approved packages, and scheme conditions:

• Cashless hospitalisation: Treatment at government hospitals and empanelled private hospitals, diagnostic and imaging centres without upfront payment.
• ₹5 lakh family floater cover: New beneficiaries get treatment up to ₹5 lakh per year for the whole family.
• Catastrophic illness cover: The scheme covers hospitalisation expenses above ₹5 lakh per family per year for specified catastrophic illnesses.
• Cashless OPD medicines: Beneficiaries can get prescribed medicines from CONFED stores, Jan Aushadhi Kendras and empanelled pharmacies.
• Day-care and diagnostics:  Covered day-care procedures and investigations at government and empanelled centres.
• Maternity and child care: The scheme covers OPD, IPD, day care, maternity and child care as per CGHS packages and rates.
• AYUSH treatment:  Treatment under Ayurveda, Homeopathy and Unani systems is included.
• Treatment outside Rajasthan:  Selected specialty hospitals outside the state are empanelled (40 hospitals as per the portal), with treatment allowed on reference through the RGHS portal.
• Hospital accommodation:  Ward entitlement depends on basic pay, ranging from private ward to the lowest-category rental ward.
• Medical advance: In exceptional cases, up to 75% of the estimated expenditure for indoor treatment can be paid to the hospital in advance through the RGHS portal.
• Electronic Medical Record (EMR):  Digital health records of beneficiaries are maintained on the system.
• Self-managed e-card:  Beneficiaries can print their own card and add or remove dependants through the SSO login.
• Card tracker:  Beneficiaries can check their OPD and IPD limits through the SSO login.

Hospital Accommodation Entitlement

The amended Rajasthan Civil Services (Medical Attendance) Rules fix the ward class according to the government servant's basic pay in the Pay Matrix.

Reimbursement Provisions

• No reimbursement where cashless is available:  RGHS cardholders cannot claim reimbursement for treatment that is available on a cashless basis.
• Emergency treatment:  Treatment in an unapproved private hospital in a grave emergency, life-threatening disease, or accident is reimbursed at RGHS rates or actual cost, whichever is less.
• Proof of emergency:  The employee must submit an affidavit supported by a certificate from the treating doctor. No follow-up treatment is allowed in such cases.
• Online claims only: All reimbursement claims are decided through the RGHS portal.
• Time limit: The claim must be submitted within two years from the date of completion of treatment.

Eligibility Requirements

RGHS is not available to every resident of Rajasthan. Eligibility depends on the beneficiary’s service, pension or office category. The following categories are covered under the scheme:

• Ministers of the Government of Rajasthan
• Serving MLAs, former MLAs and eligible family pensioners
• Serving and retired All India Services (AIS) officers
• Serving and retired judicial officers.
• Serving state government employees under both the old and new pension schemes
• Pensioners and family pensioners under the Rajasthan Civil Services (Pension) Rules, 1996
• Employees and pensioners of State Autonomous Bodies, Boards and Corporations (with separate provisions for those appointed before and on or after 1 January 2004)
• Eligible dependent family members as per the applicable rules (for state government servants, a family member is treated as dependent if their income is up to ₹6,000 per month; income from CPF, gratuity, prize bonds and insurance benefits is not counted)

Required Documents

For RGHS application, the following documents and details are generally required:

• Jan Aadhaar ID or Enrolment ID
• SSO ID
• Employee ID (For serving government employees, to verify service details)
• Pension details (For pensioners and family pensioners)
• Family member details (Blood group, relationship, marital status, and monthly income of each dependent)
• Income declaration (Government servants must declare the income of parents and children on the RGHS portal)
• Affidavit and doctor's certificate (Only for reimbursement claims of emergency treatment in an unapproved hospital)

Steps to Apply

RGHS registration is a completely online process. Applicants can complete the process as per their category by following these steps:

• Visit the Rajasthan SSO portal and log in with your SSO ID and password.
• If you are not registered, first register yourself.
• Click on Rajasthan Government Health Scheme (RGHS) from the list of applications.
• Inside the RGHS application, click on Beneficiary Registration.
• Choose your category (Serving Employee, AIS Officer, Ex-MLA, Serving Journalist, or Pensioner) according to your profession.
• For example, if you are a Serving Employee, choose "Employee Serving".
• When the system asks whether you have a Jan Aadhaar ID or enrolment ID, select "Yes", enter the details, and click "Continue".
• From the Jan Aadhaar family list, find the employee's name, select the "Government Employee" option against it, and proceed.
• Choose the applicable serving-employee category, enter the Employee ID, and click "Verify" to fetch the service details.
• Select the dependants you want to include and fill in their blood group, relationship, marital status, monthly income, and retirement date where applicable. Use your official service records for the retirement date.
• Check all details carefully, accept the confirmation prompt, and click "Submit".
• The system displays a confirmation message once the registration is complete.
• Open the Beneficiary Module, click "Download RGHS Card", check the details, and download or print the e-card.

How to Take Cashless Treatment

Once registered, beneficiaries can use their RGHS card for cashless treatment in the following way.

• Check the district-wise list of empanelled hospitals or pharmacies on the official portal.
• Visit any Health Care Network Provider, such as a government, empanelled private, PPP, or referral hospital.
• Show your RGHS card. If the card is lost, use your unique RGHS card number.
• Get treatment as per your category entitlement and RGHS package rates.
• For OPD medicines, take the prescription to a CONFED store or empanelled pharmacy. You can also upload OPD prescriptions through your SSO login.
• For treatment outside Rajasthan, get a reference through the RGHS portal before visiting the referral hospital.

Relevant Links

• Rajasthan Government Health Scheme Login
• Rajasthan Government Health Scheme (RGHS) Registration
• Rajasthan Government Health Scheme (RGHS) Portal
• Guidelines of Rajasthan Government Health Scheme (RGHS)
• Rajasthan Government Health Scheme (RGHS) Notification

Contact Information

• Rajasthan Government Health Scheme (RGHS) Helpline Number: 181
• RGHS Helpdesk Email for Serving Employees: [email protected]
• RGHS Helpdesk Email for Pensioners: [email protected]