According to Ayushman Bharat Health Scheme; this scheme will be implementing through identity card of an eligible family. The benefit for family will be on floater basis and can be availing of individually or collectively by members of the eligible family during the policy year with number of times the benefit is availed; saying the request for selection of TPA for claim processing of beneficiary families of Ayushman Bharat in Rajasthan.
Selected TPA will be involved in claim processing services families. It will be the responsibility of the TPA to put in place a flawless mechanism for processing of claims which will ensure the achievement of the objective of the scheme. Patients belonging to the eligible families will be the beneficiaries under the scheme.
Socio-Economic Caste Census (SECC) families (who belong to nn-National Food Security Act) from eligible categories who have got their Bhamashah card (new name Jan Adhaar card) and appearing on JA card will be eligible for the scheme. Selecting TPA will be involving in claim processing services for eligible families.
Implementing through identity card
It will be the responsibility of the TPA to put in place a flawless mechanism for processing of claims which will ensure the achievement of the objective of the scheme. But the AB-MGJAY will be implementing by the state health Assurance agency (SHAA); Jaipur. For AB-MGRSBY, but the health department will select a third party administrator (TPA); whom the scheme may be awarded through bidding.
But the duration of the contract will be for a period of four months from September 1 to December 31. The AB-MGRSBY portal is already preparing; and operational by department of information technology (DoIT); says the request for proposal for selection of TPA for claim processing of beneficiary families of Ayushman Bharat in Rajasthan.
Complaints of irregularities
But health department will carry out the activities related to the AB-MGRSBY through a dedicated portal of BSBY with new name may be AB-MGRSBY. But there are 80% common beneficiaries of AB-PMJAY; and BSBY. The rest of 20% families will be adding to the new insurance scheme. But by recieving complaints of irregularities in BSBY; and these short comings will be removing in new scheme.
But the scheme aims at making interventions in primary; secondary and tertiary care systems, covering both preventive and promotive health, to address healthcare holistically. But it is an umbrella of two major health initiatives namely, But health and Wellness centres and National Health Protection Scheme. But the state is adopting and implementing Centre’s Ayushman Bharat.