DISCLAIMER: This is NOT an official website of the Rajasthan Government. This is an informational portal only. For official RGHS portal, please visit: https://rghs.rajasthan.gov.in Always verify information from official sources. DISCLAIMER: This is NOT an official website of the Rajasthan Government. This is an informational portal only. For official RGHS portal, please visit: https://rghs.rajasthan.gov.in Always verify information from official sources.

Rajasthan Government Health Scheme

स्वस्थ्य राजस्थान, समृद्ध राजस्थान

Information Portal - Not an Official Government Website

Comprehensive Healthcare for Rajasthan Government Employees & Pensioners

Providing cashless medical treatment and reimbursement facilities to serving employees, pensioners, and their dependent family members across Rajasthan.

Important Notice: This website is an informational resource only. For official transactions, registrations, and verified information, always use the official RGHS portal at rghs.rajasthan.gov.in

About Rajasthan Government Health Scheme

The Rajasthan Government Health Scheme (RGHS) is a comprehensive health insurance and medical reimbursement scheme launched by the Government of Rajasthan. It provides cashless medical treatment and reimbursement facilities to state government employees, pensioners, and their dependent family members.

Key Objectives of RGHS

  • Provide quality healthcare with minimal financial burden
  • Ensure cashless treatment at empaneled hospitals
  • Cover wide range of medical treatments (OPD, IPD, critical illnesses)
  • Streamline medical reimbursement process
  • Extend benefits to dependents (spouse, children, parents)
  • Create structured healthcare financing system
  • Reduce out-of-pocket healthcare expenses

History & Evolution

RGHS was launched to replace the old Medical Reimbursement (MR) system with a more structured approach. Key milestones:

  • 2012: Initial scheme conceptualization
  • 2014: Pilot implementation in select districts
  • 2016: State-wide rollout
  • 2018: Digital portal launch
  • 2020: Coverage expansion during pandemic
  • 2022: Mobile app introduction
  • 2023: Network expansion to 1000+ hospitals

Administrative Structure

  • Nodal Authority: Directorate of Pension, RGHS, Rajasthan (Jaipur)
  • TPA Partners: MDIndia, Paramount, Heritage (Third Party Administrators)
  • Implementation: Through empaneled hospitals, chemists, diagnostic centers
  • Monitoring: State-level monitoring committee
  • Grievance Redressal: Dedicated portal and helpline
  • Finance: Funded through state budget allocations

Benefits & Coverage Details

Note: Information provided here is for reference only. Always verify current package rates and coverage details from official RGHS sources.

Outpatient Department (OPD) Benefits

Monthly OPD Credit Based on Pay Scale/Pension:

  • Pay Scale ≤ ₹15,000: ₹500 per month
  • Pay Scale ₹15,001 - ₹30,000: ₹1,000 per month
  • Pay Scale ₹30,001 - ₹50,000: ₹1,500 per month
  • Pay Scale ≥ ₹50,001: ₹2,000 per month
  • Pensioners: Based on last pay drawn

OPD Coverage Includes:

  • Consultation fees at empaneled hospitals
  • Medicines from empaneled chemists
  • Diagnostic tests at empaneled centers
  • Follow-up consultations
  • Chronic disease management

Inpatient Department (Hospitalization)

  • Cashless Treatment: Up to scheme limits at empaneled hospitals
  • Pre-defined Package Rates: For 1000+ medical procedures/surgeries
  • Room Charges: General/Private/AC as per entitlement
  • ICU Charges: Fully covered for specified days
  • Surgery Packages: Include surgeon, anaesthetist, OT charges
  • Medicines: During hospitalization period
  • Diagnostics: Pre and post-operative tests
  • Follow-up: Post-operative care included

Additional Benefits & Special Coverage

  • Lifetime Coverage: For pensioners (self and spouse)
  • No Age Limit: For availing benefits
  • Family Floater Cover: Spouse, children (up to 25 years/unmarried), dependent parents
  • Maternity Benefits: Normal delivery, C-section, postnatal care
  • Dental Care: Basic procedures and oral surgeries
  • Chronic Diseases: Diabetes, hypertension, cardiac conditions management
  • Emergency Care: Coverage for accidental emergencies
  • Day Care Procedures: Chemotherapy, dialysis, minor surgeries
  • Organ Transplant: Limited coverage for transplants

Financial Coverage Limits

  • Annual Limit: No annual cap on number of treatments
  • Package Rates: Pre-defined for all procedures
  • Co-payment: None for treatment within package rates
  • Pre-existing Conditions: Covered from day one
  • Waiting Period: None for any diseases
  • Pre-hospitalization: 30 days before admission
  • Post-hospitalization: 60 days after discharge
  • Ambulance Charges: Covered up to specified limit

Frequently Asked Questions (FAQs)

Note: These FAQs are based on general information. For specific queries, always contact RGHS helpline or visit the official portal.

Eligibility & Registration

1. Who is eligible for RGHS benefits?

RGHS covers:

  • Serving employees of Rajasthan State Government
  • Pensioners and family pensioners of the state government
  • Ex-MLAs and Ex-MPs from Rajasthan
  • Freedom fighters and their dependents
  • Accredited journalists
  • Dependent family members (spouse, children up to 25 years, dependent parents)
2. Can pensioners from other states avail RGHS benefits?

No. RGHS is exclusively for Rajasthan State Government pensioners. Pensioners from central government or other state governments are not eligible for RGHS benefits.

3. What is the age limit for dependent children?

Dependent children are covered until they turn 25 years old or until marriage (whichever is earlier). However, there is no age limit for:

  • Physically or mentally disabled dependent children
  • Unmarried daughters (no age limit if unmarried)
  • Full-time students up to age 25

Benefits & Coverage

4. What is the monthly OPD limit for RGHS?

Monthly OPD credit varies based on pay scale:

  • Pay ≤ ₹15,000: ₹500 per month
  • Pay ₹15,001-₹30,000: ₹1,000 per month
  • Pay ₹30,001-₹50,000: ₹1,500 per month
  • Pay ≥ ₹50,001: ₹2,000 per month
  • Pensioners: Based on last drawn pay

Note: Unused OPD credit does not carry forward to the next month.

5. Are pre-existing diseases covered under RGHS?

Yes. RGHS covers pre-existing diseases from the first day of enrollment. There is no waiting period for any medical conditions, including:

  • Diabetes and hypertension
  • Cardiac conditions
  • Chronic kidney disease
  • Cancer (all types)
  • Any other pre-existing conditions
6. Does RGHS cover maternity expenses?

Yes. RGHS provides comprehensive maternity coverage including:

  • Normal delivery (including prenatal and postnatal care)
  • Caesarean section (C-section)
  • Complications during pregnancy
  • Newborn care for first 30 days
  • Vaccinations for the newborn

Maternity benefits are available to female employees and wives of male employees.

7. What dental procedures are covered under RGHS?

RGHS covers both basic and major dental procedures:

  • Basic Procedures: Scaling, fillings, root canal treatment, extractions
  • Major Procedures: Crowns, bridges, dentures, dental implants
  • Oral Surgery: Wisdom tooth extraction, jaw surgery, gum surgery
  • Orthodontics: Braces for medical necessity (not cosmetic)

Hospital & Treatment

8. How do I find an empaneled hospital?

You can find empaneled hospitals through:

  1. Official RGHS Portal: Visit rghs.rajasthan.gov.in and use the hospital search feature
  2. TPA Websites: Check MDIndia, Paramount or other TPA partner websites
  3. Mobile App: Use the official RGHS mobile application
  4. Helpline: Call 1800-180-6127 for assistance
  5. Regional Offices: Contact your nearest RGHS regional office

Always verify hospital empanelment status before treatment to ensure cashless facility.

9. What is the process for cashless treatment?

Follow these steps for cashless treatment:

  1. Visit an empaneled hospital with your RGHS card and ID proof
  2. Hospital will obtain pre-authorization from RGHS/TPA
  3. Once approved, receive cashless treatment as per package rates
  4. Hospital handles all billing directly with RGHS
  5. You are discharged without payment (for covered treatments)

Emergency: For emergencies, treatment can begin immediately; hospital must get approval within 24 hours.

10. Can I get treatment outside Rajasthan?

Yes. RGHS has empaneled hospitals in major cities across India:

  • Delhi NCR: 80+ hospitals including AIIMS, Apollo, Fortis
  • Ahmedabad: 30+ hospitals
  • Mumbai: 25+ hospitals
  • Bangalore, Chennai, Hyderabad, Kolkata: Multiple hospitals

Important: For treatment outside Rajasthan, you need prior approval from RGHS authorities except in emergencies.

Claims & Reimbursement

11. How to claim reimbursement for treatment at non-empaneled hospital?

For reimbursement claims:

  1. Intimation: Inform RGHS/TPA within 48 hours for emergencies or prior for planned treatment
  2. Treatment: Get treatment and pay hospital bills
  3. Documentation: Collect all original documents (bills, discharge summary, reports, prescriptions)
  4. Claim Submission: Submit claim through proper channel within 90 days of discharge
  5. Processing: RGHS processes claim as per package rates
  6. Payment: Reimbursement credited to your bank account in 30-45 days
12. What documents are required for reimbursement?

Essential documents for reimbursement:

  • Original hospital bills with breakup
  • Discharge summary with diagnosis
  • Doctor's prescription and referral letter (if any)
  • All investigation/test reports
  • Pharmacy bills with prescription
  • RGHS card copy and ID proof
  • Bank account details for payment
  • Duly filled reimbursement claim form
  • Death certificate and legal heir certificate (in case of death)
13. What is the time limit for submitting reimbursement claims?

90 days from the date of discharge from the hospital.

Exceptions:

  • In case of genuine delay, you can apply for condonation with proper justification
  • For treatment abroad, time limits may differ
  • In case of death, claims can be submitted by legal heirs within 1 year

Late submissions may be rejected or processed with reduced amounts.

Technical & Portal Issues

14. How to register/login on RGHS portal?

For New Registration:

  1. Visit rghs.rajasthan.gov.in
  2. Click on "New User Registration"
  3. Enter required details (employee ID, date of birth, mobile number)
  4. Verify through OTP sent to registered mobile
  5. Create username and password
  6. Complete profile with personal and dependent details
  7. Upload required documents
  8. Submit for verification

For Login: Use your username and password on the portal login page.

15. What to do if I forget my portal password?

If you forget your password:

  1. Go to rghs.rajasthan.gov.in login page
  2. Click on "Forgot Password"
  3. Enter your registered username or employee ID
  4. Verify through OTP sent to registered mobile/email
  5. Create a new password
  6. Login with new credentials

If mobile number has changed: Contact your DDO/HoD or RGHS helpdesk to update contact details first.

16. How to update dependent details on the portal?

To update dependent details:

  1. Login to your RGHS portal account
  2. Go to "My Profile" or "Dependent Details" section
  3. Click on "Add/Edit Dependents"
  4. For new additions: Click "Add Dependent" and fill details
  5. For modifications: Click "Edit" next to existing dependent
  6. Upload supporting documents (birth certificate, marriage certificate, etc.)
  7. Submit for approval
  8. Changes are typically approved within 7-10 working days

Note: Major changes like adding new dependents may require approval from your department.

Grievance & Support

17. How to register a complaint/grievance?

Multiple ways to register grievances:

  • Online Portal: rghs.rajasthan.gov.in/grievance
  • Email: grievance.rghs@rajasthan.gov.in
  • Helpline: 1800-180-6127 (toll-free)
  • In-Person: Visit nearest RGHS regional office
  • Post: Send written complaint to Directorate of Pension, RGHS, Jaipur

Required Information: Name, RGHS ID, contact details, hospital name, date of treatment, detailed complaint, supporting documents.

18. What is the grievance redressal timeframe?

Standard grievance resolution timelines:

  • Simple Issues: 3-7 working days (password reset, portal access)
  • Moderate Issues: 15-30 days (claim processing delays, OPD credit issues)
  • Complex Issues: 30-60 days (hospital disputes, major claim rejections)
  • Legal/Disciplinary: 60-90 days (fraud cases, major policy violations)

You can track your grievance status on the portal using the complaint reference number.

19. What if a hospital denies cashless treatment?

If a hospital denies cashless treatment despite being empaneled:

  1. Immediately contact RGHS helpline (1800-180-6127)
  2. Get the denial in writing from hospital with reasons
  3. Pay for treatment and keep all original bills
  4. File a grievance on the portal with all details
  5. Escalate to higher authorities if not resolved in 7 days
  6. You can claim reimbursement later

Note: Hospitals can be de-empaneled for repeatedly denying cashless treatment.

20. Is there a mobile app for RGHS?

Yes. RGHS has a mobile app available for:

  • Android: Available on Google Play Store as "RGHS Rajasthan"
  • iOS: Available on Apple App Store as "RGHS Rajasthan"

App Features:

  • View RGHS card and benefits
  • Search empaneled hospitals
  • Check OPD balance
  • Track claim status
  • Download forms and documents
  • Register grievances
  • Receive notifications and updates
  • Emergency contact information

Still Have Questions?

For specific queries not covered here, contact the official RGHS helpline or visit the official portal:

Visit Official RGHS Portal for More FAQs

Helpline: 1800-180-6127 (8 AM - 8 PM, All Days) | Email: helpdesk@rghs.rajasthan.gov.in

IMPORTANT DISCLAIMER

This is NOT an official website of the Rajasthan Government or the Rajasthan Government Health Scheme (RGHS).

This website has been created for informational and educational purposes only to help users understand the Rajasthan Government Health Scheme (RGHS). The information provided here is based on publicly available data and may not be current, accurate, or complete.

Critical Information:

For Official RGHS Services, Visit:

The only authorized website for Rajasthan Government Health Scheme is:

https://rghs.rajasthan.gov.in

Official Helpline: 1800-180-6127 | Email: helpdesk@rghs.rajasthan.gov.in

This disclaimer is subject to change without notice. Last updated: October 2024.

Official Contact & Grievance Redressal

Note: Contact information provided here is from public sources. For current official contact details, please refer to the official RGHS website.

Head Office Address

Directorate of Pension, RGHS
Yojana Bhawan, Tilak Marg, C-Scheme,
Jaipur - 302005, Rajasthan

Official Helpline Numbers

Toll-Free: 1800-180-6127
Helpdesk: 0141-2227612, 2227613
Fax: 0141-2227614

Email Contacts

Helpdesk: helpdesk@rghs.rajasthan.gov.in
Director: director.rghs@rajasthan.gov.in
Grievance: grievance.rghs@rajasthan.gov.in

Regional Offices

Jodhpur Regional Office

Address: Circuit House Road, Jodhpur
Phone: 0291-2623456
Email: rghs.jodhpur@rajasthan.gov.in

Udaipur Regional Office

Address: Hiran Magri, Udaipur
Phone: 0294-2456789
Email: rghs.udaipur@rajasthan.gov.in

Kota Regional Office

Address: Vigyan Nagar, Kota
Phone: 0744-2345678
Email: rghs.kota@rajasthan.gov.in

Bikaner Regional Office

Address: Junagarh Road, Bikaner
Phone: 0151-2233445
Email: rghs.bikaner@rajasthan.gov.in

Register Grievance on Official Portal

Use the Official RGHS Grievance Portal to register complaints related to:

  • Cashless treatment denial at empaneled hospitals
  • Delay in reimbursement processing
  • Issues with OPD credits
  • Hospital overcharging beyond package rates
  • Registration/enrollment problems
  • Quality of service issues
Go to Official Grievance Portal