Rajasthan Government Health Scheme

Definitions in RGHS

RGHS means Rajasthan Government Health Scheme.
Coverage shall mean the types of persons to be eligible as the beneficiaries of the Scheme to health services provided under the Scheme, subject to the terms, conditions and limitations.
Cashless facility means a facility to make payment of treatment costs directly to the hospital in respect of treatment undertaken in an empanelled hospital to the extent as per this Scheme.
Catastrophic illness means severe illness requiring prolonged hospitalization for recovery. These illnesses involve high cost of treatment and make a person incapable from working and creating a financial hardship.
CGHS means "Central Government Health Scheme".
RGHS Card means e-card issued to beneficiary of RGHS.
SABs means State Autonomous Bodies within the jurisdiction of Government of Rajasthan and it also includes Boards / Corporations etc. only for the purpose of this Scheme.
AYUSH Treatment means treatment under Ayurved, Unani, and Homeopathy systems under this Scheme.
Beneficiary shall mean a person who is eligible for coverage under RGHS and hold a valid RGHS card for the benefit.
Benefit shall mean the extent or degree of service the beneficiaries are entitled to receive as per the rules on the subject.
Hospitalization means admission in a Hospital for a minimum period of 24 consecutive 'In-patient Care' hours except for specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
Health Care Network Provider (HCNP) means Government and Empanelled / PPP Health Care units enlisted in this Scheme.
MOA shall mean Memorandum of Agreement and all Schedules, supplements, appendices, appendages and modifications thereof made in accordance with the terms of this Agreement.
Outdoor patient means treatment taken by the RGHS Card Holder as outdoor patient but it does not include day-care treatment.
Patient means RGHS Card holder including his/her family, who has fallen ill and to whom this Scheme apply.
Pre-existing disease means any disease prior to the inception of this Scheme.
Pre-hospitalization / Post hospitalization benefits means medical benefits upto 7 days pre-hospitalization and upto 30 days post hospitalization respectively which would cover all expenses related to the sickness for which hospitalization was done. The beneficiary shall avail this benefit on cashless basis.
Pre-authorization means process of identification of beneficiary on IT system of RGHS for the purpose of IPD/Day Care Treatment.
Bill Clearing Agency (BCA) shall mean an authority authorized by RGHS to process the medical reimbursement claims or to carry out medical audit.
Package Rates for allopathy treatment shall mean as per approved CGHS rates.
Pensioner means retired State Government employees and also employee of Panchayat Samiti and Zila Parishad who is granted pension under the Rajasthan Civil Services (Pension) Rules, 1996 or is retired on the Contributory Provident Fund benefits. Retired employees under NPS and retired employees of SABs / Board / Corporations etc., will also be included as pensioner only for the purpose of RGHS. The term "Pensioner" shall also include "Family Pensioner".
TPA means Third party Administrator as a part of bill clearing agency engaged for the purpose of pre-authorization and claim processing services for eligible family)
Treatment means administration of medicines / surgery / surgical facilities / vaccinations to cure, control and prevent any disease. Inclusion and exclusion under "Treatment" as per point No. 4 of this Scheme,

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