GOVERNMENT OF RAJASTHAN

Office of the Project Director, State Insurance & P.F. Department

(Rajasthan Government Health Scheme)

2nd Floor, D-Block, Vitta Bhawa, Janpath, Jaipur

email: helpdesk.rghs@rajasthan.gov.in     Phone: 0141-2740219     website:https://www.rghs.rajasthan.gov.in

OPTION FORM FOR OPTING RGHS

I, , , hereby declare that I opt to avail medical facilities under RGHS of Govt. of Rajasthan. I, authorize monthly pay bill deduction for RGHS (Fund) as per prescribed pay slab rate by State Government from time to time.

I understand that once above option is exercised, I shall not be entitled for reimbursement of expenses incurred by me on medical attendance and treatment of myself and my family members under RCS (MA) Rules, 2013; RPMF and other group mediclaim policies issued by SIPF department.