Rashtriya Swasthya Bima Yojana (RSBY) – How to Apply, Eligibility, Coverage & Benefits
RSBY or National Health Insurance Programme is a Government-backed health insurance scheme for Indian citizens falling under the BPL (Below Poverty Line) category. The full form of RSBY is Rashtriya Swasthya Bima Yojana. RSBY works as a family floater plan where the unorganised sector worker and their family (unit of 5) will be covered. The total sum insured under the RSBY scheme is Rs.30,000.
Point to Note
Rashtriya Swasthya Bima Yojana is currently available under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).
Features of Rashtriya Swasthya Bima Yojana for Beneficiaries
RSBY scheme is like a helping hand for people who can’t afford medical treatments. Here are some of the features of the scheme:
1. Assured Treatment
Rashtriya Swasthya Bima Yojana is specifically designed for people falling under BPLcategory. Any person falling under this category can avail RSBY scheme and get treated at a lower cost.
2. No Age Limit
Any eligible individual can register for an RSBY card. There are no age limit restrictions for RSBY.
3. Low Premium Amount
The beneficiary is required to pay Rs.30 per annum as registration or annual fee. The premium is far lower than other health insurance policies. The rest of the premium amount, subject to a maximum of Rs.565 per family per annum would be borne by the Government.
4. Flexibility to Choose Hospital
It’s not compulsory for beneficiaries to undergo treatment at Government hospitals. Any individual registered under RSBY can undergo treatment at any RSBY empanelled hospital.
5. Technology-Driven RSBY Smart Card
The RSBY smart card is a technology-driven card that stores the biometric information of the policyholder in a safe and secured manner. The smart card is used for facilitating cashless transactions at network hospitals and portability of benefits across the nation.
Benefits of Rashtriya Swasthya Bima Yojana for Beneficiaries
The benefits of RSBY includes:
- The unorganised sector worker and their family (unit of five) would be covered under this scheme.
- The total sum insured would be Rs. 30,000/- per family per annum on a family floater basis.
- Coverage of pre-existing disease
- Cashless claims in empanelled hospitals
- Transportation costs (with maximum limit of Rs.100 per visit) within an overall limit of Rs.1000
- Hospitalisation expenses are covered
- Low premium of Rs.30
Eligibility Criteria for Rashtriya Swasthya Bima Yojana Scheme
The RSBY eligibility parameters are as follows:
- Workers who belong to the unorganised sector whose family falls under the BPL category can be insured.
- Register member of welfare boards
What is Covered Under Rashtriya Swasthya Bima Yojana?
Coverage under the Rashtriya Bima Yojana is available for the following types of medical expenses:
| Type of Medical Expense | Coverage Allowed |
| Inpatient hospitalisation | If the beneficiary is admitted to a hospital for 24 hours or more, the incurred medical expenses will be covered. Coverage is allowed for room rent, nurse’s fees, doctor’s and surgeon’s fees, anaesthesia, medicines, blood, oxygen, etc. |
| Pre and post-hospitalisation | The medical expenses incurred one day before hospitalisation and up to five days after discharge are covered. |
| Transportation expenses | The expenses in transporting the beneficiary to the hospital will be covered up to Rs.100/instance. The maximum coverage limit is Rs.1000 |
| Dental treatments | Dental treatments required due to accidental injuries are covered |
| Daycare treatments | Hospitalisation for a few hours for daycare procedures are covered including Contracture release of a tissue, Dental surgery following an accident, Ear surgery, Eye Surgery, Gastrointestinal surgeries, Genital surgery, Haemo-Dialysis, Hydrocele surgery, Identified surgeries under general anaesthesia, Laparoscopic therapeutic surgeries allowed under daycare, Lithotripsy, Minor reconstructive procedures of limbs, Nose surgery, Parenteral Chemotherapy, Prostate surgery, Radiotherapy, Surgery of urinary system, Throat surgery, Tonsillectomy, Treatment of fractures/dislocation, etc. |
| Maternity cover | The plan covers the costs incurred in normal or Caesarean deliveries. The coverage limit is Rs.2500 for normal and Rs.4000 for C-section births.Complications arising before delivery and involuntary termination are also covered |
| Newborn coverage | A newborn baby is automatically insured up to the expiry of the one-year tenure |
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What is Not Covered Under Rashtriya Swasthya Bima Yojana?
Though the Swasthya Bima Yojana provides comprehensive coverage, there are some exclusions under the plan too. These exclusions are as follows:
- Cost of tonics, vitamins or other supplements
- Medical expenses that are not covered under hospitalisation
- Outpatient expenses
- Congenital diseases or illnesses
- Cosmetic procedures
- Fertility or assisted reproductive treatments
- Dental treatments not necessitated by accidents
- HIV/AIDs
- Attempted suicides or self-inflicted injuries
- AYUSH treatments
- War or nuclear perils
- Hormone replacement or gender change treatments
How to Register for Rashtriya Swasthya Bima Yojana?
The process of enrolling eligible families under the scheme is quite simple. Here’s the process:
- Step 1
The insurance company gets a list of eligible families and their beneficiaries
- Step 2
The insurance company, with help from the district level officials, creates an enrolment schedule for each village. The enrolment date is also determined
- Step 3
The list of eligible households is, then, posted in different parts of the village and the enrolment date is announced beforehand
- Step 4
On the enrolment date, mobile enrolment centres are established at local centres, like schools
- Step 5
The centres have the required tools to record the biometric and demographic details of each eligible family
- Step 6
The families can visit the enrolment centre, follow the enrolment process, provide their biometric information and pay Rs.30 registration fee to avail coverage
- Step 7
A Smart Card is printed with the member’s details and handed over immediately. The card serves as a proof of coverage and allows members to avail of cashless coverage
Rashtriya Swasthya Bima Yojana Claim Process
To make a claim under the coverage, the insured member will have to visit a network hospital and provide the Smart Card as proof of insurance. Members are provided with a list of network hospitals and a claim helpline number. They can call the number if they need help with the claim. Note that cashless claim settlements can be done only at RSBY-empanelled hospitals.
After getting admitted to the hospital, the members can avail of cashless treatments up to the insured amount of up to Rs.30,000. The hospital would send the bills to the insurance company, either directly or through a TPA (Third Party Administrator) and the insurer would settle the claim.
How to Check Rashtriya Swasthya Bima Yojana Smart Card Status Online?
Follow the steps below to check RSBY smart card status online:
Step 1: Go to the RSBY portal and select on ‘Scheme Status’
Step 2: From the Scheme Status dropdown menu, click on ‘State Wise’ option
Step 3: Go to ‘Track your State’ and select your state
Step 4: Once done, status will be displayed on screen
Final Word
The Rashtriya Swasthya Bima Yojana is a social welfare scheme designed to allow healthcare facilities to the economically weaker sections of society. The scheme is currently available under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana to millions of households and helps them meet the medical expenses of any illness or injury. As the Government pays a significant percentage of premium and the insurance companies pay for the hospital bills, BPL families are spared the financial burden of a medical contingency through RSBY insurance.
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FAQs
The Government funds the scheme. While the Central Government funds 75% of the premium, up to Rs.565 per family, the State Government funds the remaining 25% plus any additional premium not paid by the Central Government.
There’s no minimum age. Children of all ages can be covered. However, in the case of automatic coverage for the new born baby, the coverage is allowed only up to the end of the tenure. On renewal, the baby should be covered separately provided that five members are not already added to the plan.
An additional member, beyond five members, can be added only if any added member dies. However, if the coverage does not include five members, then an additional family member can be added to the coverage even during the term of the policy.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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