What Is Rashtriya Swasthya Bima Yojana (RSBY) – How to Apply Online and Claim Process
The Rashtriya Swasthya Bima Yojana is a health insurance scheme launched by the Ministry of Labour and Employment. The scheme offers free health insurance coverage against hospitalisation costs to people in the low-income or BPL (Below Poverty Line) groups or unorganised sectors.
Read on to know the features and benefits of Rashtriya Swasthya Bima Yojana, eligibility criteria, how to register and the claim process.
Features and Benefits of Rashtriya Swasthya Bima Yojana for Beneficiaries
The eligible families and their members are the beneficiaries of the RSBY scheme who get the benefit of free insurance coverage. The features and Rashtriya Swasthya Bima Yojana benefits for such beneficiaries are as follows:
- The beneficiaries can avail of coverage up to Rs.30,000 for their whole family on a floater basis.
- The coverage is free of cost which means that the families have to pay nothing to get insured. Only a minimal registration or renewal fee of Rs.30 is required to enrol under the scheme.
- The inpatient hospitalisation expenses are covered by the RSBY scheme. Thus, beneficiaries do not have to bear the medical costs incurred if they are hospitalised.
- There are minimal exclusions and no waiting period.
- Coverage is available for up to five family members.
- Beneficiaries can avail of cashless treatments at specified private and Government hospitals
- The scheme does not specify any age limit. Beneficiaries of all ages can be covered.
Features and Benefits of Rashtriya Swasthya Bima Yojana for Stakeholders
Stakeholders include all entities that are affected by the scheme. These include the following:
- Central and State Governments
- Empanelled hospitals
- Micro-finance institutes and NGOs who act as intermediaries
- Insurance companies that provide the coverage
These stakeholders also benefit from the Rashtriya Swasthya Bima Yojana. Here’s how:
- Insurance companies get the premium for insuring the beneficiaries. The Government pays the premium on the beneficiaries’ behalf
- Hospitals are also paid for treating the beneficiaries. Hospitals get payment from insurance companies
- Intermediaries, like NGOs and microfinance institutes, also earn monetary compensation for ensuring that eligible beneficiaries are enrolled under the scheme
- IT companies that provide service to the Government for issuing Smart Cards and enrolling beneficiaries digitally are also compensated
- The Government, through the social welfare scheme, can improve the standard of living of the backward sections of the society and contribute to the development of the country. As the country develops, the Government is also benefited as it is recognized for its efforts
Eligibility Criteria for Rashtriya Swasthya Bima Yojana Scheme
The Rashtriya Swasthya Bima Yojana is available for eligible families and their members. The eligibility parameters are as follows:
- Workers who belong to the unorganised sector and whose family falls under the BPL category can be insured.
- Besides the worker, four other family members can get coverage under the RSBY scheme.
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 |
| 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 |
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:
- The insurance company gets a list of eligible families and their beneficiaries
- The insurance company, with help from the district level officials, creates an enrolment schedule for each village. The enrolment date is also determined
- The list of eligible households is, then, posted in different parts of the village and the enrolment date is announced beforehand
- On the enrolment date, mobile enrolment centres are established at local centres, like schools
- The centres have the required tools to record the biometric and demographic details of each eligible family
- The families can visit the enrolment centre, follow the enrolment process, provide their biometric information and pay Rs.30 registration fee to avail coverage
- 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 networked hospital and provide the Smart Card as proof of insurance. Members are provided with a list of networked hospitals and a claim helpline number. They can call the number if they need help with the claim.
After admission into the hospital, the members can avail of cashless treatments and the RSBY scheme will pay the medical bills, up to Rs.30,000. Then 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.
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 to millions of households and helps them meet the medical expenses of any illness or injury. As the Government pays the premium and the insurance companies pay for the hospital bills, BPL families are spared the financial burden of a medical contingency through RSBY insurance.
FAQs
Ans: 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.
Ans: 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.
Ans: 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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