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.
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:
Stakeholders include all entities that are affected by the scheme. These include the following:
These stakeholders also benefit from the Rashtriya Swasthya Bima Yojana. Here’s how:
The Rashtriya Swasthya Bima Yojana is available for eligible families and their members. The eligibility parameters are as follows:
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|
Though the Swasthya Bima Yojana provides comprehensive coverage, there are some exclusions under the plan too. These exclusions are as follows:
The process of enrolling eligible families under the scheme is quite simple. Here’s the 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.
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.
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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