What Is Rashtriya Swasthya Bima Yojana (RSBY)?

The cost of healthcare is soaring day by day due to technological improvements and medical inflation. It has become an arduous job for a common man to avail quality medical services for his treatment. Though government-run hospitals offer treatment at a minimal rate still, it is difficult for the underprivileged population to bear their healthcare expenses.

Apart from medical costs, they also need to spend a lot of money on transportation. Healthcare emergencies can hit anyone at any time; thus, the need for quality healthcare has become imperative for everyone. To address the healthcare needs of the underprivileged population, the government has introduced Rashtriya Swasthya Bima Yojana or RSBY. In 2008, the Ministry of Labor and Employment launched RSBY insurance to secure healthcare facilities for those who live below the poverty line.

RSBY accumulated data from the Union Planning Commission. Each state government is required to prepare and submit the BPL data in an electronic format, as given by the government of India.

What is Rashtriya Swasthya Bima Yojana (RSBY)?

In 2008, the government launched a nationwide health insurance policy for the Below Poverty Line (BPL) sector. RSBY full form is the Rashtriya Swasthya Bima Yojana.

Under this RSBY scheme, the insured member, his/her spouse, and three other dependents like children or parents are covered for health expenses of Rs. 30,000/- per annum.

The prime benefit of this Swasthya bima yojana is that the applicant needs to pay only the registration fees of Rs. 30/- every year. The premium of this swasthya bima is shared by both the central and the state government, respectively.

Eligibility Criteria for Rashtriya Swasthya Bima Yojana

• The person should belong to the BPL. He must work in an unorganized sector.
• There is no upper age limit for the RSBY card. This scheme is for everyone, irrespective of their age.
• Nearly one-third of India’s population is covered by this scheme.

What is Covered Under RSBY?

• Hospitalization Expenses

This health policy plan offers all expenses related to illness, accident, or any disease. You can get the best treatment at a hospital or nursing home run by a qualified physician. The scheme also offers expenses regarding nursing & boarding charges, bed charges, surgeon charges, doctor’s consultation fees, blood, oxygen, OT charges, medicines, prosthetic devices, and so on.

• Pre-and Post-Hospitalization Expenses

This scheme offers coverage for all diagnostic tests and medication expenses one day before hospitalization and even offers coverage up to five days after discharge.

• Transportation Expenses

The scheme offers transportation expenses of Rs.100 per visit.

• Dental Treatment   

The insured policyholder can claim the treatment of dental injury due to an accident.

• Daycare Treatments

The scheme offers coverage for various daycare treatments, including eye/ear surgery, nose/throat surgery, radiotherapy, tonsillectomy, prostate surgery, gastrointestinal surgeries, Lithotripsy, etc.

• Maternity Benefit

This scheme compensates for both normal and cesarean deliveries of pregnant women. For normal delivery, the policyholder can claim Rs.2500. On the other hand, for cesarean delivery, the policyholder can get up to Rs.4500. If there is a life risk in pregnancy or involuntary termination of pregnancy, the policyholder can initiate the claim for it.

• Newborn Coverage

You are free to add the name of your newborn baby under this policy and get the RSBY card check online.

What is Not Covered Under this Policy?

• Cost of medicines or treatments if not prescribed by a physician
• Cosmetic surgeries and dental treatments
• Congenital external diseases
• AYUSH
• Vaccinations
• AIDS
• Suicide or self-harmed injuries
• Injuries due to war, nuclear weapons, or similar situations
• Hormone replacement therapy
• Illness due to excessive consumption of alcohol or drugs

Rashtriya Swasthya Bima Yojana Benefits

• Extensive Treatment

Very often underprivileged people won’t get adequate treatment for their illnesses. But this scheme is only applicable to them. This scheme ensures that they will get the required medical attention and treatments against their illnesses.

• Low Premiums

To enroll in this plan, the policyholder needs to pay Rs.30 at the start of the policy. The Central and the State government pay the rest of the premium amount (Rs. 750 annually per family).

• No Age Limit

There is no age restriction for this plan.

• Sum Insured

This policy offers a sum insured of Rs. 30,000/- per year on a family floater basis.

• Coverage for the Entire Family

Under this policy plan, you can add up to 5 members of the family. This includes the applicant, their spouse, and three other dependents (children or parents).

• No Waiting Period

Most health insurance policies come up with a waiting period and within this period; the insured person can’t initiate a claim for a disease. The person needs to pay all medical expenses from his/her pocket. But there is no waiting period with RSBY.

• Pre-existing Diseases

Pre-existing diseases are the diseases that a person possesses before buying a policy. For RSBY, all these diseases are covered from day 1.

• Choice of Hospitals

Now, many private and public hospitals are associated with Rashtriya Swasthya Bima Yojana. An insured person can choose a hospital as per his/her wish.

• Portability of Smart card

After purchasing the policy, beneficiaries will receive health smart cards that are valid in any network hospitals that are associated with RSBY. All partnered hospitals of RSBY offer cashless facilities for treatment to policyholders.

The beneficiary’s identity, along with his/her smart card, fingerprints, and photographs, are verified at the help desk of the network hospitals. In the case of hospitalization, the help desk is used to check the treatment procedure and its price from the health insurance provider. After discharge, the smart card is used to swipe again and the fingerprint will also be verified. The pre-decided cost of the treatment is deducted from the smart card.

• RSBY Enrolment Process

First, an insurance provider releases the scheme for RSBY enrolment for villages. The government centers in a particular village take this enrollment task as per the schedule. All BPL people need to reach the centers on a specific date and time. The center offers a printed RSBY card to the policyholder, and after the registration, all beneficiaries receive RSBY smart cards. The card gets activated after the registration process.

The Conclusion

The Rashtriya Swasthya Bima Yojana is an astonishing and useful health insurance scheme for underprivileged people in India. Now, with the help of this scheme, BPL people are also getting quality treatment without stretching their finances.