Rashtriya Swasthya Bima Yojana
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Rashtriya Swasthya Bima Yojana or RSBY: Scheme Benefits, Apply Online
Overview of Rashtriya Swasthya Bima Yojana or RSBY
In India, the vast majority of the workforce, around 93%, operates in the unorganised sector, often without any social security coverage. This leaves them vulnerable to unexpected health expenses, making illness a common cause of hardship.
To address this, a parliamentary committee has described the Ayushman Bharat scheme as an adaptation of the Rashtriya Swasthya Bima Yojana or RSBY, providing health insurance to those without access. This initiative aims to protect vulnerable households from the financial burdens of healthcare and reduce the risk of falling into poverty due to medical expenses.
Name of the Scheme | Rashtriya Swasthya Bima Yojana or RSBY |
Launched By | Ministry of Labour and Employment |
Launched On | April 1, 2008 |
Serves | People in the Below Poverty Line Category (Family of 5) |
Premium paid by Insured | ₹30/ family |
Premium paid by Government | 75% of the premium is paid by Central Government 25% of the premium is paid by State Government |
Coverage Up to | ₹30,000 |
Treatment can be taken in | Any registered private/ public hospital across India |
Type of Policy | Family Floater |
Identification through | Biometric Enabled Smart Card |
Cashless Treatment | Available across India in empanelled hospitals |
What is the Rashtriya Swasthya Bima Yojana or RSBY?
In 2008, the Indian government introduced a health insurance program, the Rashtriya Swasthya Bima Yojana or RSBY (RSBY). Under the leadership of the then Prime Minister, Dr Manmohan Singh, the scheme was designed for people classified as Below the Poverty Line (BPL). Under RSBY, those insured, along with their spouse and up to three dependents (children or parents), are covered for medical expenses up to ₹30,000 every year.
One of the highlighting features of this program is that applicants only need to pay a small annual fee of ₹30. The rest of the premium is shared between the central and state governments. RSBY offers cashless insurance for hospitalisation in both public and private hospitals. Additionally, it started enrolling people on April 1, 2008. Since that time, the program has distributed 34,285,737 Smart Cards and recorded 5,097,128 instances of hospitalisation.
Any family classified as “below the poverty line” with a yellow ration card can pay ₹30 for a biometric-enabled smart card, including their photos and fingerprints. This card allows them to get in-patient medical care up to ₹30,000 per family per year in empanelled hospitals. The goal of RSBY is to cover the entire BPL population.
As of March 31, 2011, the policy enrolled about 10% of the Indian population. It is expected to cost the government at least ₹3,350 crore annually to cover the entire BPL population. The scheme has earned accolades from the World Bank, the United Nations (UN) and the International Labour Organisation (ILO) as one of the world’s top health insurance programs.
Germany is even considering adopting the smart card-based model to update its social security system. This collaboration is part of the Indo-German Social Security Programme, a cooperation pact between the two countries.
Purpose of Rashtriya Swasthya Bima Yojana or RSBY
RSBY aims to make healthcare affordable and available for poor people in India. It helps those who can’t afford medical care. Anyone who fulfils the eligibility criteria can apply for the policy. In short, RSBY wants to help everyone get the medical care they need and avoid going into debt because of it.
Medical Packages and Hospitalisation Process in Rashtriya Swasthya Bima Yojana or RSBY
In Rashtriya Swasthya Bima Yojana or RSBY, different medical packages are provided for various health conditions and treatments. When a beneficiary requires hospitalisation for an eligible health issue, they can choose a hospital from the list of empanelled/ network hospitals. At a network hospital, you can avail cashless treatment.
In a cashless claim settlement, the beneficiary doesn’t need to pay upfront. The hospital will verify the patient’s RSBY card and provide the necessary treatment. The cost of the hospitalisation process, from admission to discharge, is taken care of by the policy, making it more accessible and affordable for those in need.
The medical packages cover various hospitalisation expenses in Rashtriya Swasthya Bima Yojana or RSBY (RSBY). These include nursing and boarding, general ward bed expenses, surgeon and doctor fees, anaesthetics, implants, operation theatre expenses, X-rays, diagnostic tests, and even food expenses.
The scheme also covers pre-hospitalisation expenses up to a day before admission and post-hospitalisation expenses for up to five days after discharge. Additionally, RSBY reimburses transportation costs (up to ₹100 per visit, with an annual limit of ₹1,000), dental treatment due to accidents, and daycare treatments for procedures requiring less than 24 hours of hospitalisation.
If you’re planning to start a family soon, RSBY offers coverage for covers maternity expenses, including natural and caesarean deliveries, complications before delivery, and even expenses due to pregnancy termination from an accident. Moreover, the medical cost of newborns can be covered under the policy, even if the limit for beneficiaries has been reached.
How Does the Rashtriya Swasthya Bima Yojana or RSBY Work?
The Rashtriya Swasthya Bima Yojana or RSBY (RSBY) is designed to provide health insurance for unorganised sector workers and their families in India. To participate, applicants must first verify their eligibility, confirming that they belong to the unorganised sector, fall under the Below Poverty Line (BPL) category, and are registered members of the welfare board. Importantly, there is no age limit for those applying.
Once eligibility is confirmed, individuals and their families receive smart identification cards, making it easier to access healthcare services.
When the need for healthcare arises, participants can utilise the RSBY claim process. Most claims are processed without the need for cash, with applicants presenting their RSBY cards at designated hospitals. Cashless claims are only accepted at network/ empanelled hospitals. After presenting the card, the hospital transmits essential data to the insurance provider or Third Party Administrator (TPA) in charge of managing the claim. Following data verification, claims are directly settled between the hospital and the insurance company or TPA, eliminating the hassle of paperwork.
PMJAY Illness Coverage
PMJAY, or the Pradhan Mantri Jan Arogya Yojana, offers comprehensive illness coverage to millions of eligible individuals across India. This healthcare initiative provides financial protection, ensuring that people can access necessary medical treatment without facing the burden of high healthcare costs.
Things To Consider When Applying For The Rashtriya Swasthya Bima Yojana or RSBY
If you are thinking of applying for the RSBY scheme, make a note of these things:
1. Ensure you belong to the unorganised sector, fall under the Below Poverty Line (BPL) category, and are a registered welfare board member. There is no age limit for applicants.
2. Implementing agencies will validate the eligibility of you and your family members who will benefit from the scheme.
3. Expect to receive smart identification cards for easy access to healthcare services.
4. Most claims under RSBY are cashless. Present your RSBY card at a designated hospital.
5. Only eligible hospitals can process cashless claims.
6. The hospital will transmit essential data to the insurance provider or Third Party Administrator (TPA).
7. After verification, the claim will be settled directly between the hospital and the insurance company/TPA. No paperwork is necessary.
8. This scheme covers hospitalisation expenses, reimbursement for transportation costs, coverage for daycare treatments, etc.
9. The policy doesn’t cover cosmic surgery and specific other treatments.
Eligibility Criteria For Rashtriya Swasthya Bima Yojana or RSBY
To qualify for the Rashtriya Swasthya Bima Yojana or RSBY, an applicant must satisfy the following conditions:
1. The applicant should work in the unorganised sector as an employee.
2. The State government maintains a list of individuals classified as Below the Poverty Line.
3. The person must be a registered member of the welfare board.
4. There is no maximum age limit, meaning people of all ages can apply for the RSBY scheme.
Benefits of the Rashtriya Swasthya Bima Yojana or RSBY
The beneficiaries of Rashtriya Swasthya Bima Yojana or RSBY (RSBY) can access in-patient healthcare insurance benefits customised by their respective State Governments to meet the specific needs of the people and the region. Here are the following benefits of the package:
1. Coverage for Unorganised Sector Workers and their Families:
RSBY extends coverage to unorganised sector workers and their families, with each family unit comprising up to five members.
2. amily Floater Sum Insured:
Each family is provided with a total sum insured of ₹30,000 per annum on a family floater basis. This means the sum can be used by any family member as needed.
3. Cashless Medical Care:
RSBY ensures that beneficiaries have access to cashless medical services for all covered ailments. This simplifies the process of receiving medical treatment.
4. Comprehensive Hospitalisation Coverage:
The scheme aims to cover hospitalisation expenses, addressing a wide range of common illnesses with minimal exclusions, thus providing extensive medical coverage.
5. Coverage for Pre-Existing Diseases:
RSBY includes coverage for pre-existing diseases, ensuring that individuals with existing health conditions receive the necessary medical attention.
6. Transportation Cost Coverage:
Beneficiaries are entitled to transportation cost coverage, with actual expenses reimbursed, subject to a maximum limit of ₹100 per visit. The overall annual limit for transportation expenses is set at ₹1,000.
Key Features of Rashtriya Swasthya Bima Yojana or RSBY
The features of Rashtriya Swasthya Bima Yojana or RSBY (RSBY) are as follows–
1. Guaranteed Treatment:
RSBY ensures that underprivileged individuals have access to quality medical treatment in the event of accidents or illnesses, eliminating barriers to essential healthcare.
2. Low Premiums:
To enrol in RSBY, policyholders pay a minimal registration fee of ₹30. The remaining premium amount, ₹750 per family annually, is covered jointly by the central and state governments.
3. No Age Restrictions:
Unlike traditional health insurance plans, there are no maximum age limits for enrolling in RSBY. Eligibility is open to individuals of all ages.
4. Freedom of Choice:
RSBY policyholders can choose their preferred empanelled hospital for treatment; they are not restricted to public hospitals.
5. Technology and Security Integration:
The scheme incorporates advanced technology with IT-enabled applications and smart card chips. These cards contain policyholders’ biometric data and connect to local servers, ensuring quick data exchange and monitoring through a high-security system.
6. Benefiting all Stakeholders:
RSBY is structured to benefit not only the insured and their families but also the various stakeholders involved in the program, including microfinance institutions (MFIs) and Non-Governmental Organisations (NGOs), who receive incentives for their participation.
Inclusions Under PSBY or the Rashtriya Swasthya Bima Yojana:
RSBY offers coverage for various healthcare expenses, including:
1. Hospitalisation Expenses:
This includes a wide range of costs associated with hospitalisation, such as nursing and boarding expenses, bed expenses in a general ward, surgeon’s fees, doctor’s consultation fees, anaesthetics, implants, OT (Operation Theater) expenses, oxygen, surgical appliances, prosthetic devices, X-rays, and diagnostic tests, as well as costs associated with food for the patient.
2. Pre-Hospitalisation Expenses:
RSBY covers the expenses incurred before being admitted to the hospital, and this coverage extends up to one day before hospitalisation.
3. Post-Hospitalisation Expenses:
After you’ve been discharged, RSBY continues to provide coverage for medical costs associated with the treatment for which you were hospitalised. This benefit extends for up to five days following hospitalisation.
4. Transportation Expenses:
The policy covers transportation expenses, providing up to ₹100 per visit, with an annual limit of ₹1,000. This can help with the costs of getting to and from medical facilities.
5. Dental Treatment Expenses:
RSBY also includes coverage for dental treatment resulting from an accident. If you require dental care due to an accident, the policy can assist with the expenses.
6. Daycare Treatments:
Daycare treatments are those that require hospitalisation for less than 24 hours. RSBY covers a variety of day facility treatments, including ear surgery, dental surgery resulting from accidents, eye surgery, genital surgery, contracture release of tissue, gastrointestinal surgeries, hydro surgery, haemodialysis surgery, lithotripsy, throat surgery, and more.
7. Costs Associated with Maternity:
If you’re expecting, RSBY covers the expenses associated with childbirth, including both natural delivery and caesarean section. For natural delivery, it offers coverage of ₹2,500, while caesarean delivery expenses are covered up to ₹4,500. The policy even covers expenses resulting from the unintended termination of pregnancy owing to an accident or when the mother’s life needs to be saved.
8. Newborn Coverage:
Even if the beneficiary number under the policy has already reached its limit, RSBY will still cover costs associated with a newborn baby throughout the policy term. You can decide whether to include the baby under the policy during renewal.
Exclusions Under RSBY or the Rashtriya Swasthya Bima Yojana
While Rashtriya Swasthya Bima Yojana or RSBY (RSBY) provides extensive coverage for a wide range of healthcare expenses, there are certain exclusions to be aware of. RSBY does not provide coverage to the insured person for these expenses:
1. HIV/AIDS Treatment:
Expenses incurred for the treatment of HIV/AIDS are not included under RSBY.
2. Non-Covered Hospitalisation:
Any hospitalisation claim that falls outside the policy’s coverage guidelines will not be approved.
3. Hormone Replacement Therapy:
costs associated with hormone replacement therapy are not covered.
4. Corrective or Cosmetic Dental Treatment:
RSBY does not cover dental treatments which are purely corrective or cosmetic in nature.
5. Substance-Related Illness:
Expenses incurred for the treatment of illnesses resulting from excessive use of drugs, alcohol, or similar substances are not covered.
6. Congenital External Disease:
Medical expenses for the treatment of congenital external diseases are excluded from coverage.
7. Vitamins or Tonics:
costs associated with vitamins or tonics are only covered if they are prescribed as part of a treatment regimen by a certified medical practitioner.
8. Gender Reassignment Treatments:
Treatments related to gender change or gender reassignment are not covered under RSBY.
9. Fertility and Assisted Conception Procedures:
Expenses incurred for fertility treatments and assisted conception procedures are not covered by RSBY.
10. Other Things:
Suicide, AYUSH, and Vaccinations are also not included.
How to Register For The Rashtriya Swasthya Bima Yojana or RSBY Scheme?
Here is how you can register for the scheme:
1. Visit the official RSBY website
2. Go to the “Register Online” option
3. Complete the online application with your details and required documents
4. Authorities will verify your eligibility
5. You’ll receive your RSBY card from the enrollment centre on the specified date if approved.
Required Documents To Register
To register for Rashtriya Swasthya Bima Yojana or RSBY, you should provide photocopies of the following documents:
1. Aadhar Card
2. BPL Certificate
3. Income Certificate
4. Ration Card
5. Address Proof
6. Passport-size photograph.
How To Apply For Rashtriya Swasthya Bima Yojana or RSBY Online?
To apply for RSBY online, you can follow these steps:
The insurance company collaborating with RSBY will organise an enrollment timetable for villages. This schedule will be posted in all government centres at the village level well in advance of the registration date.
Those eligible for the scheme can visit the designated enrollment centre according to the schedule at the specified date and time. Following the completion of the registration, beneficiaries will swiftly obtain their RSBY card. This card contains the biometric particulars of the insured individual, along with the RSBY customer care number. The entire process is conducted under the supervision of a government officer, a field officer, and a representative from the insurance company.
How Can I Check The Rashtriya Swasthya Bima Yojana or RSBY Status Online?
You can easily track the status of your RSBY Smart Card online by these steps–
1. Visit the official website at www.rsby.gov.in.
2. Click on ‘Scheme Status’ and opt for ‘State Wise.’
3. Choose your respective state from the list.
4. Input your RSBY insurance number.
5. Click ‘Submit’ to promptly check your Smart Card status.
How To Renew Rashtriya Swasthya Bima Yojana or RSBY?
Those who want to renew the RSBY scheme need to pay ₹30 as the registration fee to renew their cards. Once the renewal process is successfully done, the beneficiary will be given a Swasthya card, which they can use like before.
Frequently Asked Questions (FAQs)
No, there is no upper age limit. Individuals of any age can apply for RSBY.
You will typically need documents like your Aadhar Card, Ration Card, BPL Certificate, Income Certificate, Address Proof, and passport-sized photographs.
Biometric information from any family member can be provided for the smart card.
You can find the forms at the enrollment centre or download them from the state government's official website.
The maximum coverage amount for Rashtriya Swasthya Bima Yojana or RSBY is ₹30,000 per year.
Rashtriya Swasthya Bima Yojana or RSBY (RSBY) has now transformed into Ayushman Bharat Yojana under the leadership of Prime Minister Narendra Modi and the Government of India.
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