All About Rashtriya Swasthya Bima Yojana

The Rashtriya Swasthya Bima Yojana (RSBY) is a health scheme that provides health insurance to those below the poverty line and workers serving the unorganized sectors. It offers a sum of Rs. 30,000 on a floater basis.

The scheme is an initiation of the Department of Labor and Employment, Government of India. Coverage extends to the individuals’ families of up to five members.

With the help of this scheme, those from society’s economically weaker sections can avail of free medical facilities in the network hospitals.

Rashtriya Swasthya Bima Yojana: Features

• Guaranteed Treatment
• No age limit
• Low premium (Rs. 30 registration fee)
• Option to choose (from a list of network hospitals)
• Incentives for all stakeholders
• Claim up to Rs. 30,000 for different healthcare expenses
• Technology and security-enabled (IT-enabled apps are used. Chips on the smart card support rigorous monitoring and evaluation. The cards also contain biometric data and are connected to local servers for speedy data sharing. A high-security system keeps tabs, does regular reporting and manages biometric data and transaction records.)
• Pre-existing disease coverage (an illness which the policyholder was not aware of at the time of policy purchase)
• Family coverage (family head, spouse and three dependents)

What Does the Scheme Cover?

Hospitalization expenses

Such expenses related to an illness, a disease or an accident are also receivable by the policyholder’s family members. Such medical expenses include bed charges, doctor’s consultation fees, nursing and boarding charges, implants, surgeon’s charges, blood, diagnostic tests charges, prosthetic devices, anesthetics, consultation fees, oxygen, OT (Operation Theatre) charges, food expenses and medicines.

Pre-Hospitalization Expenses

This includes expenses concerned with diagnosis and medicines.

Post-Hospitalization Expenses

The scheme covers all medical expenses for up to 5 days of post-hospitalization in case of surgery or long-term treatment.

Transportation Expenses

While such expenses are receivable up to Rs. 100/visit, a maximum of Rs. 1,000 can be claimed.

Dental Treatment

The RSBY incurs the cost of dental treatment that’s occurring due to an accident.

Daycare Treatment

For daycare treatment, the patient is hospitalized for less than 24 hours. Treatments covered include ear surgery, eye surgery, dental surgery required due to an accident, lithotripsy, hemodialysis surgery, etc.

Maternity Expenses

Rs. 2,500 are receivable for normal delivery and Rs. 4,500 for caesarean delivery. The scheme also covers unintentional pregnancy termination which could be due to an accident or to save the mother’s life.

Newborn Coverage

RSBY covers the healthcare expenses incurred on a newborn even when the number of beneficiaries has exceeded. This can be claimed until the end of the term of the policy. However, it is up to the policyholder to add the name of the newborn under the BSBY during renewal.

What is Not Covered Under RSBY?

Having known all that the RSBY scheme covers, let us come to what it does not cover:

• Hospitalization charges for treatments not mentioned in the policy
• Expenses related to HIV/AIDS treatment, change of gender, hormone replacement therapy and substance abuse (like excessive intake of alcohol/drugs)
• Congenital external disease
• Dental treatments that are cosmetic or corrective in nature and expenses of a root canal or cavity filling
• Suicide, AYUSH and vaccination

Rashtriya Swasthya Bima Yojana: Eligibility Criteria

• The applicant should be an Indian citizen
• Family members should be listed in the BPL list
• S/he should be registered under welfare boards

How to Apply for Rashtriya Swasthya Bima Yojana

An enrolment schedule will be issued at villages by the insurance company that has partnered with RSBY. The schedule will be available at all village-level government centres before the registration date. The eligible people willing to register for the scheme need to reach the enrolment centre as per the date and time.

After registration, you’re given an RSBY card in a plastic cover. The card contains your biometric details and RSBY customer care number.

The entire procedure takes ten minutes and happens in the presence of a government officer, a representative of the insurance company and a file officer.

Documents required during application include an Aadhaar card, ration card, BPL certificate, income certificate, address proof and a passport-size photograph.

Checking RSBY Smart Card Status Online

• Visit http://www.rsby.gov.in/, go to ‘Scheme Status’ and select ‘State Wise’.
• Select your state and enter your RSBY insurance number.
• Finally, submit and check the status.

Filing Claims Under RSBY

One can avail of the cashless treatment facilities by carrying the Smart Card to an RSBY empanelled/network hospital. The officials of the hospital will send the necessary details to the insurance company. Post-verification, the claim will be settled between both the parties.

A Few Points to Note

• The renewal fee per annum is Rs. 30.
• Any of the family members can give their biometric information for the Smart Card.
• The enrolment forms can also be downloaded from the website of the state government.
• Family members can be removed or added in the middle of a policy period only when there’s been a birth or death of one of the beneficiaries in the family.

Conclusion

The government had tried to provide health insurance to selected beneficiaries in the past but to no avail. RSBY was finally started while keeping in mind a design that avoids the pitfalls of the earlier schemes and provides a world-class model. This scheme started to roll from the 1st of April, 2008.