Rashtriya Swasthya Bima Yojana {राष्ट्रीय स्वास्थ्य बीमा योजना}

Updated on Sep 14, 2020

Overview

At present, the cost of health care facilities is prohibitive. Even the families who can bear a medical emergency find it's challenging to carry out the expense of treatment. The government hospitals operate at a lower cost as compared to private ones, but, it may not be possible for families to bear the cost at government hospitals. 

The reason might be range from infrastructure to transportation challenges. Those people are not able to get proper treatment at their choice of hospital. So, to overcome this problem, Rashtriya Swasthya Bima Yojana was made. It is produced by giving a helping hand to those who are not able to afford the cost of a medical emergency. 

What is Rashtriya Swasthya Bima Yojana?

Rashtriya Swasthya Bima Yojana is the scheme that is sponsored by the government for citizens of India, which belongs to the low-income level or below the poverty line. The scheme can be classified as a family floater health insurance plan where the policyholder and his family members can take advantage of this scheme. It is a different health insurance plan which covers many benefits as compared to a commercial plan. 

What is Covered under Rashtriya Swasthya Bima Yojana?

Hospitalization charges

All expenses related to hospitalization for the treatment of illness, accident, or disease will be covered in the scheme. This coverage will be offering to the family members of policyholders. Although the treatment and hospitalization shall be taken at a hospital by a qualified physician or medical practitioner. The following expenses will be covered in hospitalization charges:-

  • Bed charges
  • Surgeon charges
  • Doctor visits
  • Nursing and boarding charges
  • Blood oxygen 
  • OT charges
  • Medicines
  • Implants
  • Consultation fees
  • X-Ray and diagnostic charges

Pre hospitalization charges

Under this scheme, the pre-hospitalization expenses will also be covered, such as the cost of diagnostic tests and medicines up to one day before the person gets admitted to the hospital.

Post hospitalization

The expenses related to the surgery for which the person was admitted will be covered for five days after the patient is discharged from the hospital.

Transportation charges

The person can claim up to the charges of Rs 100 per visit under transportation. The annual amount for this is one thousand rupees.

Dental treatment

Under this scheme, the cost of dental treatment needed as a result of an accident will be covered.

Daycare treatments

A daycare treatment is a surgical process that doesn't require hospitalization for a long time. There is a list of daycare treatments which covered under the RSBY:- 

  • Eye surgery
  • Ear surgery
  • Nose surgery
  • Dental surgery following an accident
  • Haemo-dialysis
  • Contracture release of a tissue
  • Gastrointestinal surgeries
  • Parenteral chemotherapy
  • Throat surgery
  • Treatment of fractures
  • Screening and follow up care

Maternity benefit

Under this scheme, both types of deliveries: normal or cesarean, will be covered. A policyholder can claim Rs 2500 for normal or Rs 4500 for cesarean. Any kind of complication during pregnancy will be covered. The cost of voluntary termination of pregnancy which is occurred due to an accident or in a situation where saving the life of a mother is necessary will be covered in the scheme.

Newborn coverage

The newborn baby will be automatically added in the family of policyholders even the number of beneficiaries has more. And, it will be valid until the end of the policy period. The decision of including the baby in the policy at the time of renewal of the policy.

Features

  • Low premium: The eligible person can enrol in the scheme by paying Rs 30 as a registration fee for getting the benefit of RSBY. And, the remaining premium amount Rs 750 per family per year will be borne jointly by the central government or state government.
  • No age limit: There is a specific age required to enrol in the scheme. Any eligible person can register and take advantage of the scheme. 
  • Beneficial for stakeholders: Not only the policyholder and his family member can take advantage of the RSBY scheme but every person who is involved in this service to the policyholder. It is designed in a way that each stakeholder can take the get the incentives such as NGOs and MFIs.
  • Guaranteed treatment: Basically, RSBY can be produced for people below the poverty line of India. Those people might not get the treatment of accidental injuries. This scheme aims to reduce this situation to a great extent. 
  • Technology and security enabled: RSBY health scheme utilizes robust monitoring and evaluation through the IT-enabled apps and chips present on the smart card. The cards have the biometric information of the policyholder and are associated with the server at the local levels for faster exchange of data. 

Advantages of Rashtriya Swasthya Bima Yojana

  • Sum insured: A person can claim up to Rs. 30,000 for many expenses that are covered under the policy.
  • Coverage for the family: Five members of the family can avail of the benefit of the scheme. The head of the family, his or her spouse, and three dependents are eligible to take the benefit. A newborn baby can become an additional beneficiary until the policy is valid.
  • No waiting period: A waiting period is a period when the policyholder can't claim against specific conditions such as specified in the policy. And, in that situation, they have to pay from their pocket during the waiting period. However, the RSBY does not have any such clause.

Eligibility Criteria

The family who fulfils the criteria of eligibility of RSBY is permitted to enrol under the scheme. Here is the eligibility required for RSBY:-

  • The members of the family below the poverty line list made by the state government can be enrolled in the scheme,
  • Any person working in the unorganized sector,
  • Registered member of the welfare boards

How to Claim under Rashtriya Swasthya Bima Yojana?

Mostly, the claim under the RSBY can be made cashless. The policyholder needs to make a smart card at the hospital. Ensure that the empanelled hospital under RSBY can settle cashless claims. The hospital will further send the necessary information to the third-party administrator or the insurance company. The claim will be settled between the insurance company and the hospital once the verification procedure is done.

Frequently Asked Questions

Q: Why are the beneficiaries charged Rs 30 if the government is paying for the scheme?

The amount taken from the beneficiary is the registration fee which helps the Nodal agency to cover the administration charges. The central and state government makes the actual premium amount of the policy of India.

Q: Who can register under the Rashtriya Swasthya Bima Yojana?

Any person below the poverty line can register themselves under the Rashtriya Swasthya Bima Yojana. This plan is mainly for rickshaw pullers, mine workers, sanitation works, drivers of commercial workers, and rag pickers.

You can learn more about this scheme here.

Q: From where you can get the registration form for RSBY?

You can install the Rashtriya Swasthya Bima Yojana app on your mobile phone.  

Q: What is the age limit for dependent children to be covered under this scheme?

There is no specific age limit for the dependent children to be covered under this scheme. In case, there are three of four children in a family then the policyholder should decide which of them will be covered under the scheme.


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WRITTEN BYVarsha Verma

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