Rashtriya Swasthya Bima Yojana (Rsby) Insurance Scheme

16 August 2023

654 10 mins read

Know all about Rashtriya Swasthya Bima Yojana and explore the latest from government schemes in healthcare under this scheme.

Table of Contents

Overview of Rashtriya Swasthya Bima Yojana

The Rashtriya Swasthya Bima Yojana (RSBY) is a special health insurance plan by the Indian government. It was made to support families from the lower economic group for hospital stays. The program covers the costs of being admitted to the hospital and also takes care of some illnesses that were already there before joining.

Objectives of RSBY

The RSBY wants to help people by making it easier for them to pay for hospital expenses. They do this by providing health insurance that doesn’t need cash. Their goal is also to help those who are marginalised or don’t have much money to get affordable healthcare.

Eligibility Criteria for RSBY

To be eligible for the RSBY, you need to meet certain conditions. These conditions include being considered as living below the poverty line, working in the unorganised sector, or being part of specific government welfare programs.

Enrolment Process

How to Enrol for RSBY

If you can join the RSBY, you can go to the enrollment center in your area. You will need to give the right identification papers and fill out the application form. Once they confirm everything is good, they will give you an RSBY smart card. This special card lets you get health insurance benefits without paying cash, as long as everything is checked and approved.

Documents Required for Enrolment

To enroll in the Rashtriya Swasthya Bima Yojana, you need to provide the following documents:

Proof of Identity: You must submit one document that verifies your identity, such as:
- Aadhaar card
- Voter ID card
- Ration card
Proof of Eligibility: You must provide a document that demonstrates your qualification for the program, such as:
- Certificate indicating that you are below the poverty line
- MGNREGA employment card
- ID card for unorganized workers

These documents are required to validate your identity and eligibility for enrollment in the RSBY.

Enrolment Camps

The RSBY has special places in local communities and public areas where eligible people can go to sign up, give the required papers, and get their RSBY smart cards. This makes it easy for them to get health insurance benefits.

Benefits of RSBY

Coverage Under RSBY

With RSBY, you can get medical care without paying cash for being admitted to the hospital, surgeries, tests, and other treatments up to a certain limit. It covers the expenses of staying in the hospital, including if you already had a condition before.

Medical Expenses Covered Under RSBY

The RSBY helps people who qualify by paying for different healthcare expenses. This includes costs for going to the hospital, surgeries, tests, medicines, and treatments for various illnesses. It also covers pre-existing conditions and services related to pregnancy.

Pre-existing Conditions Covered Under RSBY

If you have conditions like high blood pressure, diabetes, or other long-term illnesses already, the RSBY will still cover you. This means you can get medical care and go to the hospital for treatment without any extra charges or exclusions, as long as you follow the rules they have.

What is Covered Under Rashtriya Swasthya Bima Yojana?

The RSBY is a special health insurance program that gives more advantages than regular insurance plans. Here are the things that the RSBY insurance covers:

Hospitalisation Expenses: The RSBY will pay for the expenses of going to the hospital and getting treated for a sickness or accident. The policyholder’s family members will also be covered. However, a doctor or specialist who is qualified must give the treatment and arrange for the patient to be admitted to a hospital or nursing home. The insurance company will pay for things like:

Charges for Nursing & Boarding
(General Ward) Bed fees
Surgical fees
Anaesthetists
Doctor visits
Fee for consultation
Anaesthesia
Blood
Oxygen
Charges in OT
Costs associated with using surgical devices
Medicines
Devices for prosthetics
Implants
A diagnostic test with X-ray
(Patient only) Food
Etcetera

Pre-Hospitalisation: They will pay for diagnostic tests and medicines up to one day before the patient goes to the hospital
Post-Hospitalisation: After the patient leaves the hospital, they will cover the costs related to the condition or treatment for the next five days
Transportation Expenses: Every time the policyholder goes for a visit, they can ask for up to ₹100 to cover transportation costs. The most they can get in a year for transportation is ₹1000
Dental Care: If you have an accident and need dental care, the RSBY will pay for it
Daycare Procedures: A daycare procedure is when you have an operation but don’t need to stay in the hospital for a long time. They are sometimes called outpatient treatments. The RSBY covers different types of daycare procedures, including but not limited to:

Surgery to release tight tissues
Dental surgery after an accident
Surgery on the ears
Vision therapy
Operations on the intestines
Surgery done with general anaesthesia
Haemo-Dialysis
Surgery for hydroceles
Operations done with general anaesthesia
Therapeutic procedures using laparoscopy in daycare
Lithotripsy
Minor techniques to fix limbs
Nose surgery
Intravenous chemotherapy
Prostate resection
Radiotherapy
Surgery on the urinary system
Vocal surgery
Tonsillectomy
Treatment for dislocations and fractures
Costs for screening and ongoing medical care, including tests and medicines
Any medical procedure that your insurance covers.

Maternity Benefit: This program pays for both regular and caesarean deliveries. If you have a regular delivery, you can claim ₹2500, and if you have a caesarean section, you can claim ₹4500. They also cover any problems that happen before the delivery. If a pregnancy ends by accident or if the mother’s life is in danger and they have to stop the pregnancy, the scheme supports the expenses.

8. Newborn Coverage: If the RSBY policy has already reached the highest number of people it can cover, a baby who is just born will still get added to the policy automatically. The coverage will stay until the policy period ends. When the policy is renewed, the person who has the policy can decide whether to keep the baby included in the coverage.

Did you know: The Rashtriya Swasthya Bima Yojana (RSBY) was launched by the Central Government in response to the demand for social security for these employees. The program had 5,097,128 hospitalization cases and 34,285,737 Smart Cards as of 25 March 2013.

What is Not Covered Under RSBY?

The RSBY enables those who are less fortunate to receive essential care during a medical emergency. As a result, the following ailments are not covered by the plan:

If the plan doesn’t cover a hospitalization claim, then it won’t cover the same
It won’t cover the prices for vitamins or tonics unless a doctor prescribes them as part of the treatment
They won’t give money back for cosmetic or corrective dental procedures. The scheme also won’t cover operations that fix cavities or root canals
If you get sick from using too much alcohol, drugs, or other substances, the scheme won’t pay for it
The scheme won’t cover procedures to help with getting pregnant or fertility problems
The scheme won’t pay for Gender change operations
They won’t cover hormone replacement therapy unless you need it for an accident or sickness.
They won’t pay for cosmetic or plastic surgery unless it’s necessary because of an accident or sickness
The scheme won’t cover vaccinations
The scheme won’t pay for treatment for HIV/AIDS
The scheme won’t cover expenses if someone intentionally hurts themselves
The scheme won’t pay for injuries caused by war, invasion, or nuclear weapons
The scheme won’t cover treatments from alternative systems of medicine like AYUSH
The scheme won’t pay for treatments at rehab places like rehab hospitals or nature care clinics, unless it’s mentioned in the policy documents.

Regarding Maternity Benefit Exclusions

The following aspects are covered by the scheme

Pregnancy costs
The price of a pregnancy that is voluntarily ended
48 hours following the delivery and any associated procedures, the hospitalisation was over.

Hospitalization and Treatment Under RSBY

The RSBY makes sure that people who qualify get full care and money help when they go to linked hospitals and healthcare places. It pays for things like staying in the hospital, surgeries, medical treatments, seeing the doctor, tests, medicines, and even care after leaving the hospital.

How to Apply for Rashtriya Swasthya Bima Yojana?

If you are eligible for the RSBY, you can go to the nearest place where they enroll people. Bring your ID and papers to show that you qualify, and fill out a form for them to check everything. After that, they will give you your RSBY smart card.

How To Check RSBY Smart Card Status Online

Visit the official RSBY website to access the enrollment tracking feature
Enter the smart card number or application details on the website
Check the status of the RSBY smart card to see its progress
Track whether the card is being processed, sent out, or already delivered
This feature provides transparency and allows individuals to easily monitor the progress of their enrollment in RSBY
It helps beneficiaries stay informed and keep track of their smart card status in a clear and convenient manner.

How to File Claims under Rashtriya Swasthya Bima Yojana

By following this process, you can easily claim and receive money back for the medical expenses covered under RSBY:

Visit the hospital where you received medical treatment under the RSBY coverage
Present your RSBY smart card to the hospital staff
Provide the necessary papers and records required for the claim process
The hospital will assist you with the claim process and handle the rest of the procedure
They will take care of submitting the claim and coordinating with the RSBY authorities
The hospital staff will help ensure that you receive the reimbursement for the medical expenses covered by RSBY

Features of Rashtriya Swasthya Bima Yojana

RSBY is not just a simple health insurance choice. It is also a smart business strategy. Here are some things that make this plan special:

Guaranteed Treatment: The RSBY was made for poor people in India who may not always get the right care when they are sick or have accidents. This plan tries really hard to stop those kinds of situations from happening.
No Age Limit: In this plan, people of any age can join, unlike other health insurance plans that have specific age requirements.
Low Premium: If you want to join the program and get health insurance, you need to pay ₹30 as a registration fee. The rest of the money needed for the insurance, which is ₹750 per family each year, will be shared by the Central Government and the State Governments.
Option to Choose: If you have RSBY insurance, you can go to a special hospital chosen by RSBY. You don’t need to meet any special conditions to get care at a public hospital.
Incentives for All Stakeholders: The RSBY scheme helps not just the person who has the insurance and their family, but also everyone who helps provide this service. This includes organizations like NGOs and MFIs, who will receive rewards for participating in the scheme.
Sum Insured: The policy lets you ask for up to Rs. 30,000 for different expenses.
Technology and Security Enabled: The RSBY health insurance program uses special technology like apps and chips to keep track of things. The smart card has the policyholder’s fingerprint information and can quickly share data with local servers. They have a very secure system to manage the fingerprint data and keep track of transactions.
Pre-Existing Disease: A pre-existing condition means an illness that someone already had before getting insurance. It includes illnesses that they might not have known about when they bought the insurance. Usually, health insurance policies have a waiting period of 2 to 4 years for pre-existing conditions. However, with RSBY, these conditions are covered from the day the insurance is bought, no matter how old the person is.
Coverage to the Family: This plan is for a regular Indian family with five people. It covers the head of the family, their spouse, and three dependents. If a new baby is born before the plan ends, they can also be added as a beneficiary.

Implementation of RSBY

Implementation Process of RSBY

Step 1: Identification of eligible individuals who can join the RSBY
Step 2: Setting up enrollment centers or designated places for eligible individuals to sign up for RSBY
Step 3: Verification of documents to ensure applicants meet the necessary eligibility criteria
Step 4: Issuing special smart cards with fingerprint identification to enrolled individuals
Step 5: Selection of hospitals and healthcare facilities to participate in the RSBY program
Step 6: Ensuring beneficiaries can receive medical help without immediate payments
Step 7: All of these steps, including identification, enrollment, document verification, smart card issuance, hospital selection, and hassle-free medical assistance, are crucial for the successful implementation and functioning of the RSBY

RSBY Implementation Partners

The Rashtriya Swasthya Bima Yojana (RSBY) is a program that involves different groups working together. Insurance companies provide the coverage, healthcare providers like hospitals and clinics are chosen to give medical help, and government organisations take care of signing up people, making sure they qualify, and running the program. They all work together to make sure the program is successful.

Roles and Responsibilities of Implementing Agencies

The people who run the RSBY program have important jobs. They sign up the people who qualify, check their documents, give them smart cards, find healthcare providers, handle insurance claims, and make sure everything runs smoothly. Their goal is to give everyone who enrolls complete health insurance coverage.

Monitoring and Evaluation of RSBY

Monitoring Mechanism Of RSBY

The RSBY program is regularly checked by the government to make sure it’s working well. They do audits, inspections, and evaluations to see if the program follows the rules and if insurance companies, healthcare providers, and others are doing a good job. This helps make sure everything is done correctly and efficiently.

Evaluation of RSBY

The RSBY is being looked at closely to see if it is doing what it was meant to do. They want to know if it’s helping people get healthcare, feel more secure about money, and pay less from their own pockets for medical expenses.

Impact of RSBY

The RSBY has made a big difference in healthcare and in helping people who are vulnerable. It gives them insurance for their health, which means they don’t have to worry about money when they need medical help. It also helps them get good care and protects them from having to pay a lot for very expensive treatments.

Conclusion

RSBY has had a significant impact on improving healthcare affordability and accessibility for the vulnerable sections of society. The scheme has successfully provided health insurance coverage to millions of families who were previously deprived of such benefits. By offering cashless hospitalisation and covering a wide range of medical expenses, RSBY has helped reduce the financial burden on the poor and ensured their access to quality healthcare services.

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FAQs

What is RSBY?

RSBY is a health insurance scheme for the below poverty line (BPL) families in India.

Who is eligible for Rashtriya Swasthya Bima Yojana?

All Indian citizens are eligible for RSBY.

What benefits does Rashtriya Swasthya Bima Yojana provide?

RSBY provides health insurance cover of up to ₹30,000 per family per year. The scheme also covers pre-existing diseases. In case of hospitalisation, it covers expenses on medicines, diagnostics, room charges, etc.

How can I enroll in RSBY?

You can enroll in RSBY by visiting your nearest enrolment centre with your biometric details (Aadhaar number or ration card) and a passport size photograph. You will also need to submit a self-declaration of family income.

How do I get a RSBY card?

You can get an RSBY card that gives you health insurance without having to pay upfront. To get the card, go to the nearest enrollment centre with your identification and proof that you qualify. Fill out the application and make sure it gets verified.

How can I check my RSBY card details online?

Go to the official RSBY website and enter your application information or RSBY card number. Then, you can look at your card details online, such as what the card covers and other important information.

What is the RSBY card?

The RSBY card, also called the RSBY card, is a special card with your fingerprint that you can use to get medical help and pay for hospital visits. It's given to people who qualify for the RSBY program.

What is the use of RSBY?

The RSBY helps people who don't have a lot of money by giving them affordable health insurance. Its goal is to make sure everyone can get healthcare and not have to worry about the cost. It also protects them from having to pay a lot of money if they need to go to the hospital. The program makes it easier for them to get good healthcare when they need it.

How do I register with RSBY?

Visit the closest enrollment center, present the required identification and eligibility documentation, complete the application form, and go through the verification process to complete your registration and receive the RSBY smart card for health insurance coverage. Talk to our legal experts for more information.

What is the amount of Rashtriya Swasthya Bima Yojana?

The RSBY usually gives a specific amount of money, between ₹30,000 to ₹50,000, to cover hospital expenses and medical treatments for each eligible family. The exact amount depends on the rules of the plan.

What is the benefit of RSBY cards in Kerala?

The RSBY card in Kerala is helpful because it gives people insurance that covers their medical expenses without them having to pay upfront. This means they can go to the hospital and get treatments without worrying about the money. It makes healthcare more affordable and reduces the amount of money they have to pay from their own pockets.

What is the RSBY scheme in Kerala?

In Kerala, there is a program called RSBY that is based on the RSBY. It helps people in the state by paying for hospital visits and making it easier to get healthcare services. The program provides health insurance for workers who don't have a regular job and for families who don't have a lot of money.

When did RSBY start?

The Government of India's Ministry of Labour and Employment started the RSBY on April 1. The aim of this program is to give health insurance to families who don't have a lot of money and groups of people who face challenges in society.

What are the services under RSBY?

The RSBY program provides full health insurance coverage to eligible individuals and families. It includes payment for hospital stays, operations, tests to find out what's wrong, conditions that were already there before getting the insurance, taking care of someone after they leave the hospital, and services related to having a baby.

What is the RSBY number?

The RSBY scheme gives a special number to each person or family called an RSBY number. This number helps keep track of and identify people who can get insurance money and benefits.

How can I check my RSBY card status?

To check the status of your RSBY card, you can do two things. First, you can go to the official RSBY website and give them your information, like your application number or RSBY card number. Second, you can call the helpline number they provide and ask them about your card. They will be able to tell you if your card is being processed or if it has been delivered.

Who are the beneficiaries of RSBY?

The Rashtriya Swasthya Bima Yojana (RSBY) gives health insurance and money protection for hospital bills to families who don't have much money, people who work in jobs without regular pay, and others who are financially struggling. But they have to meet certain conditions to be able to join the program.

How do I apply for the RSBY scheme?

To join the RSBY program, go to the enrollment centre near you. Make sure to bring important documents that show who you are and if you qualify. Fill out the form they give you and give it back to them. They will check everything and if everything is okay, you will get a special card called the RSBY smart card. This card helps you use the health insurance benefits.

What is the full form of RSBY?

The long name of RSBY is Rashtriya Swasthya Bima Yojana.

Is RSBY Yojana still valid?

In India, the RSBY was a health insurance plan that was in place.

What is the total amount of RSBY?

The amount of money you can get from RSBY depends on the rules of your state. Usually, it's between ₹30,000 to ₹50,000 for each family that can join. This money helps pay for hospital bills and other medical treatments if someone in your family needs to stay in the hospital.

What is the age limit for dependent children to be covered under RSBY?

Usually, kids who rely on RSBY can be covered until they turn 21. But remember, the rules about the age limit might be different in different states or places, so it's important to check the specific rules of the plan where you live.

Who can enroll under RSBY?

If your family doesn't have much money, if you work in a job without a regular salary, or if you receive help from the government, you can join RSBY. But you have to meet certain requirements to be able to join the program.

Where can I get the application form for RSBY?

To apply for RSBY, you can go to the places near you that help with the program or ask the government organisations in charge. They will give you the forms you need to fill out. If you want more information on how to get the form, you can either visit the official RSBY website or call the helpline number.

What is the aim of Rashtriya Swasthya Bima Yojana?

The goal of RSBY is to make sure that poor families and workers who don't have regular jobs can get affordable health insurance. This way, they can get good healthcare without having to spend too much money. It's all about helping people and making life better for everyone in India.