What Is Rashtriya Swasthya Bima Yojana?

A government-sponsored programme known as RSBY, or the National Health Insurance Programme, is available to Indian individuals who fall under the BPL (Below Poverty Line) category of income. Rashtriya Swasthya Bima Yojana is the full name of the programme. This programme falls under the category of a family floater health insurance plan because both the policy holder and his or her family are eligible for benefits.

What Is Included in Rashtriya Swasthya Bima Yojana (RSBY)?

The Rashtriya Swasthya Bima Yojana is an uncommon health insurance policy that offers additional benefits in comparison to commercial plans. Here are the RSBY insurance coverages:

1. Hospitalization Expenses:

The RSBY will cover costs associated with hospitalisation for the treatment of a disease, ailment, or accident. This protection will also extend to the policyholder’s family. However, the medication and hospitalisation must be administered by a qualified Physician/Medical Specialist/Medical Practitioner in a Nursing Home/Hospital. The insurance company will cover the expenses associated with the following (but not limited to):

• Nursing & Boarding Charges
• Bed charges (General Ward)
• Surgeons charges
• Anesthetists
• Doctor visits
• Consultation fee
• Anaesthesia
• Blood
• Oxygen
• OT Charges
• Expenses related to the use of Surgical Appliances
• Medicines
• Prosthetic Devices
• Implants
• X-Ray and Diagnostic Test
• Food (patient only)
• Etcetera

2. Pre Hospitalization:

The programme will cover the cost of diagnostic procedures and medications up to one day prior to a patient’s hospital admission.

3. Post Hospitalization:

The patient’s hospitalization-related medical expenses will be covered for five days following the date of discharge.

4. Transportation Expenses:

Under transportation, the policyholder can claim a maximum of Rs. 100 per visit. The annual maximum for these costs is 1,000 rupees.

5. Dental Treatment:

The Rashtriya Swasthya Bima Yojana will cover the cost of dental treatments required as a consequence of an accident.

6. Daycare Treatments:

A nursery treatment is a surgical procedure that does not necessitate hospitalisation for an extended period of time. These remedies are also known as outpatient care. RSBY covers the following (not exhaustive) catalogue of nursery treatments.

• Contracture release of a tissue
• Dental surgery following an accident
• Ear surgery
• Eye Surgery
• Gastrointestinal surgeries
• Genital surgery
• Haemo-Dialysis
• Hydrocele surgery
• Identified surgeries under general anaesthesia
• Laparoscopic therapeutic surgeries allowed under daycare
• Lithotripsy
• Minor reconstructive procedures of limbs
• Nose surgery
• Parenteral Chemotherapy
• Prostate surgery
• Radiotherapy
• Surgery of urinary system
• Throat surgery
• Tonsillectomy
• Treatment of fractures/dislocation
• Screening and follow up care including medicine cost with and without diagnostic tests
• Any procedure covered by the insurance company

7. Maternity Benefit:

This scheme covers both natural and caesarean births. The policyholder can submit a claim for Rs. 2500 for a natural birth and Rs. Also covered are any complications prior to delivery.

Accidental or life-threatening circumstances that necessitate the termination of a pregnancy will be covered.

8. Newborn Coverage:

The newborn will be promptly added to the RSBY policy even if the maximum number of beneficiaries has already been reached. This protection will be in effect until the conclusion of the policy period. At the time of policy renewal, the policyholder must decide whether or not to include the infant.

What Is Excluded from Rashtriya Swasthya Bima Yojana (RSBY)?

In the event of a medical emergency, the Rashtriya Swasthya Bima Yojana enables underprivileged individuals to receive necessary care. Thus, the following conditions are excluded from coverage:

• Any claim for hospitalization that is not covered under the scheme will not be honoured
• Cost of vitamins or tonics unless prescribed as a part of treatment by a certified medical practitioner
• Dental treatments that are cosmetic or corrective in nature will not be covered. Also, root canal, filling of cavity, or procedures related to wear and tear are not covered.
• Congenital external diseases
• Substance abuse: Any illness arising out of excessive use of alcohol, drugs, or any intoxicating substance is not covered.
• Fertility, sub-fertility or assisted conception procedures
• Physical changes for resembling the opposite sex
• Hormone replacement therapy
• Plastic/cosmetic surgery unless required due to an accident or as a part of a disease
• Vaccinations
• HIV/AIDS
• Suicide
• War, an act of a foreign enemy, invasion, or warlike operations by nuclear materials
• AYUSH
• Treatments availed at a convalescent hospital, health hydro, convalescent home, nature care clinic, etc as described in the policy documents. 

Regarding Maternity Benefit Exclusions:

• Prenatal expenses
• The cost of voluntary termination of pregnancy
• Hospitalization ended 48 hours after delivery and related operations

Rashtriya Swasthya Bima Yojana features include:

RSBY is a lot more than a straightforward health insurance option. Additionally, it is a profitable business strategy. These are this plan’s characteristics:

1. Guaranteed Treatment:

The Rashtriya Swasthya Bima Yojana was developed for those in India who live in poverty. They might not always receive the proper care for diseases or accidents. This plan attempts to substantially eliminate such circumstances.

2. Low Premium:

In order to take advantage of the coverage provided by the health insurance policy, an eligible person can participate in the programme by paying a registration fee of Rs. 30. The Central Government and the corresponding State Governments will split the remaining premium cost, or Rs. 750 per family each year.

3. No Age Limit:

An eligible person from any age group who meets the eligibility requirements can enrol in the plan, unlike commercial health insurance policies where an entry age is set.

4. Option To Choose:

The policy holder has the option to receive care at a hospital that has received endorsement from RSBY. There are no prerequisites to receiving care at a public hospital.

5. Beneficial For All Stakeholders:

The RSBY programme benefits everyone involved in providing this service to the insured, not only the policyholder and their family. Every player, including NGOs and MFIs, will get incentives under the scheme’s planned implementation.

6. Technology And Security Enabled:

The RSBY health insurance programme makes use of IT-enabled apps and chips on the smart card for robust monitoring and evaluation. These cards contain the policyholder’s biometric data and are connected to local servers for speedier data sharing. A high-security system that keeps tabs and does regular reporting is used to manage biometric data and transaction records.

Rashtriya Swasthya Bima Yojana Benefits:

The RSBY is special and well-liked due of the following advantages. To far, this programme has enrolled millions of families. The plan has the following advantages:

1. Sum Insured:

Up to Rs. 30,000 can be claimed for a variety of expenses that are protected by the policy.

2. Coverage For The Family:

This layout is suitable for a five-person Indian family. The plan covers the family’s head, spouse, and three dependents. Until the policy’s expiration, a new baby may be added as a beneficiary.

3. No Waiting Period:

A waiting period is a period of time during which a policyholder cannot file a claim for a particular set of circumstances as determined by the insurance provider. During the waiting period, one must cover the expense of the treatment out of their own cash. However, there is no such clause in the RSBY.

4. Pre-existing Diseases:

A pre-existing disease is, as the term implies, any illness that the policyholder or the beneficiaries had before they bought the policy. This covers any illnesses that the policyholder might not have known about at the time of policy purchase.Pre-existing conditions typically have a 2 to 4 year waiting period in health insurance policies. Nevertheless, from the date of purchase, these are protected by RSBY regardless of the beneficiary’s age.

Eligibility For Rashtriya Swasthya Bima Yojana:

Only the family that satisfies the RSBY’s eligibility requirements is permitted to enrol in the programme. The following qualifies one for RSBY:

• The members of a family who are included on the state government’s “Below Poverty Line” list are eligible to enrol in this programme.
• The candidate may work in any unorganised field.
• member in good standing with the welfare boards

What Is The Rashtriya Swasthya Bima Yojana Claim Procedure?

Most claims submitted under the RSBY are cashless in nature. The Smart card must be presented at the hospital by a beneficiary of this coverage. It should be noted that the only facility eligible to resolve cashless claims is a hospital. The hospital will transmit the required data to the insurance provider or the Third Party Administrator (TPA). After the verification process is finished, the claim will be resolved between the hospital and the insurance company/TPA. When a claim is settled, no paperwork is needed.

Rashtriya Swasthya Bima Yojana Enrollment Process:

A schedule for enrolment at the village level will be released by insurance companies who are authorised to offer this programme. Before the start of the enrollment procedure, the schedule will be made available at all conceivable government centres.

BPL list members are welcome to visit the enrollment centres on the day and hour specified in the schedule. The RSBY Cards can be printed at the enrolling centre as well. Within 10 minutes of completing the RSBY registration process, a listed beneficiary can obtain the swasthya bima card.

Soon after registration, the Rashtriya Swasthya Bima Yojana card status becomes operational. The smart card will include biometric information as well as the RSBY Customer Care Number. There will also be a hospital list for the Rashtriya Swasthya Bima Yojana at the specific enrollment location.

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