Rashtriya Swasthya Bima Yojana (RSBY) Features and Benefits

Rashtriya Swasthya Bima Yojana (RSBY) – Know in Detail

The Rashtriya Swasthya Bima Yojana was launched by the Ministry of Labour and Employment, Government of India, in 2008. It aims in providing health insurance coverage to families that come under the specific category of Below Poverty Line (BPL) category. As per the Rashtriya Swasthya Bima Yojana, households get protection against financial liabilities that arise because of health emergencies that can result in hospitalization.

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What is Rashtriya Swasthya Bima Yojana?

Often called RSBY or National Health Insurance Programme, it is a government-sponsored scheme that has been brought into the picture for the BPL section of the society. The Government of India majorly finances this scheme (around 75%), while the respective state government partially finances it. If we talk about Jammu and Kashmir, and north-eastern states, 90% is contributed to the Government of India, and 10% of the premium is contributed by the respective state government. The beneficiaries have to pay a minimal registration fee, which is INR 30. This is used for covering the administrative costs under the scheme.

Eligibility criteria of Rashtriya Swasthya Bima Yojana

Mentioned herein below are the eligibility criteria for Rashtriya Swasthya Bima Yojana

Unauthorized workers and their family members who belong to the BPL category are eligible for this scheme. Up to five members of the family can be added under this scheme. You need to know that the implementing agencies will verify the eligibility of the workers of the unorganized sector as well as their family members who want to be covered under this policy. Smart cards are issued to the beneficiaries and are used for identification purposes.

6 Features of Rashtriya Swasthya Bima Yojana

It is a beneficial health insurance product and the features are mentioned herein below:

1. Easy access to healthcare facilities

This scheme was designed especially for people who fall under the category of BPL in the country. Since it can be quite difficult for them to get the needed treatment if they meet with an accident and it results in an injury, they can use this policy.

2. Pocket-friendly premium

The premium to be paid for this policy is highly affordable. If you meet the eligibility criteria of the policy, you have to pay a registration fee of INR 30 to avail of the benefits of the policy. The rest of INR 750 is jointly paid by the central government and the respective state government.

3. No limit on maximum entry age

If you are wondering about the age criteria to apply for this policy, you would be happy to know that there is none. Your age does not matter, all that matters is your eligibility for the policy.

4. Option to choose a hospital

You can choose from the Rashtriya Swasthya Bima Yojana hospital list for 2022 and opt for an empanelled hospital. You do not necessarily need to seek treatment in a public hospital.

5. Technology and security enabled

This health insurance scheme uses thorough monitoring as well as evaluation with IT-enabled applications on the smart card. The RSBY card will come with your biometric information and make sure of fast data exchange since these are connected to the servers at the local level.  Since they use a high-security system, it becomes easier for tracking as well as report frequently.

6. Useful for all stakeholders

This scheme is not only good for the beneficiary and his/her family but also for the stakeholders. The stakeholders can enjoy incentives such as NGOs and MFIs.

Inclusions in Rashtriya Swasthya Bima Yojana

The healthcare expenses covered under Rashtriya Swasthya Bima Yojana for the insured include the following.

• Hospitalization expenses: Costs incurred due to treatment of an illness or accident are covered under Rashtriya Swasthya Bima Yojana. The expenses include Nursing and boarding expenses, Bed expenses for the general ward, Consultation fees, Doctor’s consultation, Anesthetics, Implants, Surgeon’s expenses, Oxygen, Expenses related to the use of surgical appliances, OT expenses, Prosthetic devices, X-rays and diagnostic test, Expenses related to food for the patient.

• Pre-hospitalization costs: Even before getting hospitalized, the insured will get coverage for the expenses incurred, for up to one day.

• Post-hospitalization costs: The scheme provides coverage to the insured for costs that have been incurred after hospitalization. A period of up to 5 days after hospitalization is covered under this scheme.

• Transportation costs: The insured can avail of coverage for transportation costs for up to INR 100, each visit. The annual limit for availing of this benefit is INR 1,000.

• Costs arising from dental treatment: The costs incurred for dental treatment that is the result of an accident are covered.

• Daycare treatments: Daycare treatments that do not need you to be hospitalized for more than 24 hours are covered. The kinds of treatments included are Ear surgery, Eye surgery, Hydro surgery, Dental surgery required because of an accident, Genital surgery, Haemo-dialysis surgery, Contracture release of tissue, Lithotripsy, Gastrointestinal surgeries, and Throat surgery.

• Costs related to maternity: For natural delivery, the cost covered is INR 2,500 and for C-section, the cost covered is INR 4,500. If there is any complication that is arising before the delivery the expenses for that will also be covered.

• Newborn coverage: Even if the beneficiaries exceed in number, the policy will still provide coverage that is related to the newborn baby.

Claim process of Rashtriya Swasthya Bima Yojana 

Once the beneficiary has availed of the necessary treatment, he/she has to send an electronic report to the insurer or the Third Party Administrator (TPA). The TPA or the insurer will then check the record information and according clear the payment to the hospital. This is all done within the stipulated time that is decided by the insurance provider and the hospital.

Rashtriya Swasthya Bima Yojana is one of the best health insurance schemes for people in the BPL category. All the required information about the scheme can be found online.

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