Everything About Rashtriya Swasthya Bima Yojana – Its Benefits, Premium, & Eligibility!

Rashtriya Swasthya Bima Yojana Policy – What it is?

The RSBY Policy is a medical insurance facility given by the Indian government to the people belonging to BPL – Below the poverty line. This policy aims to help those individuals who belong to the below poverty line. Both the policyholders & their family members can avail the benefit of this medical insurance policy.

The RSBY’s main goal

RSBY has two main goals:

• Reduce financial strain to give financial security against extremely expensive medical bills
• To increase disadvantaged populations in the unorganised sector’s access to high-quality healthcare by reducing out-of-pocket hospital expenses for households living below the poverty line.

What services are included under the RSBY Policy?

The RSBY Policy is a medical insurance facility that offers many extraordinary healthcare services to people belonging to BPL. Here we have listed what services are covered under the RSBY policy:

The Expense of Hospital Service:

Under this policy, many medical services, and treatments for illness, disease, or any sort of accident are covered. These services apply to the policyholder’s family members too. The treatment of the patient will be taken under the supervision of the professional staff of the hospital such as nurses/physicians/ medical specialists. All medical expenses will be covered under this scheme.

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

Post Medical Services

Five days following the date of release, the costs associated with a condition or procedure for which the patient was hospitalised will be paid.

Treatment Charges of Day-care

A nursery surgery is a surgical procedure that doesn’t need a lot of time in the hospital. These are additionally known as outpatient therapies. The RSBY covers the following (but is not limited to) a list of nursery procedures.

• Dental surgery following an accident
• Contracture release of a tissue
• Ear surgery
• Gastrointestinal surgeries
• Eye Surgery
•  Haemo-Dialysis
• Genital surgery
• Hydrocele surgery
• Laparoscopic therapeutic surgeries allowed under daycare
• Identified surgeries under general anesthesia
• Lithotripsy
• Nose surgery
• Minor reconstructive procedures of limbs
• Parenteral Chemotherapy
• Radiotherapy
• Prostate surgery
• Surgery of the urinary system
• Tonsillectomy
• Throat surgery
• Treatment of dislocation/ fractures

Pre-Hospital services

Under this medical policy, the costs of medicines & diagnostic test one day before the patient gets admitted is covered.

Dental Service

The RSBY Scheme would pay for any necessary dental work needed as a consequence of an accident.

Transportation Charges

The policyholder is only allowed to submit one travel claim each visit, up to Rs. 100. The yearly cost for this is about Rs1000/-.

Maternity Facility

Under the RSBY Policy, both the caesarean and normal deliveries are included. The policyholder can claim Rs 4500/- for the caesarean delivery and Rs 2500/-  for the normal delivery. This policy also covers the complication that occurred a few minutes before the delivery.

The costs related to an accidental miscarriage resulting from an accident or when the mother’s life must be preserved will be covered.

New-born Facility

Even if there are more beneficiaries than space available, the newborn child will still be immediately enrolled in the RSBY insurance. Until the conclusion of the policy term, this coverage will remain in effect. The policyholder chooses whether to add the infant to the policy when it is renewed.

Key Features of the RSBY Policy

The RSBY Policy is more than a common healthcare insurance policy. This medical insurance policy is also considered to be the most lucrative business model also. Here, we have outlined the key features of the RSBY Policy:

No Age Restriction

There is no age bar or age restriction to avail of the medical services under this medical insurance policy. Individuals of any age group can apply for this medical policy.

Best-assured medical treatment

The RSBY Policy is introduced to offer guaranteed medical services to those who are in great need of medical treatment and also belong to the Below poverty line. This policy assured that they will get the maximum healthcare facility possible.

Low Premium

Interested individuals can take benefit of this policy by paying a small registration amount of Rs 30. The Central Government and the corresponding State Governments will split the remaining premium cost, or Rs. 750 per household each year.

Choice of Hospital

The policyholder has the right to choose the hospital of their choice. The policyholders have the option to choose their hospital.

Benefits for Stake Holders

Everyone engaged in delivering this service to the policyholder benefits from the RSBY program, including the policyholder, their family, and all other stakeholders. Every player, including MFIs & NGOs, will get incentives under the scheme’s planned implementation.

High-Tech Technology & equipment

Robust monitoring & evaluation is done through the smart devices with smart applications and the chips available on the smart cards. Such smart cards consist of the biometric details for the policyholder which is further connected with a common server to have an easy & convenient exchange of information.

With the aid of a high-security system that keeps track of things and performs regular reporting, biometric data, and transaction records are controlled.

What is not covered under RSBY Policy?

RSBY Policy doesn’t offer insurance facility for the below given medical expenses:

• Expenses related to the treatment of AIDS or HIV
• Any hospitalisation claim which is not included under the policy will not be considered
• Any dental treatment including cosmetic or corrective in nature will not be considered
• The costs associated with treating illnesses brought on by heavy drinking, drug usage, etc.
• external congenital illness
• Unless they are prescribed by a licenced doctor as part of therapy, costs associated with vitamins or tonics
• Treating genders differently
• Techniques for assisted conception and reproduction

Advantages of the RSBY Policy

Many benefits of the RSBY Policy make it the most popular medical assurance service among the other facilities. Take a look at the top most benefits of the scheme:

Insurance service for the family member too:

If you have a family member of 5 people, then all of them can take benefit from this healthcare insurance. The policy covers the coverage for the head of the family, three dependents & spouse. Up until the policy’s end, a newborn child may be added as a beneficiary.

Pre-existence illness or disease

This is one of the most important benefits of the RSBY Policy. A pre-existing sickness is, as the name suggests, any disease that the beneficiaries or a policyholder had prior to purchasing the insurance. This protects against any ailments that the policyholder might not have been aware of while buying insurance.

Health insurance policies sometimes feature a 2 to 4-year waiting period for pre-existing diseases. But regardless of the age of the recipient, these are covered by RSBY as of the purchase date.

Insured Amount

You can claim up to Rs 30000/- for different healthcare expense that is included in the RSBY Scheme.

No need to wait much

The waiting period is the time during which a stakeholder can’t rise a claim against a particular condition as declared by the insurance firm. The policyholder will have to pay money from their pocket during the waiting period. But there is no such restriction in the RSBY Policy.

Eligibility Conditions for the RSBY Policy

Only those who met the eligibility criteria for the RSBY Policy. Here we have outlined the main eligibility conditions to apply for the RSBY Policy:

• The family members must belong below the poverty line. Their name must be there in the list of the people who belong to BPL created by the Indian government.
•  Individual must be a certified member of the welfare board
• The candidate may work in any unorganised field.

Enrolment Procedure for RSBY Policy

Insurance firms that are eligible to offer insurance services under the RSBY Policy will make a specific schedule at the village level. The timetable will be made available at all conceivable government centres before the start of the enrolment procedure.

The individuals belonging to the BPL can visit the centre at the mentioned time and date in the given schedule. They must carry their RSBY Smart cards with them. The certified member will receive the RSBY card once the registration is done.

The RSBY Card will become active after the successful registration at the centre. The RSBY Smart card consists of biometric information and & an RSBY helpline number too.

What is RSBY Smart Card?

Once the policyholder successfully registered for the RSBY policy, he or she will get a smart card which is further used as an identity consisting of a fingerprint & photograph, and other details about the patient. The major benefit of this smart card is that a policyholder can make a cashless transaction at the specified hospital with whom one has an affiliation. The recipient shall get the authenticated smart card at the enrolment station itself.

How to raise a claim for RSBY Policy?

After getting the necessary care & treatment, the policyholder must file an electronic claim to the insurance firm. When a particular time is passed, as agreed upon by the insurance company and the hospital, the insurance company or TPA reviews the record information and pays the hospital.

The claims arising under the RSBY Scheme are mostly cashless. To rise a claim, a beneficiary will have to submit an RSBY Smart card at that hospital. Make sure that only those hospitals which come under the RSBY Scheme can offer cashless claims. Once the claim is raised, the specific hospital will send a detailed report to the TPA (Third party Authority).  There is no unnecessary paperwork is needed for the settlement of the claim.

Frequently Asked Questions for RSBY Policy

What is the age of the children to get eligible for the RSBY policy?

The kids of the policyholder are not restricted by age limit under RSBY Scheme. But if a family has more than two kids, then, in that case, a beneficial will have to pick which of them will get benefit under the scheme.

From where can I access the registration form for RSBY Policy?

You can get the RSBY registration form at the particular state government-authorised website.

How much does the RSBY Policy cost to renew?

The RSBY Policy has a Rs 30 yearly renewal cost.

Who are eligible for the RSBY Policy benefits?

Anyone who falls BPL -below the poverty level is eligible to join this healthcare insurance policy. Particularly benefited from this scheme are rag collectors, rickshaw pullers, mining employees, commercial truck drivers, sanitation workers, etc.

Why the policyholder has to pay Rs 30?

Receivers only need to pay Rs. 30 application fee, which helps the Nodal agency cover its administrative costs. The whole actual premium for the scheme is the responsibility of the State & Central Governments of India.