Rashtriya Swasthya Bima Yojana – A government-sponsored healthcare insurance program

The highlight of the RSBY Policy

• The Indian government introduced the RSBY Scheme, a national health insurance program in which the state governments contribute to a portion of the premium costs. It is a program for unorganised sector workers who cannot afford high-quality medical treatment.
• The program intends to offer free healthcare at a list of hospitals (including private & public institutions) to underprivileged groups of society through a cashless insurance program.
• The RSBY also covers a long range of other medical costs, including pre-hospitalization, transportation, and post-hospitalization costs.
• The recipient, their spouse, and his/her three dependents make up the five family members that are covered by the program.
• A biometric-enabled Smart Card containing the recipient’s fingerprint and photo is issued in exchange for a yearly registration fee of Rupees 30 from the beneficiary.

Rastra Swasthya Bima Yojana: Goals

The following are the RSBY Scheme’s main goals:

• Protection against high medical costs: With changing times and rising out-of-pocket costs over the past several decades, health has become a privilege of the elites. The Indian government’s insurance program offers underprivileged groups the much-needed defence against pricey medical care and treatments.
• All People Should Have Access to High-Quality Health Care: The Directive Principles of State Policy (DPSP) in the Indian Constitution also emphasise the government’s efforts to provide social services to all segments of society. The State is required by the Constitution to provide everyone with high-quality healthcare. For numerous societal groups, RSBY increases access to high-quality healthcare.

RSBY Scheme Benefits

• The beneficiaries of this program are given insurance protection up to Rs. 30,000 per year on a family floater basis, which covers a maximum of five family members, including the head of the household, their spouse, and up to three dependents.
•  A smart card with biometric capabilities is given to the recipients.
•  For the North-eastern states & J&K, the Central Government of India contributes 90%, and 75% of the expected yearly premium.
• The state governments contribute 10% in the case of J&K and the Northeastern states and 25% of the overall yearly premium.
•  It offers cashless insurance protection for all hospital stays and medical treatments.

Eligibility Conditions for the RSBY Scheme

The RSBY Scheme’s health benefits are only available to those who meet the following criteria:

• The person should be employed in a BPL household’s unorganised unrelated sector. People registered with welfare boards are also permitted to enrol in the program.
• The RSBY system has no maximum application restriction. Any member of a person’s family can use it.
• Due to its availability to everyone who qualifies to purchase it, this program can help close to one-third of our population.

Characteristics of the Indian Swasthya Bima Yojana

The following are some salient characteristics of the RSBY Scheme:

• This program provides coverage for up to Rs. 30,000 in hospitalisation costs.
• The Central Government and the corresponding State Governments share in the cost of the premiums for this medical insurance coverage.
• The registration fee for recipients is Rs. 30, and the government will cover the remainder.
•  Benefits under this insurance are available to people of any age.
• Starting on the first day of operation, this program covers all pre-existing conditions.
• This coverage’s primary goal is to lower the out-of-pocket costs experienced by poor families in the event of severe medical crises.
• This is a cashless plan that pays the network facility according to pre-set package pricing for particular ailments.
• Every family member is covered by this RSBY program.
• This plan is created as a business model that provides incentives for all parties involved. The government pays the insurers the premium amount on behalf of each registered member.
• The government offers a maximum reward of Rs. 750 per family each year. This aids the government in giving all disadvantaged families simple access to high-quality healthcare.
•  Families signed up for this program will receive a smart card containing fingerprints among other biometric data. This plan is secure and impenetrable thanks to the biometric method.

What is included under RSBY Scheme?

The RSBY Scheme is a cutting-edge health insurance scheme that provides extra advantages in comparison to a commercial plan. The following healthcare costs for an insured person are covered by the plan:

The cost of hospitalisation

• Hospitalisation costs resulting from an illness, sickness, or accident are covered by RSBY. Keep in mind that the hospitalisation costs will also be covered for the policyholder’s family members. The medical costs that will be paid by this program are listed below:
•  Fee for seeing a doctor
• Fees for boarding & nursing
• cost of a bed
• Surgical costs
• Charges for blood in the operating room
• Oxygen
• Cost of Medicines
• The cost of diagnostic tests
• Implanted anesthetics
• The patient’s food costs
• Consultation charges
• Prosthetic tools

Amounts Spent on Hospitalisation 

The insured’s expenditures following hospitalisation are covered under RSBY Scheme. If the insured has had surgery or long-term care, the plan will pay for all medical costs for up to five days after the insured is released from the hospital. 

Transportation Charges 

Expenses for travel up to Rs. 100 for each visit are also covered for policyholders. A maximum of Rs. 1,000 in transportation expenses per year can be claimed by an insured.

Costs of Pre-Hospitalisation 

An insured person will be covered for pre-hospitalization costs under this plan, including those for tests and prescription drugs. 

Systematic Therapy 

The program pays for dental work required as a result of an accident. 

Nursery Services

• A patient receiving daycare therapy must stay in the hospital for fewer than 24 hours. The following daycare procedures are covered under the program:    
• due to an incident, dental surgery was required. 
• Ear surgery
• Surgery of the digestive system
• vision therapy 
•  Vocal surgery
• General anesthesia 
•  Lithotripsy 
• A nose operation
• intravenous chemotherapy
• surgical hemodialysis 
• therapeutic laparoscopic surgery 
• prostate resection
• Radiotherapy 
• surgery of the urinary system 

New-born Baby Coverage

Even if the number of beneficiaries has increased, RSBY still covers the newborn’s medical costs. Up to the conclusion of the policy’s term, the policyholder may claim the costs associated with treating a newborn. However, the policyholder has the choice of including the name of the newborn child in the RSBY insurance or not when the policy is renewed.

Maternity Costs 

Both natural and cesarean births are covered under the program. For a regular delivery and a cesarean section, the insured person will earn Rs. 2,500 and Rs. 4,500, respectively. The costs related to an accidental miscarriage resulting from an accident or when the mother’s life must be preserved will be covered.

What Does the RSBY Not Cover?

The RSBY Scheme does not cover the following healthcare costs:

• The hospitalisation costs for treatments not covered by the insurance are not covered by the plan. 
• Expenses for the treatment of HIV/AIDS. 
•  Monetary costs related to hormone replacement treatment. 
• Corrective or purely cosmetic dental procedures are not covered. In addition, the program does not pay for the costs of a root canal or cavity filling. 
• Costs associated with excessive alcohol or drug usage or other substance misuse are not reimbursed. 
• AYUSH
• external congenital illness treatments for changing one’s gender 
• Suicide
• Vaccination 

What distinguishes the RSBY from other government-sponsored health insurance programs?

There are other health insurance programs offered by the government, but RSBY stands apart from the rest for several reasons. Some of the several reasons are included in the list below:

Hospitals: There are significant incentives for the insurer and the hospitals to promote RSBY. Hospitals are paid directly by the recipient, and the insurer, or the Government of India, can also keep an eye on the hospitals to avoid wasteful expenditure or abuse of the funds they have been given. As a result, hospitals are motivated to promote the program and deliver high-quality treatment.

Enhanced Monitoring: A well-developed backend administration system enables the provision of regular analytical reports. The room for several iterations necessary for the scheme implementation process is provided by this assessment and monitoring system.

Coverage: The program gives beneficiaries the choice to receive care anywhere in the nation, making it the ideal insurance program for foreign workers. The system covers the most significant difficulty better than other schemes because of its broad reach.

Recipient freedom: The recipient is given the option to select either a public or private hospital. The hospitals are encouraged by the direct transfer of cash to support the beneficiaries’ decisions regarding their preferred facilities for their medical care.

Intermediaries: The program also incorporates the involvement of several non-governmental organisations (NGO) and microfinance institutions. These middlemen are compensated for their services, which has several advantages such as improving healthcare delivery and fostering economic growth.

What are the main concerns with the RSBY Scheme?

Failed to provide necessary financial protection against high medical costs: RSBY has had significant penetration across the targeted population groups, yet out-of-pocket healthcare spending has declined over the past year.

High Hospitalisation Costs: As a result of the country’s rising hospitalisation costs, citizens have repeatedly fallen below the poverty line. The advantages provided by RSBY have had little impact on the predicament of these disadvantaged groups.

What is Smart Card RSBY?

Smart cards are utilised for a range of tasks, including patient information and beneficiary identification using a photograph and fingerprints. The capacity to conduct cashless transactions at the accredited hospital and transfer rewards throughout the nation is the smart card’s most crucial feature.

The beneficiary will receive the authenticated smart card right there at the enrolment centre.

Rashtriya Swasthya Bima Yojana Policy: How to Register?

An enrolment timetable for villages will be published by the insurance firm that is affiliated with RSBY. Before the registration date, the schedule will be made accessible at all of the village-level government centres. 

The qualified individuals can show up at the enrolment facility on the day and time specified in the enrolment schedule. Within ten minutes of enrolment, a beneficiary who has completed registration will receive an RSBY card. The insured’s biometric information as well as the RSBY customer service number are both on the RSBY card. An official from the government, a field officer, and a representative from the insurance company will all be present during the entire procedure.

Claim Resolution Process

After the patient has received treatment, the hospital under contract will electronically submit a report to the insurance company or third-party administrator (TPA). According to the agreement between the hospital and the insurance, the TPA or insurer will review the information records and pay the hospital within the allotted period.

FAQ SECTION

Where can I get the BSBY enrolment documents?

The enrolment centre will have the forms on hand, or they may be obtained from the state government’s website.

What is the RSBY Scheme’s promised amount?

Under the RSBY Scheme, a total of Rs 30,000 is guaranteed.

What distinguishes RSBY from Ayushman Bharat Policy?

The Ayushman Bharat Policy is currently offered in place of the RSBY. The RSBY is currently included in the Ayushman Bharat Policy as part of the Senior Citizen Health Insurance Scheme.

What is the cost of renewing an RSBY policy?

An applicant must pay a renewal cost of Rs. 30 for each RSBY Scheme insurance every year.

What does RSBY Policy’s major goals?

Rastra Swasthya Bima Yojana Scheme is the Indian government’s program for providing health insurance to low-income residents. The program’s objective is to provide BPL-eligible unrecognised sector workers with health insurance. The participants’ families will also gain from this initiative.

What advantages does the RSBY Scheme offer?

The advantages of RSBY include better coverage, a Rs 30,000 insurance benefit, including all pre-existing conditions, hospitalisation costs, and transportation costs.

When was the RSBY Scheme introduced?

The RSBY Policy was introduced on April 1st, 2008.

What distinguishes RSBY from Ayushman Bharat?

The Ayushman Bharat Yojana is currently offered in place of the RSBY. The RSBY is currently included in the Ayushman Bharat Yojana as part of the Senior Citizen Health Insurance Scheme.

Whose biometric data is needed to provide the smart card?

Any family member can provide their biometric data for the smart card.