Rashtriya Swasthya Bima Yojana (RSBY) – Overview

Government of India has been introducing social security schemes for the well-being of citizens, specifically for the uninsured population of the country. With the medical cost rising, the Government has introduced a scheme to address the lack of healthcare access to the people below poverty line (BPL). In 2008, the Ministry of Labour and Employment came up with a health insurance programme called Rashtriya Swasthya Bima Yojana for the below poverty line population of India. The scheme is extended for the workers in an unorganised sector. In this article, let’s learn about Rashtriya Swasthya Bima Yojana in detail.

The objective of Rashtriya Swasthya Bima Yojana

The primary objective of RSBY scheme (Rashtriya Swasthya Bima Yojana) is to provide financial protection to Indian poor families from healthcare expenses.

Eligibility criteria for Rashtriya Swasthya Bima Yojana

Individuals working in unorganized sector belonging to BPL (below the poverty line) category and their families are eligible for benefits under the RSBY scheme. Five members of the family irrespective of their age are covered.
The eligibility of the workers of the unorganized sector and his family will be verified by the implementing officer. The beneficiaries will be issued a pm smart card – RSBY card for the purpose of identification.

Features and benefits offered by Rashtriya Swasthya Bima Yojana

Following are the features and benefits offered by the RSBY scheme:

Coverage:

Total cover of INR 30,000 is given for the family on family floater basis for a year. Hospitalisation and in-patient care for most common illnesses are covered. The policy covers transportation charges of up to INR 1,000 for the policy period. INR 100 will be paid as transportation cost for each hospitalisation.

Cashless facility:

Cashless medical treatment facility can be availed at any empanelled hospitals across the nation by using RSBY card (smart card) issued under the RSBY scheme

The network of hospitals:

There are public and private hospitals are empanelled under the RSBY scheme which gives BPL populations to access the healthcare facility through RSBY card (smart card) anywhere in the country

Pre-existing illness:

All pre-existing illnesses are covered

Safe and secure:

As the biometric-based smart card is used for availing the cashless facility, fraud claims are easily avoided. As the benefits reach out to the right hands, the RSBY scheme is safe and secure

No paperwork:

At the time of claim, manual paperwork is not involved. Claim settlements are done electronically

Premium/cost:

The beneficiary is required to pay INR 30 per annum as a registration or renewal fee. Out of estimated annual premium of INR 750, 75% of the premium (maximum of up to INR 565 per family per annum) along with the cost of the smart card is borne by the Central Government. The remaining 25% of the premium + additional premium, if any + administrative charges will be borne by the State Government

How to enroll for Rashtriya Swasthya Bima Yojana

Here is how the enrolment is done into Rashtriya Swasthya Bima Yojana-

• List of BPL households is provided to the insurance provider in an electronic format based on the data from Union Planning Commission
• The insurance company will then prepare an enrolment schedule for each village with the help of the district level officials
• The scheduled list will be posted at enrolment station and prominent places of each village. However, date and location for enrolment will be published in advance
• Mobile enrolment centres will be set up in each village with stations being equipped to collect biometric information and photographs of the members of the eligible families
• Centres are also equipped with printing machines to print the RSBY cards
• Government officer called FKO –Field Key Officer needs to be present at the enrolment station for the process of verification of the legitimacy of enrolment. Health insurance company representative and smart card agency official also need to be present at the time of enrolment. Data related to enrolled households will be maintained by the state nodal agency and also maintained centrally by the Government
• A beneficiary can make payment of registration fees INR 30 and avail the card within 10 minutes

List of both public and private hospitals empaneled with insurance provider under the RSBY scheme will be provided at the time of enrolment. Along with this, smart card (RSBY card) will carry details of helpline numbers. Particularly, the state nodal agency plays an important role by monitoring, implementing and supervising of the RSBY scheme (Rashtriya Swasthya Bima Yojana). State nodal agency also coordinates with all the parties involved in the scheme such as district authorities, insurance companies and hospitals etc

Claim settlement process in Rashtriya Swasthya Bima Yojana

Claim settlement process under the RSBY scheme (Rashtriya Swasthya Bima Yojana) is hassle-free and simple. Here is the process to follow:

• The beneficiary needs to produce RSBY card (smart card) at the network hospital while availing the healthcare services
• After providing healthcare services, hospitals need to send an electronic report to Third Party Administrator or to the Insurance provider.
• After verifying the information and records provided by the hospital, Third Party Administrator or the Insurance provider will settle the claims by making direct payment to the hospital within the specified time limit.
• That’s it! It reduces the burden of out of pocket cost for the BPL population who has availed benefit under the RSBY scheme.

Rashtriya Swasthya Bima Yojana is definitely unique and cost-effective healthcare insurance made available for Indian poor families. 

Frequently Asked Questions (FAQs)

1. What is referred to as ‘hospitalization’ in RSBY scheme?

   Hospitalisation refers to seeking healthcare treatment at the hospital by being admitted for more than 24 hours.

2. What are the exclusions applicable under the RSBY scheme (Rashtriya Swasthya Bima Yojana)?

   RSBY scheme does not the following expenses:

   • OPD (outpatient department) expenses. 
   • Any dental treatment or surgery unless arising out of an injury or disease
   • Congenital external diseases
   • War and nuclear perils
   • Alcohol and drug abuse
   • Fertility related treatment expenses
   • Intentional self-injury and suicide

3. Does Rashtriya Swasthya Bima Yojana cover maternity benefits?

   Yes. Maternity benefits are covered under the RSBY scheme in case of RSBY cards issued after 1st April 2009.

4. Does Rashtriya Swasthya Bima Yojana cover new-born member of the family?

   Yes. A newborn baby is automatically covered under Rashtriya Swasthya Bima Yojana since birth for the remaining period of the health insurance policy. To continue the cover, the head of the family can include the baby at the time of renewal.

5. If the family has only three members, will the coverage amount change?

   No. coverage amount of INR 30,000 will remain the same irrespective of the number of members in the family as the coverage is issued on family floater basis. Family floater refers to a single cover for the entire family. This means coverage amount can be utilised by any member or all members of the family.

6. What if the head of the family and dependants are staying in two different places for work purposes? Who can keep the RSBY card?

   If the head of the family is travelling to another district for any purpose, the dependent beneficiary can get a split card for using the same scheme at different places. Family can decide the splitting amount for the cards depending on their requirements. However, the beneficiary may have to bear the cost of issuance of the split card.

7. What if one member of the family dies during the policy period? Can changes be made into the policy?

   If the insured member dies during the policy period, the family can provide details of another member if his/her name is included in the BPL list.

8. What is the difference between RSBY and Ayushman Bharat?

   RSBY offers coverage up to INR 30,000 while under Ayushman Bharat scheme coverage is offered for up to INR 5 lakhs. Moreover, Ayushman Bharat scheme is supposed to absorb RSBY and offer one insurance cover for the BPL families and workers in the unorganized sector.

9. Who is eligible for RSBY?

   Anyone in the BPL family is eligible to apply for the RSBY Scheme. If the family is registered by the State Government as a BPL family, he is eligible to apply for RSBY from the enrollment centre wherein the head of the family’s identity would be confirmed.