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What is Rashtriya Swasthya Bima Yojana?
The unorganised sector constitutes about 93% of the total workforce in India. However, workers and employees often need help in meeting their healthcare needs since many jobs in the sector involve high-risk environments. There’s also the absence of adequate health insurance coverage in most cases. Aiming to alleviate such issues, the Ministry of Labour and Employment, Government of India, developed the Rashtriya Swasthya Bima Yojana scheme.
The Rashtriya Swasthya Bima Yojana targets individuals and families in the Below Poverty Line (BPL) category. Under this government-funded insurance scheme, workers in the informal or unorganised sector and their family members are insured for a specified amount to cover health-related liabilities, including hospitalisation.
Features of Rashtriya Swasthya Bima Yojana The Rashtriya Swasthya Bima Yojana (RSBY) comes with several features designed to make healthcare accessible and affordable for the underprivileged sections of society. These include the following:
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Guaranteed Treatment RSBY ensures enrolled families receive guaranteed treatment at government-listed hospitals, covering various medical procedures and treatments.
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No age limit Under RSBY, there is no age limit for beneficiaries, making it accessible to all members of the enrolled families regardless of their age.
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Option to choose Beneficiaries can choose from a nationwide network of government-listed public and private hospitals for their medical needs.
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Low premium The total premium for RSBY is estimated to be around Rs. 750, which the insured is not to pay. The government of India is to pay 75% of the premium, and the state government is to pay the remaining 25%. The insured is required to pay only Rs. 30 as yearly renewal/registration fees.
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Sum insured RSBY provides a sum insured of up to Rs. 30,000 for each family per annum for hospitalisation expenses, thereby ensuring adequate coverage for various medical treatments.
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Incentives for all stakeholders The scheme includes incentives for various stakeholders, such as insurance companies, hospitals, and intermediaries, to ensure efficient service delivery and encourage wider participation.
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Technology and security enabled RSBY utilises smart card technology to store data on enrolled families, ensuring secure and hassle-free access to medical facilities. The smart card also helps track and monitor service utilisation.
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Pre-existing disease coverage Under RSBY, pre-existing diseases are covered from day one, providing immediate relief and support to beneficiaries suffering from chronic conditions.
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Coverage to the family The scheme covers up to five family members, including the head of the family, their spouse, and up to three of their dependents, ensuring comprehensive health protection for the entire household.
Eligibility Criteria for Rashtriya Swasthya Bima Yojana
The socio-economic status of families primarily determines the Rashtriya Swasthya Bima Yojana eligibility criteria. It focuses on those classified as Below Poverty Line (BPL) cardholders. Here is a detailed look at the criteria:
- Below Poverty Line (BPL) status: Families must be identified as BPL based on the criteria set by the state government. The BPL status of families is verified using government records and databases. Eligible families are then issued a BPL card as proof of eligibility.
- Family size and structure: Each enrolled family can include up to five members. This typically includes the head of the household, spouse, and up to three dependents, who can be children or elderly members of the family. Families have the flexibility to decide which members are enrolled under the scheme. This allows them to prioritise members who are most likely to require healthcare.
- Age limit: There is no minimum or maximum age limit for applying for an RSBY card.
What is Covered Under Rashtriya Swasthya Bima Yojana? RSBY provides extensive coverage to meet the diverse medical needs of beneficiaries, including the following:
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Hospitalisation expenses RSBY covers various hospitalisation expenses, including room charges, nursing, consultation fees, surgical expenses, and ICU charges.
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Pre-hospitalisation expenses The scheme also covers pre-hospitalisation expenses for up to one day before the admission date, ensuring that initial medical consultations and tests are included.
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Post-hospitalisation expenses Post-hospitalisation expenses are covered for up to five days after hospital discharge, ensuring support for follow-up treatments and medications.
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Transportation expenses Transportation expenses to and from the hospital are covered under RSBY up to Rs. 100 per visit, greatly easing the financial burden on beneficiaries.
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Dental treatment RSBY also includes coverage for dental issues caused by accidents requiring hospitalisation, ensuring comprehensive healthcare for the beneficiaries.
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Daycare treatment The scheme covers daycare treatments that do not require an overnight stay in the hospital, including minor surgeries and procedures.
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Newborn coverage Newborns are automatically covered under RSBY, ensuring they receive necessary medical attention and care right from birth.
What is Not Covered Under RSBY?
While the Rashtriya Swasthya Bima Yojana provides essential medical coverage to underprivileged families, it does not cover a few conditions and treatments. These exclusions include the following:
- Non-scheme hospitalisations
- Vitamins or tonics not prescribed as treatment
- Cosmetic or corrective dental treatments, including
- root canals and cavity fillings
- Congenital external diseases
- Illnesses from substance abuse
- Fertility and assisted conception procedures
- Gender transition procedures
- Hormone replacement therapy
- Plastic or cosmetic surgery (unless due to an accident or disease)
- Vaccinations
- HIV/AIDS
- Suicide
- War or nuclear-related injuries
- AYUSH treatments
- Treatments at convalescent hospitals, nature care clinics, etc.
How to Apply for Rashtriya Swasthya Bima Yojana?
To apply for RSBY, eligible families must contact their local government authorities or designated enrollment centers. The enrollment process typically involves biometric data collection, issuance of a smart card, and payment of a nominal registration fee.
Heres a detailed breakdown of the application process:
- Setting up enrollment camps: Enrollment camps are set up at easily accessible locations. The schedule and location of these camps are announced in advance and local authorities may even make house visits to raise awareness about the Rashtriya Swasthya Bima Yojana benefits.
- Enrollment at the camp: Families need to bring necessary documents like BPL cards, identity proof (Aadhar card or any other government-approved ID), and proof of residence to the enrollment camp. The documents are verified by the camp officials. Once the documents are verified, the family members biometric data (fingerprints and photographs) are collected. This data is used to create a secure RSBY Card. A nominal registration fee of Rs. 30 per family is collected during enrollment.
How to Check RSBY Smart Card Status Online?
Beneficiaries can check the status of their RSBY smart card online on the official RSBY website (http://www.rsby.gov.in/faq_enrollment.html) or by visiting the designated enrollment centres. They can use their registration details to track their status and ensure that their smart card is active and valid.
Documents Required for Rashtriya Swasthya Bima Yojana The following documents are generally required for enrollment in RSBY:
- BPL card or identification
- Aadhar card or any other government-approved ID
- Family photographs
- Proof of residence
FAQS on Rashtriya Swasthya Bima Yojana (RSBY)
What is the aim of Rashtriya Swasthya Bima Yojana?
RSBY aims to provide financial protection against healthcare expenses to Below-Poverty-Line (BPL) families by offering health insurance coverage for hospitalisation and medical treatments.
Where are the enrollment forms for the RSBY available?
Enrollment forms for RSBY are available at designated enrollment centres, local government offices, and also at the official RSBY website.
What is the renewal fee of the RSBY policy?
The renewal fee for the RSBY policy is nominal at Rs.30 per family per year. This helps households get steady health coverage without any financial strain.
Where can I get the RSBY enrolment documents?
RSBY enrolment documents can be obtained from local government offices, designated enrollment centres, and the official RSBY website.