Rashtriya Swasthya Bima Yojana - RSBY Coverage & Benefits

With the healthcare costs shooting up every year, it may become difficult for a common man to avail of quality medical services. Although government-operated municipal hospitals offer treatment at a nominal rate, yet it may be tough for the underprivileged population to pay for the expenses.Not just medical costs, they may not have a penny to spend on transportation too. Medical emergencies can strike anytime; thus, the need for quality healthcare is indeed necessary. To address the growing concern of the underprivileged population, the government has come up with a Rashtriya Swasthya Bima Yojana or RSBY. Let's get to know more about the scheme in detail.What is Rashtriya Swasthya Bima Yojana (RSBY)?
In 2008, the government launched a country-wide health insurance policy aimed purely at the BPL or the Below Poverty Line sector. This health insurance scheme is called as the Rashtriya Swasthya Bima Yojana.Under this scheme, the insured, their spouse, and three other dependents like children or parents are protected from health expenses for a total of Rs. 30,000/- per annum.The most beneficial aspect of this scheme is that the applicant only must pay the registration fees of Rs. 30/- every year. The premium is shared by the central and the state government respectively.

• Hospitalization Expenses

The scheme is a comprehensive plan for you and your family members covering hospitalization expenses related to illness, accident, or any disease. You can avail of the treatment at a Hospital or Nursing home run by a qualified physician. Apart from this, RSBY also covers nursing & boarding charges, bed charges, surgeon charges, Anesthesia, doctor visit & consultation fees, blood, oxygen, OT charges, medicines, prosthetic devices, expenses related to surgical appliances, implants, etc.

• Pre-Hospitalization

With regards to this feature, the RSBY scheme compensates for the diagnostic tests and medicines expenses one day before hospitalization.

• Post-Hospitalization

The RSBY plan incurs the cost of post-hospitalization for up to five days after discharge.

• Transportation Expenses

The policyholder can also claim for transportation expenses, which is Rs.100 per visit. The annual amount is capped at Rs.1,000.

• Dental Treatment

Under the scheme, the policyholder can also claim the treatment of the dental injury caused due to accident.

• Daycare Treatments

For surgical procedures where you have to get hospitalized for a day, the RSBY scheme will also provide the necessary cover for the same. The list of daycare treatments includes eye/ear surgery, nose/throat surgery, Radiotherapy, Tonsillectomy, Prostate surgery, Gastrointestinal surgeries, Lithotripsy, etc.

• Maternity Benefit

The RSBY plan covers both normal and cesarean deliveries of pregnant women. If it is a normal delivery, the policyholder can claim Rs.2500, while for cesarean delivery, the claim can be up to Rs.4500. In case there is a situation where the mother's life is at risk or involuntary termination of pregnancy, the policyholder can claim for it.

• Newborn Coverage

Even if the number of members covered in the policy has exceeded in the RSBY policy, you are entitled to add the name of the newborn baby.

Just like regular health insurance policies where are some exclusions, similarly, the RSBY scheme does not provide cover for certain health issues to the underprivileged, these include:• Cost of medicines or treatments unless prescribed by a medical practitioner or certified physician.• Cosmetic surgeries and Dental treatments• Congenital external diseases• AYUSH• Vaccinations• AIDS• Suicide• Injuries due to war, invasion, or due to the act of foreign enemy or similar situations like these.• Hormone replacement therapy• Illness due to excess consumption of alcohol or drugs

• Prenatal expenses• The cost of voluntary termination of pregnancy• Hospitalization post 48 hours post-delivery

• Guaranteed treatment

As mentioned earlier, this scheme is for the underprivileged population, who maybe get quality treatment for accident-related injury or illness. RSBY eliminates such situations by offering the required medical attention.

• Low premiums

The policyholder has to pay a registration fee of just Rs.30 at the time of enrolling for the policy. The Central and the State government pays the rest of the premium amount, which is Rs.750 annually per family.

• No Age Limit

A person of any age can register for the RSBY scheme, which is not the case for a regular health insurance policy.

• Option to choose

It all depends on the policyholder where he/she wants to seek medical treatment at a network hospital for an illness or a disease.

• The benefit to Stakeholders

The RSBY scheme is not only helpful in offering quality healthcare at the lowest rate to the underprivileged people but also beneficial for the stakeholders involved in the plan. The stakeholders associated with the scheme receive incentives in return for providing this service.

• Technology and Security enabled

Any policyholder who applies for RSBY receives a smart card embedded with a chip. This helps to monitor and evaluate the policy with the help of IT-enabled apps. The card contains biometric information of the policyholder, and it is connected with the local servers. The insured person only needs to provide this smart card at the time of the claim to the hospital. The government manages the transaction records with the help of a high-security system.

• RSBY is completely paperless and cashless

All the required documents are submitted to the insurer electronically, making the process completely paperless. Also, the claimant only has to produce the cashless smart card to the hospital.

• Choice of hospitals

A variety of hospitals, both in the private and public sectors, is involved in the Rashtriya Swasthya Bima Yojana. The insured person gets to choose the hospital.

• Sum Insured

A health covers of up to Rs. 30,000/- is provided per year on a family floater basis.

• Coverage For The Family

A single RSBY scheme provides health cover to up to 5 members of the family. This includes the applicant, their spouse, and three other dependents. The dependents can be children or parents.

• No Waiting Period

Regular health insurance policies have a waiting period during which the insured person cannot claim any health issue. The individual has to pay from his/her pocket for medical expenses. However, this is not the case with RSBY, as there is no waiting period.

• Pre-existing Diseases

Pre-existing diseases are the ailments a person already has before buying the policy. In the case of RSBY, these diseases are usually covered from day 1.

To be eligible for the Rashtriya Swasthya Bima Yojana, the candidate should meet the following criteria:• The applicant should be an employee in any unorganized sector.• The State government has a list of people that fall under the Below Poverty Line.• The person should be a registered member of the welfare board.• There is no upper age limit. Hence persons of any age may apply for the RSBY scheme.

An insured person under the RSBY scheme can only avail cashless claims. Cashless treatment is only available at empaneled hospitals, as listed in the RSBY policy. When placing a claim request, the policyholder needs to inform the Third-Party Administrator (TPA)/insurance company. After the approval, the claim is settled between the hospital and the insurance or TPA. The claim process is thoroughly paperless.

The enrollment process begins when an insurance company releases the scheme for RSBY enrolment at the village level. The government centers in the village take up the policy enrolment task as per the schedule.
On the mentioned date and time, the people of BPL can reach the centers. The center will also provide a printed RSBY card to the policyholder, and the beneficiary receives a swasthya bima card post-registration.The card becomes active minutes after the registration process is complete. The car contains biometric data along with RSBY customer care number. The list of empaneled hospitals is available at the enrollment centers.Thus, the Rashtriya Swasthya Bima Yojana is an excellent and highly beneficial health insurance scheme for the poor masses of India. With the help of this scheme, the people in the BPL sector can avail quality healthcare without worrying about the finances.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.