What is the Sum Insured in the RSBY Scheme?

Benefits & Exclusions of Sum Insured in RSBY

The RSBY scheme was included in the Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana in 2018 under Prime Minister Narendra Modi's guidance. To date, this is the world’s largest fully state-sponsored health assurance programme. However, it's important to know the sum insured by this scheme annually.

Read ahead to learn about the total sum insured, this policy's inclusions and exclusions, and the enrolment process.

The Total Sum Insured in the RSBY Scheme

One of the main features of this scheme is that the eligible beneficiary can claim up to ₹30,000 for several expenses. This amount can be claimed per family per year on a floater basis. This enables up to five family members to use the maximum limit of the sum for any one of them.

What Does the RSBY Scheme Cover?

The RSBY scheme provides certain extra benefits when compared to the other commercial plans. The coverage under the RSBY scheme includes:

• Dental Treatment: Dental treatment required as a result of an accident is covered under Rashtriya Swasthya Bima Yojana.
   
• Maternity Care: Normal and caesarean deliveries are both included under the RSBY scheme. The beneficiary can make a claim of ₹2500 for normal vaginal delivery and ₹4500 for lower uterine caesarean section. Apart from this, expenses are covered under the policy for complications before delivery and in any life-threatening situation.

However, prenatal expenses, voluntary termination of pregnancy, and expenses after 48 hours of delivery are not covered under the RSBY scheme.
 

• Newborn Care: No matter the number of beneficiaries, whenever there is a newborn, he or she is added to the RSBY scheme. This will be valid till the end of the period. However, the decision to include the newborn in the policy during renewal solely lies with the policyholder.
   
• Day care Treatment: These treatments do not require prolonged hospitalisation, also known as outpatient treatments. The RSBY scheme covers the following day care treatments:
• Eye and Ear Surgery
• Surgery of Genitalia
• Hydrocele Surgery
• Nose Surgery
• Certain Surgeries under Anaesthesia
• Tonsillectomy
• Throat Surgery
• Prostate Surgery
• Radiotherapy
• Parenteral Chemotherapy
• Lithotripsy
• Minor Reconstructive Surgeries of Limbs
• Laparoscopic Surgeries under Day care
• Contracture Release of a Tissue
• Dental Reconstructive Surgery followed by an Accident
• GI Surgeries
• Haemodialysis
• Urinary System Surgeries
• Fracture or Dislocation Treatments
• Screening and Follow-Up Care
• Any other surgery covered by the company
  
   
• Pre-Hospitalisation: Medical expenses of diagnostic tests and medicines before the hospitalisation of the patient.
   
• Post-Hospitalisation: The insurance company will cover medical expenses for five days associated with the patient's disease or surgery.
   
• Transportation Costs: A maximum of ₹100 can be claimed for every visit under the transportation category. The annual allowance is nearly ₹1000 for transportation.
   
• Hospitalisation Costs:
  
   All the expenses related to hospitalisation for treatment are covered under the RSBY scheme. The family members also enjoy this benefit. The RSBY scheme covers the expenses related to:
   
• Consultation Fee
• Anaesthetists' Charges
• Doctor’s Fees
• Bed Charges
• Medicines
• Implants
• Prosthetic Devices
• Expenses of Surgical Appliances
• Blood and Oxygen
• OT Charges
• Nursing and Boarding Charges
• Surgeon’s Charges
• Food for Patient
• X-Ray and Diagnostic Tests
   

What the RSBY Scheme Does Not Cover?

The RSBY scheme enables people below the poverty line to get top-notch medical care at the least expense. However, the following situations are not covered under the RSBY scheme:
 

• AYUSH Treatments
• War or any kind of foreign invasion, or any warlike situation involving nuclear weapons
• Vaccinations
• HIV/AIDS
• Hormone Replacement Therapy
• Congenital External Diseases
• Any situation that is not covered under the clauses of the scheme
• Expenses related to vitamins or tonics, which are not considered part of the treatment
• Corrective or cosmetic dental treatments, such as root canals or filling of cavities.
• Substance Abuse
• Any kind of conception procedures
• Plastic or Cosmetic Surgeries
• Any type of treatment is available at a convalescent hospital.
   

How to Enrol for the RSBY Scheme?

Here is a step-by-step guide on how to enrol yourself for the RSBY scheme:

Step 1: Make sure that your family falls into the BPL category. Hence, the families of workers in the unorganised sector are eligible.

Step 2: Find out the local enrolment centres, government offices or mobile units.

Step 3: Gather the required documents, such as the Aadhar Card, MGNREGA employment card, and ID card for the workers of the unorganised sector.

Step 4: The registration fee of ₹30 will be paid annually.

Step 5: Provide biometric information, such as fingerprints and photographs, to enable the smart card.

Step 6: Obtain the smart card and put it to use when required.

 

The RSBY scheme helps underprivileged families when they need access to top-notch healthcare settings. The best thing about it is that there is no waiting period for medical emergencies. This scheme has bridged the gap between a good healthcare system and affordability.

Also Read:

→ What is the RSBY Scheme in India

→ How to Check RSBY Card Status

→ How Do I Get an RSBY Card