Rashtriya Swasthya Bima Yojana (RSBY)

Rashtriya Swasthya Bima Yojana: Coverage and Application Process

The Government of India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008 to cover the health insurance benefits of low-income groups. Individuals working in the unorganized sectors can avail of health benefits under this scheme, ensuring that they get access to quality medical facilities without high out-of-pocket expenses.  

Read on to learn about the RSBY scheme's features, benefits, enrollment process, and more.

What are the Features of Rashtriya Bima Yojana?

The RSBY scheme is unique among the other government health schemes in many ways. Here are some of its features for a better understanding:

• Beneficiaries enrolled in the Rashtriya Swasthya Bima Yojana can use their RSBY card for cashless treatment at any of the network hospitals across the country.
• RSBY-empanelled hospitals leverage information technology to connect with the district-level server. 
• The scheme ensures safety and security as it is entirely managed by biometric-enabled smart cards. They are provided to the right beneficiary, ensuring accountability while issuing and using the card. The biometric system ensures that only the original beneficiary can use the RSBY card.
• With the RSBY scheme, even the beneficiaries of the BPL category can choose whether to get treatment from a public hospital or private.
• This scheme was created as a commercial model for a social sector program. Here, each stakeholder is eligible for incentives. Such a model promotes the expansion and long-term viability of the RSBY scheme.

What are the Benefits of Rashtriya Swasthya Bima Yojana?

The following are the benefits of the Rashtriya Swasthya Bima Yojana:

• The RSBY insurance provides a maximum health coverage of maximum ₹30,000 annually on a family floater basis. It covers up to five family members: the head of the family, the spouse, and a maximum of three dependents.
• Every beneficiary is provided with a Swasthya card or smart card that enables biometric functionality.
• This scheme facilitates cashless benefits to cover hospitalization and medical costs of the beneficiaries upon providing the RSBY card details to the authorities.
• Beneficiaries can avail transportation allowances of a maximum ₹100, pre-hospitalization expenses of one day, and post-hospitalization costs of five days under the RSBY scheme.
• It also covers the medical expenses of pre-existing diseases.

Application Procedure for the RSBY Scheme

Here are the steps to follow while applying for the RSBY scheme:

1.An e-list of the eligible families under the BPL (below poverty level) categories is provided to the insurer in a specific data format.
2.The insurance company and the district-level officials schedule the enrollment procedure for each village.
3.Before initiating the enrollment process, the eligible BPL list is displayed at the enrollment centres of each village. 
4.The authorities have announced the enrollment date and venue.
5.Designated authorities set up mobile enrollment centres at schools or public centres in every village.
6.The centers include smart card printing devices and other necessary devices to collect the photographs, biometric data, etc., of the beneficiaries. 
7.Beneficiaries need to pay a fee of ₹30 and pass the verification procedure conducted by the appointed government officer to receive their RSBY smart card.

RSBY Insurance: Inclusions and Exclusions

The RSBY scheme includes the following coverage:

• Pre-hospitalization costs include the diagnosis and medicine expenses before being admitted to the hospital.
• Hospitalization costs include accident, disease, or illness-related expenses of the insured and their family members. It also provides nursing charges, consultation fees, hospital bed charges, blood or other diagnostic tests, surgeon's fees, OT charges, implants, medicines, and food costs.
• In the case of long-term treatment or surgery, this scheme covers the post-hospitalization medical expenses of a maximum of 5 days.
• It also covers the dental treatment that has occurred due to an accident.
• Female beneficiaries can get ₹2,500 and ₹4,500 for normal and cesarean delivery, respectively. 
• If the beneficiary needs to terminate her pregnancy unintentionally due to an accident or to save her own life, the expenses will be covered by the RSBY scheme.
• The healthcare costs of a newborn are also covered under this scheme even if the maximum beneficiary limit exceeds. 
• If the patient is hospitalized for a day or less than that, RSBY covers the daycare treatment expenses. It includes surgeries like eye, ear, dental, etc., caused due to an accident. The RSBY scheme also covers hemodialysis surgery, lithotripsy, and more.

Here are the exclusions of the RSBY scheme:

• Treatments for hormone replacement, gender change, HIV or AIDS, and excessive alcohol or drug intake are not covered by the scheme.
• If the beneficiary is hospitalized for any disease not included in the policy term, it will not be covered under RSBY.
• Cosmetic dental treatments, root canals, etc., are excluded from the RSBY coverage.
• Congenital external diseases are not included in RSBY insurance.
• Expenses incurred due to vaccination, suicide, or AYUSH treatments are excluded from the RSBY scheme.

Eligibility Criteria to Apply for the RSBY Scheme

The following individuals are eligible for the RSBY scheme:

• The applicant should be a citizen of India and have a BPL card. 
• Workers of the unorganized sectors belonging to the BPL category can apply for this scheme. It also covers their family members.
• To receive the RSBY card, beneficiaries need to pay ₹30 per year. It enables cashless treatment benefits.

What is the RSBY Smart Card?

The Rashtriya Swasthya Bima Yojana (RSBY) card, also known as the Swasthya card, is a biometric-enabled smart card issued to beneficiaries under the RSBY scheme. It serves multiple purposes, including identifying beneficiaries through their photographs and fingerprints and storing essential patient information.

The primary function of the RSBY card is to facilitate cashless transactions at empanelled hospitals across India. This allows families living below the poverty line to access healthcare services without upfront payments. Upon enrollment, beneficiaries receive their smart cards at designated centres. 

In cases where biometric verification fails, the card's photograph can be used for identification. This system ensures that benefits are portable nationwide, empowering users to seek treatment in any participating hospital.

Where do the Funds for the RSBY Scheme Come From?

The Central Government of India contributes 75% of the RSBY annual premium. It pays a maximum of ₹565 for each family annually. For Jammu & Kashmir, the contribution is 90%.

The respective state governments contribute the remaining 25% of the annual premium. For Jammu and Kashmir, the state government's contribution is 10%. Also, the state government bears the administrative costs and expenses associated with RSBY implementation.

How to Verify an RSBY Card Online?

Here are the steps for the RSBY card check online:

1.Log in to the official website of Rashtriya Swasthya Bima Yojana.
2.Click on "Scheme Status".
3.Select your state from the drop-down menu.
4.Navigate to the "Track your State" option to choose your state.
5.Enter your RSBY Insurance number wherever required.

Your RSBY card validity check online will be completed as the status is displayed on the screen.

The Rashtriya Swasthya Bima Yojana represents a significant step towards achieving universal health coverage in India. By providing financial protection against health expenditures for the most vulnerable sections of society, RSBY plays a crucial role in promoting health equity. However, continuous efforts are needed to address implementation challenges and ensure all eligible individuals can fully benefit from this scheme.