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rashtriya swasthya bima yojana insurance
Rashtriya Swasthya Bima

What is Rashtriya Swasthya Bima Yojana?

Launched in 2008 by the government of India, Rashtriya Swasthya Bima Yojana is a health insurance plan which covers families who are living below the poverty line. Due to limited money in their pocket, the people living under poverty have limited access to healthcare. Rashtriya Swasthya Bima Yojana or RSBY’s objective was to lessen the medical cost incurred during any medical situations.

Who should buy Rashtriya Swasthya Bima Yojana?

Rashtriya Swasthya Bima Yojana specifically provides health insurance for people living in destitution. It provides a sum assured of INR 30000 given to cover up to 5 family members under family floater plan. Additionally, this plan also issues INR 100 to INR 1000 as a transportation cost.

Features and Benefits of Rashtriya Swasthya Bima Yojana

Below covers the features and benefits of Rashtriya Swasthya Bima Yojana:

1) Options in the selection of the provider:
The Rashtriya Swasthya Bima Yojana provides various options to the policyholder to set one’s sight on the healthcare options, thus providing the opportunity to get the best treatment in either private or public sector in RSBY as per their choices.

2) Security and Safety:
With the advancement in technology, the RSBY scheme is issued with a biometric-enabled smart card. This would make sure that no unauthorized person can claim the amount.

3) Network hospitals:
The smart card issued to the policyholder can be claimed in any empanelled hospital, which is not restricted to a particular district or state. It also provides split for workers who are migrating for their work.

4) Cashless Claim facility:
Because of smart card facility, one doesn’t have to worry about reimbursement. Just by showing the smart card, one can avail for cashless claim facility, then it would be verified with their fingerprints.

5) Paperless:
All the process takes place electronically. There is no paperwork involved.

How does Rashtriya Swasthya Bima Yojana work?

Pay the registration fee of INR 30 and the central/state government pays the premium amount as per bidding. There is a State Government Agency which implements, monitors and supervises RSBY schemes. It coordinates with payors and providers. There is a list of hospitals which are covered under RSBY.

Eligibility Criteria for Rashtriya Swasthya Bima Yojana

Below people are eligible for Rashtriya Swasthya Bima Yojana:

i) People working in an unorganized sector or BPL household
ii) People who register for welfare bound
iii) People of any age, with no age barrier

This covers up to 5 family members with sum assured of INR 30000.

How does Beneficiary utilize services in Rashtriya Swasthya Bima Yojana?

The beneficiary visits the empanelled hospital. Their identity would be verified using the smart card, fingerprints and their photograph. The helpdesk would check for all the procedures and their packages if the policyholder requires hospitalization. After the discharge, the fingerprint is verified and the predetermined amount which is the cost of treatment till INR 30000 gets deducted from the smart card. No need to submit proof of transportation cost which ranges between INR 100 to INR 1000.

How to enrol for Rashtriya Swasthya Bima Yojana

In order to enrol for Rashtriya Swasthya Bima Yojana, the head of the family must show the proof of being the patriarch or the head. Also, the other member of the family must give proof of their being a member of the family. The registration process costs just 30 INR and a smart card is issued which is biometric-enabled.

What is Covered and Not Covered in Rashtriya Swasthya Bima Yojana?

In order to be eligible for Rashtriya Swasthya Bima Yojana, one must fall under below category:

i) Welfare boards building and constructions workers
ii) Street sellers
iii) Railway Porters ( Licensed )
iv) MNREGA ( worked for more than 15 days during the foregoing financial year)
v) Beedi/ Domestic/ Sanitation/ Mine Workers
vi) Ragpickers
vii) Rickshaw pullers
viii) Auto or Taxi Driver

However, there are certain things which are not covered under Rashtriya Swasthya Bima Yojana:
i) Outpatient Expenses
ii) Diagnosis Charge
iii) Co-payment or doctor’s consulting charges

Rashtriya Swasthya Bima Yojana Claim settlement process

After the beneficiary gets hospitalized, the hospital or the provider sends the electronic report to the insurer or the Third Party Administrator (TPA). After verifying the records information the TPA pays the hospital a specified amount which was agreed between the Insurer and the hospital.

What are the documents required for Rashtriya Swasthya Bima Yojana?

While claiming for Rashtriya Swasthya Bima Yojana, a smart card should be presented which would be verified with a fingerprint and their photograph.


Most frequent questions and answers about rashtriya swasthya bima yojana

Families who are under the poverty line can opt for Rashtriya Swasthya Bima Yojana.

The policyholder will have to bear the registration cost of INR 30 and the premium amount would be paid by the Central and the State government based on competitive bidding. The government pays 75 percentage and 25 percentage is paid by the state government whereas in J&K and north-eastern states, 90 percentage is borne by the government of India and remaining 10 percentage is paid by the State government.

After receiving the policy, the policyholder receives a smart card which is biometrics enabled and it can be availed in any of the network hospitals which are RSBY enabled. They offer cashless hospitalization within the network hospitals under this scheme which is verified with the help of their fingerprints.

Rashtriya Swasthya Bima Yojana was designed for BPL population of India. This scheme is sponsored by the government of India. Upto 75 percentage of financing Rashtriya Swasthya Bima Yojana is done by the government of India and the rest amount is paid by the state government. While in Jammu and Kashmir and in the north-eastern states of India, the government contributes 90 percentage and the state government pays 10 percentage of the premium amount. The policyholder must pay a registration amount of INR 30 which is used for administrative purposes.