Rashtriya Swasthya Bima Yojana (RSBY)

As the healthcare infrastructure evolves daily, it becomes more and more efficient. The surgeries and medications are now better than ever. However, this improvement in efficiency comes at a cost that not everyone can afford. That's why the Government of India has come up with the Rashtriya Swasthya Bima Yojana to make world-class healthcare facilities available for the economically weaker section of society. The scheme offers insurance coverage for citizens and their families below the Poverty Line and a cashless facility.

As the name suggests, Rashtriya Swasthya Bima Yojana is a national scheme that provides Indian citizens with government-backed health insurance. While health insurance is a financial security for people to give them stability in medical emergencies, it's not affordable for everyone. That's why the Indian government launched this programme. The scheme is jointly managed by the central government's Ministry of Health and Family Welfare and state governments.

The scheme was launched on 1st April 2008 under the Ministry of Labour and Employment; it was transferred to the Ministry of Health and Family Welfare on the 1st April 2015.

The scheme has been successful as it had 36 million enrollments in 2014 and is still continuing to benefit the BPL (Below Poverty Line) class. 

Rashtriya Swasthya Bima Yojana (RSBY) offers unique features. These features empower beneficiaries and ensure seamless healthcare access.

  - Empowering Choices:

Beneficiaries can choose between public and private hospitals. In doing so, RSBY gives them control and makes them valuable clients for healthcare providers.

  - Inclusive Business Model:

All stakeholders benefit because of the design of RSBY. Hence, it ensures the long-term sustainability of the scheme. Insurers get premiums for each enrolled household, and hospitals are also paid for each treatment. Resultantly, it drives better coverage and service throughout.

  - Wide Accessibility:

Under the RSBY scheme, the beneficiaries get biometric-enabled smart cards. So, they can access cashless health insurance at any hospital enrolled in the RSBY scheme across the country.

  - Paperless and Secure:

Secure and cashless transactions are ensured through smart cards and fingerprint verification. Moreover, the providers also profit from a paperless claim process due to online submissions.

  - Robust Monitoring:

The IT-intensive system of RSBY can also track transactions and generate analytical reports.

The Rashtriya Swasthya Bima Yojana (RSBY) offers all the important health insurance benefits. These Rashtriya Swasthya Bima Yojana benefits are specially crafted to meet the diverse needs of different regions. Here are some benefits offered by RSBY:

  - Comprehensive Coverage:

The unorganised sector workers and their families (up to 5 members) are covered under RSBY. It provides them with necessary health insurance plans for families.

  - Sum Insured:

A sum of up to Rs. 30,000 is insured for each family every year on a family floater basis. It provides the flexibility to use the sum for any family member.

  - Cashless Health Insurance:

Beneficiaries can get access to medical treatment for all the covered diseases without any upfront payment.

  - Hospitalisation Expenses:

There is minimal exclusion, and almost all the common illnesses are covered. Hence, it is one of the best health insurance plans and prevents out-of-pocket expenses regarding medical conditions.

  - Pre-existing Conditions:

This health insurance plan offers peace of mind as most pre-existing conditions are covered by it from the first day.

  - Transportation Reimbursement:

The transportation costs are refunded - up to Rs. 100 per visit with an overall limit of Rs. 1000.

The Rashtriya Swasthya Bima Yojana offers comprehensive health insurance coverage. It ensures families below the poverty line (BPL) access essential medical care. Here's what is covered under this scheme:

- Hospitalisation Expenses:

RSBY covers the cost of hospitalisation due to illness or accidents. It includes nursing, boarding, surgeon and anaesthetist fees.

  - Pre-Hospitalisation:

To ensure early and accurate diagnosis, RSBY benefits extend to diagnostic tests and medications for up to 1 day before admitting the patient to the hospital.

  - Post-Hospitalisation:

After discharge, this scheme also covers the expenses related to the same condition or surgery for up to 5 days.

  - Transportation Expenses:

Beneficiaries can also claim up to Rs. 100 per visit for transportation. However, it has an annual cap of Rs. 1000.

  - Dental Treatment:

Dental treatments that occur due to accidents are also covered under RSBY.

  - Daycare Treatments:

Outpatient surgical procedures like minor surgeries, chemotherapy, and follow-up care are also included. These are the procedures that do not need extended hospital stays.

  - Maternity Benefits:

Both natural and caesarean delivery are covered under RSBY. Moreover, complications before delivery or pregnancy termination due to accidents are also covered.

  - Newborn Coverage:

Newborns are included automatically in the policy until the end of the period with an option to renew the policy to continue this coverage.

The Rashtriya Swasthya Bima Yojana provides extensive health insurance coverage. However, there are some exclusions that the beneficiaries must know about.

  - Non-Covered Hospitalisations:

Hospitalisations due to reasons that fall outside the scope of the scheme are not covered.

  - Non-Prescribed Vitamins or Tonics:

The health insurance plan excludes vitamins and tonics not prescribed by a certified medical practitioner.

  - Cosmetic Dental Treatments:

Cosmetic dental treatments, root canals, and cavity filling are also not covered by Swasthya Bima.

  - Congenital External Diseases:

The scheme does not include congenital external diseases. Instead, it focuses on other critical illnesses.

  - Substance Abuse-Related Illnesses:

Any critical illness due to substance abuse is removed from coverage.

  - Fertility and Gender-Related Treatments:

Fertility treatments, gender-related procedures and hormone replacement therapy are excluded.

  - Plastic Surgeries:

Plastic surgeries are not covered unless needed due to an accident or disease.

  - Vaccinations and HIV/AIDS Treatment:

Vaccinations for HIV treatment are not covered by the Rashtriya Swasthya Bima Yojana. Besides, the scheme also excludes injuries due to war or nuclear material.

  - AYUSH Treatments and Convalescent Care:

Traditional AYUSH treatments are not included in the RSBY coverage.

The scheme is a collaborative effort between central government and state governments. For most states, the central government covers 70% of the cost, while the state governments contribute 30%. However, for the northeastern states and Jammu and Kashmir, the cost-sharing ratio is different. Here, state governments contribute only 10% of the cost while the central government provides the remaining 90%.

Indian citizens have to pay only ₹30 as a one-time registration fee to enrol in the scheme. The central government primarily funds the scheme, with state governments and minimal contributions from beneficiaries complementing it.

The eligibility criteria for Rashtriya Swasthya Bima Yojana are straightforward:

  - The applicant must be below the poverty line, as the scheme is designed for the BPL (Below Poverty Line) class.

  - The applicant should belong to the unorganised sector in terms of work profile.

  - The scheme covers up to 5 members of the applicant's family.

Applying for Rashtriya Swasthya Bima Yojana is a simple and organised process. Here it works-

  1. List of Eligible Households:

The insurance company provides an electronic list of eligible BPL households.

  2. Enrollment Schedule:

The district-level officials and the insurer make an enrollment schedule for each village. The dates and locations are planned.

  3. Public Announcement:

The list of BPL households is displayed publicly at specific enrollment stations. To ensure transparency, the dates and locations for enrolment are also announced in advance.

  4. Mobile Enrollment Stations:

These are set up in local centres like public schools. Moreover, these stations have all the necessary hardware for collecting fingerprints. Besides, photographs are also taken here, along with the printing of Swasthya Bima cards.

  5. Instant Card Issuance:

After paying a nominal fee of ₹30 and undergoing verification by a government officer, beneficiaries receive their Rashtriya Swasthya Bima Yojana card instantly. They also receive a pamphlet outlining the scheme's details and a list of hospitals.

  6. Efficient Process:

The entire process of RSBY insurance registration is designed to be quick. It takes less than 10 minutes per family.

Let's talk about the renewal of the Rashtriya Swasthya Bima Yojana online. This facility is not available online, so one must visit the nearest enrollment centre to renew the card. Now, in what cases should you renew your RSBY Card? Since it is a government-backed health insurance policy, it requires yearly renewal, just like a standard health insurance policy. To do this, you must take your RSBY Card to enrollment when the centres are set up. You just have to present your card and the family member whose biometrics are linked to the card (if you are not the person whose biometrics are linked to the card). For renewal, the same amount of ₹30 is charged from the beneficiary, and the card gets updated for one year.

Besides this, one may also need to renew the card In case of theft or loss of card. You should first inform the nearest enrollment centre of the theft or loss of a card. The officer at the centre will verify your identity and provide you with a new replacement card, while the older one will be blocked. 

The claim process of this scheme makes it commendable and comparable to leading private health insurance plans. Most of the claims under this scheme remain cashless. Therefore, the beneficiary doesn't have to manage money for the treatment and then apply for reimbursement. The cashless claim works similarly to modern health insurance, where you just need to admit the patient to a hospital, which is included in the list of hospital networks. At the time of treatment, show the RSBY Card to the hospital administration to identify yourself or the patient (any family member).

Once the treatment is done, the hospital will send the bill and other necessary documents to the third-party administrator. The TPA, or in simple words, the partner insurance company, will pay the hospital after successfully verifying the documents. With this cashless health insurance, the entire process remains paperless, and you don't need to spend any money on the treatment. 

The Rashtriya Swasthya Bima Yojana is a health insurance type of scheme, but there are some differences when it comes to comparing these two. Firstly, anyone can buy health insurance to cover any expected or unexpected medical expenses. While the Yojana is also intended to do the same, its focus is to provide the facility to the economically backward class. That's why there's no need to pay the premium that a normal person pays for coverage under health insurance.

Moreover, health insurance does not have eligibility criteria, meaning anyone who can afford it can obtain it. However, insurers set other criteria, which is why health insurance premiums vary for individuals. On the other hand, the RSBY scheme has eligibility criteria based on income to ensure that only the economically backward class, who are unable to afford insurance, receive free benefits. This way, the misuse of the scheme can be prevented.