Over the years, the rising cost of healthcare in India has been a growing concern. Even the economically secure families have been struggling to meet the soaring lifestyle expenses and also cover their medical costs. The plight of those in the middle and the unprivileged class families is even worse.
To provide reliable financial support to cover the shooting medical costs, the Ministry of Labour and Employment, Government of India, launched the Rashtriya Swasthya Bima Yojana Scheme (RSBY) in the year 2008. Presently, the scheme is under the purview of the Ministry of Health and Family Welfare, Government of India. The RSBY scheme specifically aims to offer affordable healthcare services and social security to the lower-income class families that are incapable to fully cover their medical expenses.
Here is everything you should know about the Rashtriya Swasthya Bima Yojana:
What is RSBY?
Also known as the National Health Insurance Programme, the RSBY is a government-sponsored health insurance scheme offered to Indian citizens living below the poverty line. The scheme ensures individuals or families of the below poverty line (BPL) that specifically work in the organized sectors and are unable to afford the medical expenses. Especially, the programme covers all financial liabilities arising out of expenditure related to healthcare, such as emergency hospitalization, etc.
The RSBY offers a reasonable sum insured of ₹30,000 on a floater basis.
What is covered in the RSBY scheme?
RSBY is the world’s largest and 100% state-sponsored health assurance plan, which offers coverage for:
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- Hospitalization expenses: RSBY covers expenses related to the hospitalization concerning the treatment of a disease, illness or accident. The benefit is available for the family of the insured as well. However, only expenses incurred at an authorized nursing home or hospital and by a qualified doctor or medical professional are considered. Specifically, hospitalization charges related to the following are included in RSBY:
- Surgery
- Bed and lodging (general ward)
- Nursing and boarding
- Anaesthesia
- Consultation
- Doctor visits
- Blood, oxygen, etc.
- All operation theatre expenses
- Medicines
- Supporting devices like prosthetics
- X-Ray and other diagnostic tests
- Food (only for the patient)
- Implants
Surgical appliances costs
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- Pre-Hospitalization costs: The RSBY plan covers any pre-hospitalization charges like diagnostic tests, medicines, imaging tests, etc. performed or issued a day before the patient admission to the hospital.
- Post-Hospitalization costs: The scheme pays for five-day post-treatment, recovery cost of an ailment/surgery for which the patient was primarily hospitalized.
- Transportation charges: The insured is given ₹100 per visit as transportation coverage, up to a maximum of ₹1,000.
- Dental treatment: Any dental treatment expenses incurred because of an accident are covered in the RSBY.
- Daycare charges: All day care or out-patient charges are a part of the RSBY scheme. Some of the daycare costs included are:
- Ear or eye surgery
- Dental surgery due to an accident
- Haemodialysis
- Nose surgery
- Parenteral chemotherapy
- Gastrointestinal surgery
- Prostate surgery
- Throat surgery
- Radiotherapy
- Fractures/dislocation
- Maternity benefit: The insurance cover extends to all types of birth deliveries. For normal delivery, the cover offers ₹2,500; whereas, for caesarean birth delivery, the policyholder gets coverage of ₹4,500. Pre-delivery complications are also included. Further, involuntary termination of pregnancy because of an accident, etc., is also funded by RSBY.
- Newborn cover: The policy automatically covers a newborn baby born during the policy tenure, even if the maximum number of beneficiaries has crossed. The cover continues till the end of the policy period, and the decision for renewal depends on the policyholder.
What is not a part of RSBY?
The main purpose of the RSBY scheme is to provide a comprehensive insurance cover for the underprivileged. Hence, the policy excludes:
- All AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) treatments
- Congenital health issues
- Vitamins or tonics
- Cosmetic or corrective dental treatments
- HIV/AIDS
- Suicide
- War
- Vaccines
- Voluntary termination of pregnancy
- Prenatal expenses
- Hospitalization costs after 48 hours of delivery or any related operation
- Plastic or cosmetic surgery of any body part unless required because of a disease
- Sex change operations
- Hormone replacement surgery
- Fertility or related procedures
- Accidents, diseases or conditions arising due to substance abuse
- Treatment at an unauthorized or registered nursing home or hospital
What is the eligibility criterion for RSBY?
The RSBY scheme is available only for people who fall under any of these categories:
- Workers or employees in the unorganized sectors
- Families or individuals living below the poverty line. The list must be issued by the State government. The RSBY scheme has no upper limit. All members of the BPL household can be a part of the RSBY scheme.
- egistered members of the welfare boards
How is RSBY financed?
In the majority, the Central Government sponsors (75%) of the RSBY scheme. The rest of the premiums (25%) are paid by the government of the respective states. The policyholder pays Rs. 30 per annum for registration or renewal. This helps the government cover the administrative costs involved in the scheme. However, for the North-Eastern States and Jammu & Kashmir, the Central Government sponsors 90% of the RSBY scheme and the state funds the rest of the insurance plan.
What are the features and benefits of the RSBY scheme?
The RSBY scheme has great features that aim to benefit the economically underprivileged class significantly. Some of these features and benefits include:
- A comprehensive sum insured of ₹30,000 for the family on a floater basis
- Cashless treatment facility up to ₹30,000 at the authorized hospital or nursing home
- All premiums are paid by the central government
- Easy registration and renewal of the policy. The policyholder pays only ₹30 for registration or renewal.
- No waiting period for inclusion of any defined benefits.
- Comprehensive medical coverage with limited exclusions
- The benefit is extended to all pre-existing diseases. This is also applicable even if the policyholder knew of the illness while buying the insurance policy
- Only family units of five members are eligible for the insurance cover
- Extensive hospital network in both public and private sector that offers cashless treatment
- Transportation costs u to ₹1,000
- Portability of the scheme. This permits the policyholder to enrol at any panel hospital irrespective of the state
- No age limit on the inclusion of the beneficiary
- Robust monitoring and evaluation via IT-enabled applications and chips on the smart card. These high-security smart cards contain biometric information of the policyholder and keep track of all transactions.
Further, the beneficiaries can also avail other health insurance plans, public or private, to enhance their financial protection against rising medical costs.
How to avail the RSBY scheme?
The form for RSBY scheme is available on the official website of each state. The government has authorized specific insurance companies to roll out the RSBY scheme at the village level. BPL families or individuals can reach the enrollment centres on the date and time, as specified in the schedule issued by the insurance companies.
The registration process is generally 10-15 minutes long, and the policyholder also gets the RSBY card. The card contains the biometric details of the policyholder, along with RSBY customer care details. The extensive of the hospitals are available in the enrolment centre.
What is the advantage of the RSBY scheme?
The aim behind introducing the RSBY scheme is to reduce the burden of the medical costs for the financially distressed families. The scheme helps to provide economical healthcare facilities to all families living below the poverty line.
The beneficiaries have the choice to get treatment in any of the listed public and private hospitals. Moreover, the insurance cover is quite extensive in its benefits. Alternatively, the RSBY scheme also benefits the healthcare providers so that the insured can get the treatment at the best hospital or nursing home.
What is the claim settlement procedure of the RSBY plan?
The RSBY scheme offers cashless claim settlement to the beneficiaries up to ₹30,000. The beneficiary is not liable to pay any charges to the authorized hospital up an upper limit of ₹30,000 on a floater basis. The benefit is available on the smart card issued under the policy. No manual paperwork is required at the time of claim settlement on the part of the insured. All claims are settled electronically. The cost of treatment is covered by the government. And once the patient is treated, the empanelled hospital sends an electronic report to the Third-Party Administrator (TPA), appointed by the government or the insurance provider.
Post receipt of the electronic report, the insurer pays the hospital in accordance with the insurance agreement between the parties.
Conclusion
Overall, the Rashtriya Swasthya Bima Yojana is a unique and cost-effective insurance plan that aims to provide affordable healthcare facilities for those below that are economically deprived. Kotak Life values progressive initiatives like RSBY and endeavours to increase insurance penetration in the country by offering highly economical and affordable health insurance plans for all Indian citizens. Together India can be healthy and prosperous.
