Eligible members get a variety of benefits under the Rashtriya Swasthya Bima Yojana (RSBY), like zero waiting period, minimal paperwork and access to a wide range of network hospitals. Beneficiaries also get to choose from public and empanelled private hospitals for their treatment. To avail all these benefits, each family is required to only pay an annual premium of ₹750.
Enrolment and Registration Process of Rashtriya Swasthya Bima Yojana
RSBY authorities have set up several enrolment centres across the country so that eligible beneficiaries under the scheme can register easily. If you meet the eligibility criteria mentioned above, then you must present proof for the same. Besides, if you wish to extend the coverage to your family members, provide their details and identity proofs during registration.
The eligible family has to pay ₹30 to register/renew their coverage for the RSBY scheme. Once registration/renewal is successful, each enrolled member will be issued a smart card with which they can avail the benefits under the scheme.
Enrolment centres usually have a list of local families that are eligible under the Rashtriya Swasthya Bima Yojana scheme. Because of this, they can ensure the right household is getting enrolled, further simplifying the process of enrolment and registration.
Features and Benefits of Rashtriya Swasthya Bima Yojana for Beneficiaries
The RSBY scheme offers more than just basic health coverage and comes with multiple benefits and salient features, such as:
Eligible beneficiaries can use the RSBY card across a wide range of network hospitals in India.
The scheme offers the freedom to select between public/government hospitals or empanelled private hospitals for treatment.
On obtaining the RSBY card, policyholders can avail of the cashless benefit across any network hospital empanelled under the scheme.
The annual premium amount is ₹750 per family and is paid jointly by the Central Government and respective State Governments.
Beneficiaries’ details are secured with a high-tech system that also keeps track of and maintains RSBY-related reports.
The RSBY scheme does not involve heavy documentation.
Additionally, the payment is made by the insurer electronically.
Eligible beneficiaries can claim up to ₹30,000 for several expenses covered under the scheme.
A newborn is automatically added to the list until the policy expires.
There is no waiting period that the beneficiaries have to complete when claiming for pre-existing diseases. RSBY also eliminates the initial waiting period clause.
Features and Benefits of Rashtriya Swasthya Bima Yojana for Stakeholders
Insurers, hospitals, and intermediaries like NGOs, State, and Central Governments are deemed stakeholders of RSBY. Here’s how stakeholders can benefit from the Rashtriya Swasthya Bima Yojana:
Premiums are paid to the insurance company for every registered household.
Hospitals receive the payment for treating each beneficiary.
Hospitals can dodge the extensive paperwork by sending online claims
Hospitals receive payments online for faster and more seamless clearance of payments.
Insurers directly credit the money to the hospitals.
Intermediaries are paid for services offered in promoting the RSBY scheme.
The government can make healthcare services feasible for families below the poverty line.
What is Covered and Not Covered Under Rashtriya Swasthya Bima Yojana?
Hospitalisation expenses for accidental injuries and diseases
Diseases that are not covered by the insurer
Pre and post-hospitalisation expenses like check-ups, diagnosis, etc.
Intake of any unprescribed vitamins or supplements
Cosmetic surgeries or treatments
Dental services like oral hygiene check-ups or cavities
Maternity and baby care
IVF, fertility-related procedures, voluntary termination of pregnancy, etc.
Daycare treatments includes -
Contracture release of a tissue
Dental surgery as a result of an accident
Identified surgeries under general anaesthesia
Laparoscopic therapeutic surgeries allowed under daycare
Minor reconstructive procedures of limbs
Surgery of urinary system
Treatment of fractures/dislocation
Screening and follow-up care that includes medicine expense with/without diagnostic tests
Any procedure covered by the insurer
Hormone replacement therapy
Congenital external diseases
Suicide or self-harm related injuries
Hospitalisation due to substance abuse
How To Check Rashtriya Swasthya Bima Yojana Smart Card Status Online?
Follow the steps mentioned below to check the Rashtriya Swasthya Bima Yojana Smart Card status online -
Open the www.rsby.gov.in. portal in your device.
Select the ‘State’ under the ‘Scheme Status’.
Enter RSBY scheme in the portal and click on ‘Submit’.
The RSBY scheme status will be displayed on your screen.
Eligibility of Rashtriya Swasthya Bima Yojana
To avail the benefits and healthcare facilities under the RSBY scheme, one has to meet the eligibility criteria. It includes:
Any individual who works in an unorganised sector is eligible to enrol for the Rashtriya Swasthya Bima Yojana policy. Additionally, those people registered under the welfare board can also register.
The scheme is applicable for every worker under the BPL category, irrespective of their age. The RSBY has no cap on the age limit of an individual.
Families with up to five members can avail the benefits of the RSBY scheme.
The RSBY scheme is open for all citizens who are eligible members
Documents Required for RSBY Scheme
To become a beneficiary of RSBY scheme, one needs to submit these documents -
Identity proof - Aadhar card, PAN card, etc.
Address proof - Utility bills, passport, etc.
Rashtriya Swasthya Bima Yojana Claim Process
The process for RSBY claim settlement is as follows:
After the beneficiary’s treatment at the empanelled hospital, the hospital authorities have to send an electronic report to the insurer/third party administrator (TPA).
This entitled individual will verify the details submitted by the hospital and make the necessary settlement with the hospital directly.
The beneficiary seeking treatment only has to present the RSBY smart card at the empanelled hospital. No other documentation is needed for claim settlement.