Rashtriya Swasthya Bima Yojana Scheme Guide

The Rashtriya Swasthya Bima Yojana (RSBY) was a government health insurance plan that helped eligible families manage hospitalisation costs.

However, one wonders what RSBY included, which family members could avail the benefits of this plan and whether Rashtriya Swasthya Bima Yojana is still there now. Here is everything you need to know about the plan.

What was the Rashtriya Swasthya Bima Yojana?

RSBY was one such public insurance scheme for people living below the poverty line and people working in the unorganised sector in India.  The scheme was introduced in 2008 but discontinued in 2018-2019 and merged under the larger scheme called Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).

Key Features of the Rashtriya Swasthya Bima Yojana Scheme

RSBY was introduced to improve access to affordable health care for those who qualify. Some of the important features of the scheme that made it beneficial to the beneficiaries include:

Smart Card-Based Cashless Treatment

The Rashtriya Swasthya Bima Yojana provided beneficiaries with biometric smart cards. These cards helped eligible families access cashless hospital treatment at empanelled hospitals without paying the covered amount upfront.

Paperless and Cashless Hospitalisation

RSBY allowed beneficiaries to receive treatment at empanelled hospitals without making upfront payments for covered services. The electronic system also reduced paperwork and helped hospitals process claims directly with the insurer.

Inclusion of Private and Public Hospitals

The Rashtriya Swasthya Bima Yojana scheme included both government and private hospitals in its network. Beneficiaries could choose a hospital from the empanelled hospitals available in their district or state.

Coverage for the Entire Family

RSBY provided coverage for up to five members of an eligible family. This generally included the head of the household, spouse and up to three dependants, helping families manage covered hospital expenses together.

Affordable Premium Structure

The scheme used a government-subsidised premium structure to keep health insurance affordable for eligible families. The Central Government paid 75% of the premium, while the State Government paid 25%, with beneficiaries paying a nominal ₹30 registration fee.

Robust Monitoring and Transparency

RSBY used biometric smart cards and electronic records to improve transparency and monitor transactions. This system helped reduce the chances of fraud, maintain beneficiary records and make the claim process more accountable.

What Did Rashtriya Swasthya Bima Yojana Scheme Cover?

The RSBY scheme included coverage for various medical and hospital expenses for beneficiaries, such as:

1. Pre-Hospitalisation Expenses: Coverage for medical diagnosis and medicines before being admitted to the hospital.
2. Hospitalisation Expenses: Coverage for a bed in the hospital, nursing care, consultations, diagnostic investigations, medicines, meals, surgery, OT and implants.
3. Post-Hospitalisation Expenses: Covered for eligible medical expenses for 5 days after being discharged from the hospital.
4. Accidental Dental Treatment: Covered for dental treatments in case of accidents.
5. Maternity Expenses: Coverage of ₹2,500 for normal delivery and ₹4,500 for cesarean delivery.
6. Pregnancy Termination: Covered for eligible expenses of termination due to an accident or if it was necessary to save the life of the mother.
7. Newborn Expenses: Covered for health care expenses of the newborn, despite exceeding the limit of family members.
8. Daycare Treatment: Covered for certain treatments or surgeries requiring hospitalisation for a period of one day or less, like dialysis and lithotripsy.

What Were the Benefits of Rashtriya Swasthya Bima Yojana Scheme?

The Rashtriya Swasthya Bima Yojana (RSBY) offered health insurance cover of up to ₹30,000 annually on a family floater plan for eligible individuals of the unorganised sector and their families.

The points below state what type of benefits were offered under the RSBY scheme:

1. Family Cover: Up to five family members were covered in the scheme, which includes the head of the family, spouse and three dependents.
2. Cashless Services: Cashless treatment was allowed to the beneficiaries through empanelled hospitals in both private and government sectors.
3. Pre-existing Diseases: It covered all pre-existing illnesses from the date of inception of the plan without any waiting period.
4. Smart Card System: The beneficiaries were provided with a biometric smart card.
5. Transport Allowance: The beneficiaries were allowed an amount of ₹100 per hospitalisation visit with a yearly ceiling of ₹1,000 for transport facility.
6. Pre- and Post-Hospitalisation Cover: It covered one day pre-hospitalisation and up to five days post-hospitalisation charges.

If you are looking for more comprehensive coverage that extends beyond basic needs, Bajaj General Insurance Limited offers robust health insurance plans tailored for individuals and families.

What is the Rashtriya Swasthya Bima Yojana Card?

The Rashtriya Swasthya Bima Yojana Card, or the RSBY Smart Card, was biometric provided to qualified families under the RSBY Scheme. It facilitated accessing cashless treatment in empanelled hospitals by beneficiaries without paying for the service in advance.

Here are some of the key features of the RSBY card:

Biometric Security

The RSBY Smart Card had biometrics and photographs of the beneficiaries to authenticate them. This ensured that the card could not be misused by people other than those who were eligible.

Cashless and Paperless Treatment

RSBY Cardholders could avail treatment services at empanelled hospitals using the RSBY Card without any upfront payment. The electronic system also minimised the need for paperwork during hospitalisation.

Nationwide Portability

The RSBY Card could be availed by beneficiaries in empanelled government and private hospitals across the country. This was quite beneficial for the labourers who changed places for job purposes.

Split Card Facility

If any member of the family got transferred to some other place for employment purposes, the RSBY Card could be split to avail services separately.

How the RSBY Smart Card Worked?

The RSBY Smart Card facilitated the usage of cashless and paperless treatment by families that met the eligibility criteria at hospitals where they had been empanelled. This is because the card contained details of beneficiaries together with their biometrics.

This is how the RSBY smart card worked:

1. Eligibility Test: BPL families and workers from the unorganised sectors who were eligible were selected for the plan.
2. Registration Camps: Registration took place using local registration camps organised by the insurance companies.
3. Biometric Information: Beneficiaries gave their photographs and fingerprints and paid a registration fee of ₹30.
4. Smart Card Issue: The beneficiaries would get their smart card after being registered.

Who Was Eligible for RSBY?

The RSBY scheme was primarily meant for low-income families and workers of the unorganised sector. The eligibility criteria were dependent on a few considerations like being below the poverty line (BPL), family information, and confirmation from the concerned authorities.

1. Indian Citizenship: The applicant needs to be a citizen of India.
2. BPL Status: The family needs to be a BPL family.
3. Employment: The scheme primarily included workers of the unorganised sector and their eligible family members.
4. Family Size: There could be coverage for five members in the family floater.
5. Official Confirmation: The name of the beneficiary needs to be mentioned in the concerned BPL list and confirmed by the concerned authorities.

What Documents Were Required for RSBY Enrollment?

Enrolling in the RSBY required proof of identity, eligibility and residence to verify that the applicant belonged to a Below Poverty Level family.

Here are some of the documents which were needed:

1. BPL Certificate: Proof that your family is listed in the official Below Poverty Line category.
2. Identity Proof: Aadhaar card, Voter ID or Ration card.
3. Residential Proof: Ration card, utility bills or other local address proof is required.
4. Income Certificate: Issued by authorised local government bodies. 

Is Rashtriya Swasthya Bima Yojana Still Available?

No, the Rashtriya Swasthya Bima Yojana is no longer available as a standalone scheme.  In 2018, the Indian government subsumed and replaced RSBY with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which is also known as PM-JAY.

Therefore, if you and your family were previously covered under RSBY, then all your benefits have been transferred to the new system, which is PM-JAY. 

Final Words

The Rashtriya Swasthya Bima Yojana (RSBY) had a significant impact in offering inexpensive and cashless medical facilities to the eligible families and workers in the unorganised sector. Nonetheless, it should be noted that the scheme does not exist independently today.

It has been included in the scheme of Ayushman Bharat  Pradhan Mantri Jan Arogya Yojana (PM-JAY). People interested in government health coverage need to assess their eligibility under PM-JAY.

Frequently Asked Questions

What replaced RSBY?

Rashtriya Swasthya Bima Yojana (RSBY) was incorporated into Ayushman BharatPradhan Mantri Jan Arogya Yojana (PM-JAY). PM-JAY was the larger health assurance scheme of the government for eligible beneficiaries.

Can I apply for a new RSBY card now?

No, you cannot apply for an RSBY card since the program is no longer offered as a standalone scheme. People who need help getting government health coverage should inquire whether they qualify under the latest PM-JAY program.

What happens if I lose my smart card?

RSBY beneficiaries who lost their smart cards could approach the designated insurance company or even relevant authorities for assistance. Since RSBY is no longer operational, individuals must contact the appropriate authority regarding any historical card-related concerns.

Did RSBY cover maternity expenses?

Yes, RSBY offered maternity insurance coverage to eligible members. The coverage was up to Rs.2,500 in case of normal delivery and Rs.4,500 in case of caesarean delivery.

How do I know which hospitals accept the card?

RSBY cardholders were able to get cashless treatments at empanelled government as well as private hospitals. The network hospitals depended on the area. Now that the RSBY scheme has been discontinued, the individual can check the hospital network under the PM-JAY scheme.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.