Rashtriya Swasthya Bima Yojana (RSBY)

The Government of India is taking strong interest to provide social security and healthcare assurance for which various steps are been taken.

For instance, Central Government started Unorganized Workers Social Security Act (2008) to provide social security and welfare for the unorganized workers. It was initiated to mitigate risks due to disability, medical emergencies, maternity and old age that unorganized workers may suffer from.

Ministry of Labour and Employment, Government of India, has introduced Rashtriya Swasthya Bima Yojana (RSBY), a Health Insurance Scheme. RSBY was launched in 2008 and is meant for all the families living below poverty line. The objective of RSBY is to cut down the medical expenditure on health which they have to shell out of their pocket. Moreover, this has helped to create awareness while increasing the access to health care.

RSBY has been expanded to cover other defined categories of unorganised workers.

• Choice of Hospital – RSBY offers freedom of choice between public and private hospitals to the below poverty line family participating in RSBY.

• Safe and Secure – It is for the first time that IT applications are being used for social sector scheme on such a large scale. RSBY scheme issues with biometric enabled smart card with insured’s fingerprints and photographs. All the registered hospitals under RSBY are IT enabled with the facility to use biometric enabled smart card and connected to the server at the district level. This makes this scheme safe and secure from fraud claims.

The key management system of RSBY make sure that the smart card reaches to the right insured person. It is also, responsible for accountability in terms of issuance of the smart card and its usage. The biometric ensures that only the real beneficiary can use the smart card.

• Backed by Network of Hospital – The smart card provided under RSBY can be used in any RSBY empaneled hospital across India. It makes RSBY scheme, a truly unique and highly beneficial scheme for the below poverty line family, especially, to the poor families that migrate from one place to the other because of work. RSBY smart card is not restricted to the district under which the card was issued. RSBY smart cards can be used across the network of empaneled hospital in India. Moreover, also provides the split for migrant workers to carry a share of the coverage with them separately.

• Cashless Claim Settlement – Because of the smart card provided to the insured under RSBY, one doesn’t have to worry about money or reimbursement. One can avail cashless benefit in any of the authorised hospitals. But to avail cashless benefit, the beneficiary needs to carry and show the smart card, which is then verified through the help of finger prints.

• Paperless – No paper work is involved. The participating network hospital does not need to collect all the papers or documents manually. It is send to the insurer online. The payment of expenses is done electronically by the insurer.

• Building and other construction workers registered with the Welfare Boards

• Licensed Railway Porters

• Street Vendors

• MNREGA workers who have worked for more than 15 days during the preceding financial year

• Beedi Workers

• Domestic Workers

• Sanitation Workers

• Mine Workers

• Rickshaw pullers

• Rag pickers

• Auto/Taxi Driver

Objective of RSBY

RSBY has two fold objectives:

1. To provide financial protection against catastrophic health costs by reducing out the financial burden

2. To improve access to quality health care for below poverty line households of pocket expenditure for hospitalization and other vulnerable groups in the unorganized sector .

• The sum insured offered is up to Rs.30,000 year in case the insured is hospitalized on family floater basis.

• The coverage is provided in case of hospitalization under the defined diseases mentioned in the plan.

• Under RSBY, pre- existing diseases are covered from day one and there is no age limit.

• The maximum number of family members that can be covered under RSBY is five, which includes the head of the house, spouse and up to three dependents.

• In case of hospitalization, the transport expenses are covered up to Rs.100/- per hospitalization, subject to a maximum of Rs.1000/- per year per family.

There are several enrolment centres set up across the country so that people can easily sign up for RSBY. In order to enrol, an individual must present proof of being the head of the household and other members must provide detailed information that identifies them as part of the household. The charge for a cumulative family to register/renew for Rashtriya Swasthya Bima Yojana is merely Rs. 30, and is collected to ensure the smooth processing of enrolment of the family. Once registered, each family member gets a SMART Card for them to prove that they are part of this scheme.

Every enrolment centre has a list of families in the local area who qualify to enrol in the scheme. This ensures that the right person in each household becomes eligible to be a part of the scheme, thereby simplifying the process of enrolment and registration.

Eligibility of Rashtriya Swasthya Bima Yojana

To be eligible for availing the health benefits by the Rashtriya Swasthya Bima Yojana, an individual will have to first meet these standards,

• If the individual works in the unorganised sector or is part of a BPL household, then he/she is eligible for this scheme. Moreover, individuals who register themselves under welfare boards also qualify to enter the program
• An advantage of this scheme is that there is no upper age limit to apply for this scheme. This scheme is suitable with any member of a person’s family, regardless of their age.
• A maximum of five family members are eligible to apply for this scheme. This scheme proves to be beneficial for people as almost one third of the Indian population is eligible for the scheme. While it is not certain how many have applied for the scheme, the scheme is available and open to all those who are eligible for it.

According To The Official Website, Following Is The Process Of Claim Settlement Of RSBY:

After rendering the service to the patient, the hospitals need to send an electronic report to the insurer/ Third Party Administrator (TPA). The Insurer/ TPA after going through the records information will make the payment to the hospital within a specified time period which has been agreed between the Insurer and the hospital.

Document Required To Process The Claim RSBY

In order to claim the health benefits offered by the Rashtriya Swasth Bima Yojana, all you need to do is present the Smart Card issued to you at the time of enrolment.

Rashtriya Swasthya Bima Yojana (RSBY) Scheme is based on strong pillars of cost-effective health care plan, freedom of choice of hospitals – private and public, smart card facility, network of hospitals across the country, cashless claim service, family floater plan, and so on. This truly makes RSBY one of the unique health care system laid down by Government of India.