Rashtriya Swasthya Bima Yojana (RSBY) - National Health Insurance Programme

The Rashtriya Swasthya Bima Yojana (RSBY) is a social health insurance scheme launched by the Government of India. It aims to provide financial assistance for medical treatment to economically disadvantaged families and workers in the unorganized sector.

Facilities

• Wide Network: A large network of government and empanelled private hospitals across India to ensure accessibility.
• Paperless Claims: Hospitals submit claims electronically, streamlining the process and faster reimbursement.
• Toll-Free Helpline: Dedicated helpline for inquiries and grievance redressal.

Why Choose RSBY

• Financial Security: Protects families from the financial burden of medical emergencies.
• Improved Healthcare Access: Enables treatment in quality healthcare facilities without upfront payments.
• Empowerment: Encourages timely medical intervention for better health outcomes.
• Simple Enrollment: Easy registration process through local authorities.

Benefits of RSBY

• Cashless Hospitalization: Up to ₹30,000 per family per year on a family floater basis (covers spouse and up to three dependent children).
• Coverage: Includes expenses related to hospitalization, pre-hospitalization (up to 1 day before admission) and post-hospitalization (up to 5 days after discharge) for the covered illness. This covers room charges, doctor consultations, surgery costs, medicines, and other medical expenses.
• Maternity Benefit: Covers childbirth expenses up to ₹30,000 within the annual limit.
• Smart Card (Swasthya Card): Provides easy identification and facilitates cashless claim processing at empanelled hospitals.
• Low Renewal Fee: Only ₹30 per year for continued coverage.

Additional Information

• Funding: The scheme is funded jointly by the Central and State Governments.
• Eligibility: Unorganized sector workers and their families identified as BPL are eligible.
• Exclusions: Pre-existing conditions, certain procedures, and outpatient treatment are generally excluded.

Current Status of RSBY

As of July 2024, the RSBY is still an active program and continues to provide health insurance coverage to eligible BPL families across India. However, there have been some recent developments and changes to the scheme:

• Increase in Coverage Amount: In 2016, the government increased the annual coverage amount from Rs. 30,000 to Rs. 50,000 per family.

• Expansion of Eligibility: In 2018, the government expanded the eligibility criteria to include all unorganized sector workers and their families, regardless of their income level.

• Issuance of Smart Cards: The government has been replacing paper-based RSBY cards with smart cards, which are more secure and easier to use.

• Online Claim Processing: The government has also introduced an online claim processing system to make it easier for beneficiaries to file and track their claims.

Conclusion

The RSBY scheme plays a crucial role in making healthcare accessible and affordable for underprivileged families and unorganised sector workers. It empowers them to seek timely medical attention and promotes better health outcomes.