Rashtriya Swasthya Bima Yojana Health Scheme

The people who are eligible for this scheme can reach the enrolment centre at the date and time mentioned in the enrolment schedule. Once the registration is done, a beneficiary will receive an RSBY card within ten minutes of enrolment. The RSBY card includes the biometric details of the insured and the RSBY customer care number. The entire process will be done in presence of a government officer, a field officer, and a representative of the insurance company. 

What is Covered Under Rashtriya Swasthya Bima Yojana?

In contrast to a commercial plan, the Rashtriya Swasthya Bima Yojana is an innovative health insurance programme that offers additional benefits. The plan covers the following healthcare expenses of an insured: 

Hospitalization Expenses 

RSBY covers hospitalization expenses related to a disease, illness, or an accident. Note that the family members of the policyholder will also receive the hospitalization expenses. Given below are the medical expenses which shall be covered under this scheme: 

1. Doctor’s consultation fee 
2. Bed charges 
3. Nursing and boarding charges 
4. Anaesthetics 

1. Implants 
2. Consultation fee 
3. Surgeon’s charges 
4. Oxygen 
5. Blood 

1. OT (Operation Theatre) charges 
2. Diagnostic Tests charges 
3. Food expenses of the patient 
4. Prosthetic devices 
5. Medicines 

Pre-Hospitalization Expenses  

Under this scheme, an insured will receive pre-hospitalization coverage, including expenses related to diagnostics and medicines.  

Post Hospitalization Expenses  

Rashtriya Swasthya Bima Yojana covers the expenses of the insured after hospitalization. If the insured has undergone surgery or long-term treatment, the scheme will cover all the medical expenses for up to five days after getting discharged from the hospital.  

Transportation Expenses  

A policyholder will also receive transportation expenses for up to Rs.100 per visit. An insured can claim a maximum annual transportation expense of Rs.1,000.  

Dental Treatment  

The scheme incurs the cost of dental treatment occurring due to an accident.  

Day care Treatment 

In day care treatments, a patient needs to be hospitalized for less than 24 hours. The scheme covers the expenses of the following day care treatments:  

1. Dental surgery needed due to an accident  
2. Ear surgery  
3. Eye surgery  
4. Gastrointestinal surgery  
5. Genital surgery  

1. Hydro surgery  
2. Throat surgery  
3. Lithotripsy  
4. Haemo-dialysis surgery  
5. Nose surgery  

1. Laparoscopic therapeutic surgery  
2. Radiotherapy  
3. Prostate surgery  
4. Urinary system surgery  
5. Parenteral Chemotherapy  

Maternity Expenses  

The scheme covers the expenses related to both natural and caesarean deliveries. An insured will receive Rs.2,500 for normal delivery and Rs.4,500 for caesarean delivery. The expenses associated with an unintentional pregnancy termination brought about by an accident or when the mother's life must be saved will be paid for.  

Newborn Coverage 

RSBY covers the healthcare expenses of the new born even if the number of beneficiaries has exceeded. The policyholder can claim the expenses incurred for the treatment of a new-born baby until the end of the policy term. However, it's up to the policyholder whether they want to add the name of the new-born baby under the RSBY policy or not during the policy renewal. 

What is Not Covered Under RSBY?

The following are the healthcare expenses that are not covered under Rashtriya Swasthya Bima Yojana: 

1. The scheme does not cover the hospitalization expenses for the treatment that are not mentioned in the policy.  
2. Expenses related to HIV/AIDS treatment.  
3. Expenses incurred for hormone replacement therapy.  
4. Dental treatments that are corrective or cosmetic in nature are not covered. Apart from this, the scheme does not cover the expenses of a root canal or cavity filling.  

1. Expenses related to substance abuse like excessive intake of alcohol or drugs are not covered.  
2. Congenital external disease  
3. Treatments related to change of gender  
4. Suicide  
5. AYUSH  

1. Vaccination 

How to Check RSBY Smart Card Status Online?

You need to follow the following steps to check RSBY Smart Card Status Online: 

1. Visit www.rsby.gov.in. 
2. Go to ‘Scheme Status’ and choose ‘State Wise’. 
3. Next, select your state. 
4. Enter your RSBY insurance number and click on ‘Submit’ to check the status. 

How to File Claims under Rashtriya Swasthya Bima Yojana?

Rashtriya Swasthya Bima Yojana offers cashless treatment to the policyholder. To avail the benefits of this scheme, am insured should carry the Smart Card to an RSBY empanelled hospital. The hospital officials will go through the smart card details and will send the necessary details to the insurance company. Once the verification is done by the insurance service provider, the claim will be settled between both parties. 

Eligibility Criteria for RSBY

You need to meet the following eligibility criteria to apply for RSBY: 

1. An applicant should be a citizen of India. 
2. The family members of the applicant should be listed in the Below Poverty Line (BPL) list. 
3. An applicant should be a registered member of the welfare boards. 

Documents Required

You need to submit the photocopies of the following documents to apply for Rashtriya Swasthya Bima Yojana: 

1. Aadhar Card 
2. Ration Card
3. BPL Certificate
4. Income Certificate

1. Address Proof
2. Passport size photograph

Features of Rashtriya Swasthya Bima Yojana

As already mentioned above, the program's goal is to give unrecognised sector employees who fall under the BPL category health insurance coverage. This programme will also benefit the members of their families. The following are the features of this scheme: 

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