Rashtriya Swasthya Bima Yojana

RSBY has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.

Eligibility

  • Unorganized sector workers belonging to BPL category and their family members (a family unit of five) shall be the beneficiaries under the scheme.
  • It will be the responsibility of the implementing agencies to verify the eligibility of the unorganized sector workers and his family members who are proposed to be benefited under the scheme.
  • The beneficiaries will be issued smart cards for the purpose of identification.

Benefits

The beneficiary shall be eligible for such in – patient health care insurance benefits as would be designed by the respective State Governments based on the requirement of the people/ geographical area. However, the State Governments are advised to incorporate at least the following minimum benefits in the package / scheme:

  • The unroganised sector worker and his family (unit of five) will be covered.
  • Total sum insured would be Rs. 30,000/- per family per annum on a family floater basis.
  • Cashless attendance to all covered ailments
  • Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible
  • All pre-existing diseases to be covered
  • Transportation costs (actual with maximum limit of Rs. 100 per visit) within an overall limit of Rs. 1000.

Funding Pattern

  • Contribution by Government of India: 75% of the estimated annual premium of Rs. 750, subject to a maximum of Rs. 565 per family per annum. The cost of smart card will be borne by the Central Government.
  • Contribution by respective State Governments: 25% of the annual premium, as well as any additional premium.
  • The beneficiary would pay Rs. 30 per annum as registration/renewal fee.
  • The administrative and other related cost of administering the scheme would be borne by the respective State Governments

Enrollment process

SMART CARD

Smart card is used for a variety of activities like identification of the beneficiary through photograph and fingerprints, information regarding the patient. The most important function of the smart card is that it enables cashless transactions at the empanelled hospital and portability of benefits across the country. The authenticated smart card shall be handed over to the beneficiary at the enrollment station itself. The photograph of the head of the family on the smart card can be used for identification purpose in case biometric information fails.

Some important Frequently Asked Questions:

Where can I get the application form for RSBY?

You can download the Rashtriya Swasthya Bima Yojana Application Form Pdf from your respective state government’s website.Why are the beneficiaries charged Rs. 30 when the government is paying for the scheme?

The amount borne by the beneficiaries i.e. Rs. 30 is simply the registration fee that helps the Nodal agency to cover the administrative costs. The actual premium of the policy is borne entirely by the Central and State Government of India.What is the age limit for dependent children to be covered under RSBY?

There is no age limit on the children of the policyholder under RSBY. However, if more than two children are present in a family the policyholder needs to decide which of them will be covered under the plan.Whose biometric information is required at the time of medical emergency?

Any beneficiary can give their biometric information at the time of hospitalization or claim. The presence of the head of the household is not mandatory at the hospital.What kind of endorsements are allowed in the smart card in the middle of the policy period?

Addition and removal of family members is allowed in the middle of the policy period only in case of death and newborn child. An additional member of the immediate family can be added only in case of the death of a beneficiary.Who can enrol under Rashtriya Swasthya Bima Yojana?

Any member belonging to the below poverty line can enrol under this scheme. This plan is beneficial especially for rickshaw pullers, rag pickers, mine workers, sanitation workers, drivers of commercial workers, etc.