Rashtriya Swasthya Bima Yojana

In 2008, the Ministry of Labour and Employment introduced the Rashtriya Swasthya Bima Yojana Scheme (RSBY) in an effort to ensure the best healthcare services and social security to the lower-income families. The purpose of RSBY is to decrease the burden of medical expense for below poverty line (BPL) families and increase their access to good healthcare.

Advantages for the Beneficiary

RSBY is intended to lighten the burden of medical expenses and provide access to healthcare to families below the poverty line. RSBY provides the ability to select health care options from the public and private hospitals to below poverty line households and individuals working in the unspecified sectors. RSBY scheme offers a substantial revenue to the healthcare providers, so the insured can receive the treatment in the best facilities.

Rashtriya Swasthya Bima Yojana Insurance Coverage

The total insured amount under RSBY scheme ranges up to Rs 30,000 on a family floater basis and up to five family members of a BPL household can be insured under the scheme. The scheme also covers the transportation expenses of up to Rs 100 per visit to the hospital, to a maximum of Rs 1,000 for a year. The scheme gets put into action from the next month of the enrolment date.

Eligibility Criteria to Enrol in RSBY

To enrol in the Rashtriya Swasthya Bima Yojana scheme, individuals need to qualify as per the following criteria:

• The applicant should be working in an unorganised sector and be a part of a BPL household.
• Individuals registered under welfare boards can also enrol in the programme.
• The RSBY scheme has no upper limit. Every member of the family of a BPL household is eligible.

Enrolment of Beneficiaries

Firstly, the health insurance company receives a digital list of all the eligible individuals falling under the BPL criteria in a pre-specified data format. The insurance company develops an enrolment schedule with dates for each village with the help of the district officials. The list is then posted at the enrolment stations in every village. The insurer then collects every eligible individual’s biometric information.

The beneficiary needs to pay a nominal fee of Rs 30. They are provided with a smart card and an information pamphlet with the necessary information about the RSBY and a list of network hospitals.

The enrolment has to be done in the presence of a field key officer or a government officer and a representative of the insurance company to attest for the enrolments legitimacy. Once all the enrolment is done, the consolidated list is sent to the state nodal agency. On the basis of the list of BPL households, the government will then make financial transfers to the state governments.

Claim Settlement Procedure

Once the patient has been treated, the empanelled hospital will send an electronic report to the Third Party Administrator (TPA) or the insurance provider. On the basis of the agreement between the insurer and the hospital, the insurer will go through the information records and pay off the hospital.

Portability of Smart Card

The beneficiary receives a smart health card, which can be used to avail health care services from any network hospital registered under the RSBY scheme. These network hospitals provide cashless hospitalisation to the insured member under RSBY.