Rashtriya Swasthya Bima Yojana

A national health insurance programme run by the Indian government is the Rashtriya Swasthya Bima Yojana or RSBY scheme. This programme intends to give the BPL group cashless insurance for hospitalisation in public and private facilities. On April 1, 2008, the Rashtriya Swasthya Bima Yojana got underway as a Ministry of Labour and Employment-run initiative. It was included in the Ministry of Health and Family Welfare on April 1, 2015.

According to sources from February 2014, the RSBY scheme has enrolled 36 million families.

The RSBY programme is unique from other government programmes in several ways, including:

• A biometric smart card or swasthya card is issued to each beneficiary family covered by the RSBY Scheme using IT applications on a massive scale. Their pictures and fingerprints are on this swasthya card. The hospitals covered by the RSBY scheme have IT capabilities and are connected to the district-level server as well.
• Giving BPL households the option to select between public and private hospitals empowers the beneficiary.
• The ability of the Rashtriya Swasthya Bima Yojana Scheme beneficiary in a specific district of any state to use their smart card at any RSBY-empanelled hospital is a vital component of RSBY.
• The RSBY scheme is safe and secure since it uses a key management system and a smart card with biometric capabilities. The RSBY key management system guarantees accountability for the issuance and use of the smart card and that the proper beneficiary receives the card. Only the legitimate beneficiary can use the smart card.
• The plan has incentives built in for each stakeholder and was created as a commercial model for a social sector programme. This scheme's expansion and long-term viability are both supported by this business model design.

• Under this programme, beneficiaries are given insurance coverage up to Rs. 30,000 per year on a family floater basis, which covers a maximum of five family members, including the head of the household, their spouse, and up to three dependents.
• The recipients receive a smart card or swasthya card with biometric functionality.
• For J&K and the Northeastern states, the Central Government of India pays 90% of the expected annual contribution and 75% of the estimated annual premium.
• The state governments contribute 25% of the total annual premium and 10% in the cases of J&K and the Northeastern states.
• It offers cashless insurance protection for all medical procedures and hospital stays.
• They provide transportation allowances, one day's worth of pre-hospitalization, and five days' worth of post-hospitalisation expenses.

Inclusions

The following costs are covered under Rashtriya Swasthya Bima Yojana:

• Pre-hospitalisation: Any diagnostic tests performed up to one day before admission to the hospital
• Post-hospitalisation: After the release date, expenses connected with the procedure or illness will be paid for up to 5 days.
• Hospitalisation: It includes the anaesthetist's price, general ward bed costs, board charges, consultation fees, doctor visits, costs associated with using surgical appliances, and patient food. Additionally, it covers the costs of medications, nursing, OT fees, oxygen, X-rays, and diagnostic tests.
• Benefits for expecting mothers: Cesarean birth, vaginal birth, and any difficulties before either are all covered. The policyholder may submit a claim for up to Rs. 4,500 for a Cesarean and up to Rs. 2,500 for a natural delivery.

Exclusions

The following costs are excluded from the Rashtriya Swasthya Bima Yojana scheme: AYUSH therapies, external congenital illnesses, vitamins or tonics unless a licenced physician has prescribed them for you; dental procedures that are primarily aesthetic or remedial, illnesses brought on by substance addiction, assisted conception; or subfertility; hormone replacement therapy; physical modifications to avoid appearing like the other sex; unless an accident or a condition requires it, plastic or cosmetic surgery and vaccinations. It also eliminates prenatal costs, hospitalisation following delivery or associated procedures, and voluntary pregnancy termination.

Rashtriya Swasthya Bima Yojana is launched to provide health services to the underprivileged population of the country. The beneficiaries will be BPL-eligible unorganised sector employees and their families (a family unit of five). The process involves verifying the eligibility of the unorganised sector workers and their family members. They are suggested to benefit from the plan and will fall under the purview of the implementing authorities. Smart cards will be given to the beneficiaries.

Insurance firms authorised to offer the RSBY programme will release a schedule for enrolment at the village level. In addition, before the start of the enrollment procedure, the schedule will be made available at all conceivable government centres.

BPL list members are welcome to visit the enrollment centres on the day and hour specified in the schedule. The RSBY Cards can be printed at the enrolling centre as well. Within 10 minutes of completing the RSBY registration process, a listed beneficiary can obtain the swasthya bima card.

Soon after registration, the RSBY card status becomes operational. The smart card will include biometric information as well as the RSBY customer care number. In addition, there will be a list of Rashtriya Swasthya Bima Yojana hospitals available at the enrollment centre.

Most claims submitted under the RSBY are cashless. The RSBY card must be presented at the hospital by a beneficiary of this coverage. Only hospitals eligible to resolve cashless claims are hospitals. The hospital will transmit the required data to the insurance provider or the Third Party Administrator. After the verification process, the claim will be settled between the hospital and the insurance company/TPA. No paperwork is needed.

RSBY cards are utilised for a range of tasks, including patient information and beneficiary identification using a photograph and fingerprints. However, the smart card's most crucial feature is the capacity to conduct cashless transactions at the accredited hospital and transfer rewards across the nation. The beneficiary will receive the authenticated smart card right there at the enrolment booth.

This programme intends to give the BPL group cashless insurance for hospitalisation in public and private facilities. The Rashtriya Swasthya Bima Yojana provides benefits to close to one-third of all Indians. Nevertheless, two-thirds of Indians must also have access to health insurance. Therefore, if you are not qualified for government-sponsored programmes, you must choose a health insurance plan that provides the broadest coverage at a reasonable price. Niva Bupa allows you to customise the healthcare plan with rewarding add-ons and the advantages mentioned above.