What Is Rashtriya Swasthya Bima Yojana?

  • Author :
  • TATA AIG Team
  • Published on :
  • 27/12/2021

Rashtriya Swasthya Bima Yojana which means the National Health Insurance program is a central government-run health insurance plan aimed at providing health insurance coverage to the unorganized sector workers who come under the “below poverty line” category. The scheme also covers the family members of the participants who shall get the floater sum insured under the scheme.

This is an affordable health insurance plan launched by the central government on April 1, 2008, and is being implemented in 25 states in India. At the time of its launch, this scheme was under the purview of the Ministry of Labour and Employment but from April 1, 2015, it has been transferred to the Ministry of Health and Family welfare for effective implementation of the scheme.

Objective of Rashtriya Swasthya Bima Yojana

The main objective of the Rashtriya Swasthya Bima Yojana health insurance plan is to provide affordable health insurance coverage to below poverty line families from financial liabilities arising out of health-related hospitalization expenses.

The noble objective is to prevent the below poverty line families from getting into debt trap for health-related treatments. Most of the people from the unorganised sector get into a debt trap in case of medical emergencies which makes them poorer day by day.

Eligibility for Rashtriya Swasthya Bima Yojana

The main eligibility to enrol under the RSBY scheme is to come under the below poverty line category and workers working in unorganised sectors. The scheme can be extended to the family of the unorganised sector workers; the definition of family under the scheme is up to 5 members who include the Self, Spouse and up to 3 children. The union government has outsourced the process to certain implementation agencies to verify the eligibility of the unorganised sector to be benefited under the affordable health insurance scheme. Once the enrolment is done under the health insurance plan, the beneficiaries would be given smart cards for the purpose of identification.

Features of Rashtriya Swasthya Bima Yojana

There are certain features of the RSBY scheme which make it attractive to the BPL families which are mentioned below:-

  • The smart cards given to the beneficiaries are safe and foolproof which means that these cards cannot be tampered with. Since the biometric data of the beneficiaries is captured it would be safe from tampering. The biometric enabled smart card ensures that only the beneficiaries could use the smart card and get the benefits from the best medical insurance policy.
  • The main advantage of the RSBY scheme is portability; if a beneficiary enrolled in a particular district wants to port the card to another city it can be done easily. This affordable health insurance plan allows the beneficiaries to port and enrol in any of their place of residence. It makes the scheme unique and beneficial to the families which travel from one place to another.
  • The major advantage of RSBY medical insurance is that it provides cashless hospitalization and paperless transactions.
  • Although there would be no health insurance tax benefits under the scheme unlike other health insurance plans in the market, RSBY is the best medical insurance plan for BPL families.

Coverage under Rashtriya Swasthya Bima Yojana

The beneficiary under the RSBY medical insurance shall be provided with the below coverage:

  • The unorganised sector worker with his family (up to 5 members) can be covered under the RSBY medical insurance policy.
  • The total sum insured is ₹30,000 per family per year. The coverage would be on a family floater basis.
  • Cashless hospitalization up to the sum insured to all the mentioned ailments.
  • In-patient Hospitalization expenses up to the sum insured
  • RSBY is the best medical insurance policy that covers pre-existing illnesses or diseases as well.
  • Transportation costs (with a maximum limit of ₹100 per visit) up to ₹1000 in a policy year is covered under the RSBY health insurance plan.

Premium Payment for Rashtriya Swasthya Bima Yojana

The premium payment for the RSBY affordable health insurance plan would be contributed by the Government of India, the State government and the beneficiary as per the below ratio:

  • The Government of India would contribute 75% of the annual premium of ₹750/-, subject to a maximum premium of ₹565 per family per annum. In addition to the above-mentioned contribution, the Government of India also bears the cost of a smart card which would be used for identification purposes.
  • The State government would contribute 25% of the annual premium. If any additional premium would also be contributed by the state government.
  • The beneficiary under the RSBY health insurance plan would contribute Rs.30 per annum towards the registration in the form of a registration or renewal fee.

RSBY is an affordable health insurance plan where the beneficiary needs to pay only the registration cost and the renewal cost.

Enrolment in Rashtriya Swasthya Bima Yojana

The enrolment in RSBY is linked with the data available in the below poverty line list prepared by the government. The list of BPL households will be posted in each village at the enrolment station or any other designated place for the villagers to verify the same. The villagers would be given ample time to enrol on the BPL list.

After this, the insurance companies are permitted to collect the biometric information of the BPL families in addition to the photographs of the family members to be included in the best medical insurance policy.

The smart card with the brochure of the scheme would be provided to the beneficiaries with the list of hospitals where the beneficiary can avail cashless hospitalization.

Health Card

The RSBY health insurance plan provides smart cards to the beneficiaries of the scheme on payment of ₹30 towards the registration charges. The smart card will come with photographs of the beneficiary and family members in addition to the list of hospitals that are authorised to give cashless treatment for mentioned illnesses or diseases under the affordable health insurance plan.

Grievance Redressal System

The Government of India has launched Central Complaint and Grievance Redressal System (CGRS) to ensure that the grievance related to the RSBY health insurance plan is disposed of by the use of ICT which automatically tracks and updates the status of grievance.

Conclusion

A health insurance plan is an agreement between the insurance company and the insured customer where the insurance company agrees to pay for the hospitalization and other related expenses of the insured customer up to a certain limit known as sum insured in return for a considerable amount known as premium.

Currently, the insurance penetration in India is 4.2% of the Gross domestic product as against the World average which is 6.31% for the FY21. Life insurance penetration stood at 3.2% while the non-life insurance penetration is 1%. If we take medical insurance penetration it would be minuscule as most of the unorganised population do not have any type of health insurance coverage in India.

Thus, most of the BPL families are against the risk of health spending thereby leading to extreme poverty, which can be reduced with the RSBY scheme. The introduction of affordable health insurance coverage for the below poverty families with the Rashtriya Swasthya Bima Yojana or the RSBY scheme has helped in this regard.

The best medical insurance policies offer the coverage of your choice at a premium cost affordable for you. And, schemes such as the Rashtriya Swasthya Bima Yojana ensure that all strata of our society can enjoy optimum health insurance coverage at affordable prices.

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