Rashtriya Swasthya Bima Yojana (RSBY) is a government-run health insurance programme for the Indian poor. The scheme initiated with a target to offer health insurance coverage to the unrecognised sector workers who come under the BPL category, and their family members shall be beneficiaries under the same scheme. It provides facilities like cashless insurance for hospitalisation both in public and private hospitals. The scheme started enrolling on April 1, 2008, and has been implemented in 25 states of India.

Primarily, RSBY was a project under the Ministry of Labour and Employment. Now it has been moved to the Ministry of Health and Family Welfare from April 1, 2015.

Rashtriya Swasthya Bima Yojana (RSBY)

The objective of Rashtriya Swasthya Bima Yojana (RSBY)

Ministry of Labour and Employment, Government of India has launched the scheme (RSBY) to offer health insurance coverage for Below Poverty Line (BPL) families. The main objective of the scheme is to protect BPL households from financial liabilities arising out of health shocks that include hospitalization.

Eligibility Criteria for Rashtriya Swasthya Bima Yojana (RSBY)

  • Under the scheme, Rashtriya Swasthya Bima Yojana (RSBY) Unorganized sector workers who belong to the Below Poverty Line (BPL) category will be the beneficiaries along with their family members.
  • It will be the accountability of the implementing agencies to confirm the eligibility of the unorganized sector workers and their family members who are proposed to be benefited under the scheme.

The beneficiaries will be issued smart cards for identification purpose.

What is covered under RSBY Scheme?

Expenses of the hospitals- The RSBY scheme is a complete plan for you and your family members covering hospitalization expenditures related to illness, accident, or any other diseases.

Compensation for Pre-Hospitalization– The scheme compensates diagnostic and medical expenses one day before the hospitalization.

Expenses for Transportation– As per Rashtriya Swasthya Bima Yojana (RSBY) scheme a policyholder can claim for the transportation expenses.

Dental Injury– Policy holder is eligible to claim for the treatment of the dental injury caused by any accident

Treatments for Day care- RSBY scheme provides the necessary cover in any surgical process where you have to get hospitalized for a day.

Maternity Benefit- The RSBY scheme covers deliveries of pregnant women for both normal and caesarean. For any normal delivery, the policyholder can claim Rs.2500, while for any caesarean delivery, the policyholder can make a claim up to Rs.4500. If there would a condition where the mother's life is at risk or unintentional termination of pregnancy, the policyholder can claim for it.

Coverage for Newborn– Policyholder is permitted to add the name of a newborn baby.

What the policy does not cover?

  • Costing of the medicines or treatments till not prescribed by a medical practitioner
  • Cosmetic surgeries and Dental treatments
  • Congenital external diseases
  • AYUSH
  • Vaccinations
  • AIDS
  • Suicide
  • Injuries due to war, attack, or because of the act of foreign enemy or similar conditions like these.
  • Hormone replacement therapy
  • Illness due to excess alcohol or drugs consumption

Benefits of Rashtriya Swasthya Bima Yojana (RSBY)

Sum Insured

A health cover of up to Rs. 30,000/- is offered per year on a family floater basis.

Coverage for the family

A single RSBY scheme provides health cover to up to 5 members of the family. The members include the applicant, their spouse, with three other dependents. The dependents can either parents or children.

No Waiting Period

There is no waiting period for RSBY scheme like other insurance policies

Pre-existing Diseases

In RSBY scheme pre-existing diseases are generally covered from the first day.

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