What is the Rashtriya Swasthya Bima Yojana?

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Rashtriya Swasthya Bima Yojana (RSBY) is a government health insurance scheme in India. It was launched to provide affordable healthcare to low-income families. The scheme helps to reduce financial burden during medical emergencies, offering inpatient medical care of up to ₹30,000. Followingly, let us take a look at its features, coverage and other details.


What are the Features of Rashtriya Swasthya Bima Yojana?


The Rashtriya Swasthya Bima Yojana supports economically weak sections of society. Its key features include:



  1. Cashless Treatment Facility: Beneficiaries can avail cashless hospitalisation at empanelled public and private hospitals.



  1. Family Floater Coverage: It is a family floater insurance policy, meaning the entire family, up to 5 members, shares a single coverage limit.



  1. Smart Card System: Each beneficiary family receives a biometric-enabled smart card for easy identification and access.



  1. Nationwide Portability: The scheme is portable across India, allowing migrant workers to access healthcare anywhere.



  1. Empanelled Hospitals: Treatment is available in both government and private empanelled hospitals.



  1. Easy Enrolment Process: Enrolment is done through government-organised camps and authorised centres.



  1. Reduced Financial Burden: The scheme aims to reduce out-of-pocket medical expenses for poor families.



  1. Government-Subsidised Premium: The government pays most of the insurance premium, while beneficiaries pay only a small fee.


For example, the Central Government of India provides 75% of the annual premium, including the cost of the smart card. State governments contribute the remaining 25% of the premium. Beneficiaries only contribute ₹30 annually for renewal or registration.


What Does the Rashtriya Swasthya Bima Yojana Cover?


RSBY provides financial protection for several essential healthcare services, including:



  1. Hospitalisation expenses for medical and surgical treatments



  1. Coverage for pre-existing diseases



  1. Day-care procedures that do not require long hospital stays



  1. Maternity benefits (up to ₹2,500 for normal deliveries and ₹4,500 for c-section deliveries)



  1. Transport expenses up to ₹1,000 (each visit capped at ₹100)



  1. Pre- and post-hospitalisation expenses for up to 5 days after discharge.


What are the Exclusions of the Rashtriya Swasthya Bima Yojana?


Certain medical services and expenses are excluded under the scheme, such as:



  1. Cosmetic surgeries (unless medically necessary)



  1. Non-essential dental treatments



  1. Outpatient department (OPD) expenses



  1. Regular health check-ups



  1. Experimental treatments



  1. Treatment in non-empanelled hospitals



  1. Expenses beyond the annual coverage limit



  1. Hospital stays without a valid medical necessity



  1. High-end private room charges.


What are the Eligibility Criteria for Rashtriya Swasthya Bima Yojana?


The eligibility for Rashtriya Swasthya Bima Yojana mainly focuses on vulnerable and low-income groups:



  1. Families living below the poverty line (BPL)



  1. Workers in the unorganised sector



  1. Households listed under government-approved beneficiary databases.


Moreover, the required documents include:



  1. Identity proof (Aadhaar card or Voter ID)



  1. Address proof (ration card or utility bill)



  1. BPL Certificate



  1. Passport-sized photographs.


After successful registration, eligible families receive a biometric smart card that enables access to benefits.


Final Words


Rashtriya Swasthya Bima Yojana is an important step towards providing affordable healthcare to the economically deprived sections of society. It reduces financial stress during medical emergencies. The scheme ensures access to cashless treatment and basic hospital care.