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Rashtriya Swasthya Bima Yojana: Eligibility, Coverage, Benefits

Rashtriya Swasthya Bima Yojana (RSBY) is the National Health Insurance coverage for individuals or families. Read to know everything about Rashtriya Swasthya Bima Yojana, eligibility, coverage, and its benefits.

  • Mar 26, 2021

Growing concerns have been raised throughout time over India’s escalating healthcare costs. Even economically secure families have struggled to meet the soaring lifestyle expenses and cover medical costs. The situation for people from lower-class and middle-class families is significantly worse.

The Rashtriya Swasthya Bima Yojana (RSBY) was introduced in 2008 by the Ministry of Labour and Employment, Government of India, to offer dependable financial assistance to cover the costs of necessary medical care. Currently, the Ministry of Health and Family Welfare, Government of India, is in charge of the programme. The RSBY scheme aims explicitly to offer affordable healthcare services and social security to lower-income families incapable of fully covering their medical expenses.

Here is everything you should know about the Rashtriya Swasthya Bima Yojana.

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What is RSBY?

The Central Government’s Rashtriya Swasthya Bima Yojana (RSBY) programme offers social security to the less fortunate segments of society. This is accomplished through providing low-income families with health insurance (BPL). The programme offers protection from any financial obligations that can develop as a result of healthcare-related expenses, such as planned or unplanned hospital stays. Families are thus protected from having their healthcare impaired owing to financial difficulties and are also protected from being financially unprepared for medical bills.

The programme provides protection for people or families who are below the poverty line (BPL), notably those who work in the organised sectors and cannot afford medical bills. The programme covers all financial liabilities from healthcare expenditures, such as emergency hospitalization.
The Rashtriya Swasthya Bima Yojana offers a reasonable sum insured of ₹30,000 on a floater basis.

What is covered in the RSBY scheme?

The world’s most extensive and 100% state-sponsored health assurance plan, Rashtriya Swasthya Bima Yojana provides health insurance coverage to individuals for:

  • Hospitalization expenses

RSBY covers expenses related to the hospitalization concerning treating a disease, illness or accident. The benefit is available for the family of the insured as well. However, only costs incurred by a licenced physician or another medical professional at an authorised nursing home or hospital are taken into account. The following hospitalisation costs are specifically covered by RSBY:

  • Surgery
  • Bed and lodging (general ward)
  • Nursing and boarding
  • Anaesthesia
  • Consultation
  • Doctor visits
  • Blood, oxygen, etc.
  • All operation theatre expenses
  • Medicines
  • Supporting devices like prosthetics
  • X-Ray and other diagnostic tests
  • Food (only for the patient)
  • Implants
  • Surgical appliances costs

  • Pre-Hospitalization costs
  • The Rashtriya Swasthya Bima Yojana covers any pre-hospitalization charges like diagnostic tests, medicines, imaging tests, etc., performed or issued a day before the patient admission to the hospital.

  • Post-Hospitalization costs
  • The scheme pays for the five-day post-treatment recovery cost of an ailment/surgery for which the patient was primarily hospitalized.

  • Transportation charges
  • The insured is given ₹100 per visit as transportation coverage, up to a maximum of ₹1,000.

  • Dental treatment
  • Any dental treatment expenses incurred because of an accident are covered in the RSBY.

  • Daycare charges

All daycare or outpatient charges are a part of the RSBY scheme. Some of the daycare costs included are:

  • Ear or eye surgery
  • Dental surgery due to an accident
  • Haemodialysis
  • Nose surgery
  • Parenteral chemotherapy
  • Gastrointestinal surgery
  • Prostate surgery
  • Throat surgery
  • Radiotherapy
  • Fractures/dislocation

  • Maternity benefit
  • The insurance cover extends to all types of birth deliveries. For standard delivery, the cover offers ₹2,500, whereas, for caesarean birth delivery, the policyholder gets coverage of ₹4,500. Pre-delivery complications are also included. Further, involuntary termination of pregnancy because of an accident, etc., is also funded by RSBY.

  • Newborn coverage

Even if the maximum number of beneficiaries has been reached, the insurance nevertheless automatically covers a newborn child born within the policy term. The cover continues till the end of the policy period, and the decision for renewal depends on the policyholder.

What is not a part of RSBY?

As its primary purpose, the Rashtriya Swasthya Bima Yojana provides health insurance coverage to the underprivileged. Hence, the policy excludes the following:

  • All AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) treatments
  • Congenital health issues
  • Vitamins or tonics
  • Cosmetic or corrective dental treatments
  • Suicide
  • War
  • Vaccines
  • Voluntary termination of pregnancy
  • Prenatal expenses
  • Hospitalization costs after 48 hours of delivery or any related operation
  • Plastic or cosmetic surgery of any body part, unless required because of a disease
  • Sex change operations
  • Hormone replacement surgery
  • Fertility or related procedures
  • Accidents, diseases or conditions arising due to substance abuse
  • Treatment at an unauthorized or registered nursing home or hospital

What is the eligibility criterion for RSBY?

The Rashtriya Swasthya Bima Yojana is available only for people who fall under any of these categories:

  • Workers or employees in the unorganized sectors
  • Families or individuals living below the poverty line. The State government must issue the list. The RSBY scheme has no upper limit. All members of the BPL household can be a part of the RSBY scheme.
  • Registered members of the welfare boards

How is RSBY financed?

In the majority, the Central Government sponsors (75%) of the Rashtriya Swasthya Bima Yojana. The rest of the premiums (25%) are paid by the government of the respective states. In addition, the policyholder pays Rs. 30 per annum for registration or renewal. This helps the government cover the administrative costs involved in the scheme. However, for the North-Eastern States and Jammu & Kashmir, the Central Government sponsors 90% of the RSBY scheme and the state funds the rest of the insurance plan.

What are the features and benefits of the RSBY scheme?

The RSBY scheme has excellent features that aim to benefit the economically underprivileged class significantly. Some of these Rashtriya Swasthya Bima Yojana benefits and features include:

  • A comprehensive sum insured of ₹30,000 for the family on a floater basis
  • Cashless treatment facility up to ₹30,000 at the authorized hospital or nursing home
  • All premiums are paid by the central government
  • Easy registration and renewal of the policy. The policyholder pays only ₹30 for registration or renewal.
  • No waiting period for the inclusion of any defined benefits
  • Comprehensive medical coverage with limited exclusions
  • The benefit is extended to all pre-existing diseases. This applies even if the policyholder knew about the illness while buying the insurance.
  • Only family units of five members are eligible for insurance coverage.
  • Extensive hospital network in both public and private sectors that offers cashless treatment
  • Transportation costs you to ₹1,000
  • Portability of the scheme. This permits the policyholder to enrol at any panel hospital, irrespective of the state.
  • Robust monitoring and evaluation using IT-enabled software and the smart card’s chips. These highly secure smart cards keep track of all transactions and store the policyholder’s biometric data.

Further, the beneficiaries can also avail of other health insurance plans, public or private, to enhance their financial protection against rising medical costs.

RSBY Benefits

This program has enrolled millions of families. The plan has the following advantages:

  • Sum Insured
  • Up to Rs. 30,000 can be claimed for a variety of expenses that are protected by the policy.

  • Coverage For The Family
  • This layout is suitable for a five-person Indian family. The plan covers the family’s head, spouse, and three dependents. Until the policy’s expiration, a new baby may be added as a beneficiary.

  • No Waiting Period
  • A waiting period is a time period during which a policyholder cannot file a claim for a particular set of circumstances as determined by the insurance provider. During the waiting period, one must cover the expense of the treatment out of their own cash. However, there is no such clause in the RSBY.

  • Pre-existing Diseases

A pre-existing disease is, as the term implies, any illness that the policyholder or the beneficiaries had before they bought the policy. This covers any illnesses that the policyholder might not have known about at the time of policy purchase. Pre-existing conditions typically have a 2 to the 4-year waiting period in health insurance policies. Nevertheless, from the date of purchase, these are protected by RSBY regardless of the beneficiary’s age.

How to avail of the RSBY scheme? What is RSBY Card?

The Rashtriya Swasthya Bima Yojana form is available on each state’s official website. The government has authorized specific insurance companies to roll out the RSBY scheme at the village level. BPL families or individuals can reach the enrollment centres on the date and time specified in the schedule issued by the insurance companies.

The registration process is generally 10-15 minutes long, and the policyholder gets the RSBY card. The card contains the biometric details of the policyholder, along with RSBY customer care details. An extensive of hospitals are available in the enrolment centre.

What is the advantage of the RSBY scheme?

Introducing the Rashtriya Swasthya Bima Yojana aims to reduce the burden of medical costs for financially distressed families. The scheme helps to provide economical healthcare facilities to all families living below the poverty line.

The beneficiaries have the choice to get treatment in any of the listed public and private hospitals. Moreover, the insurance coverage is quite extensive in its benefits. Alternatively, the Rashtriya Swasthya Bima Yojana benefits healthcare providers so that the insured can get treatment at the best hospital or nursing home.

What is the RSBY claim settlement procedure?

This scheme offers cashless RSBY claim settlement to beneficiaries up to ₹30,000. The beneficiary is not liable to pay any charges to the authorized hospital up to an upper limit of ₹30,000 on a floater basis. The benefit is available on the smart card issued under the policy. No manual paperwork is required at the time of claim settlement on the part of the insured. All RSBY claims are settled electronically. The government covers the cost of treatment. And once the patient is treated, the empanelled hospital sends an electronic report to the Third-Party Administrator (TPA) appointed by the government or the insurance provider.

Post receipt of the electronic report, the insurer pays the hospital in accordance with the insurance agreement between the parties.


Overall, the Rashtriya Swasthya Bima Yojana is a unique and cost-effective insurance plan aiming to provide affordable healthcare facilities for those below the economically deprived. Kotak Life values progressive initiatives like RSBY and endeavours to increase insurance penetration in the country by offering highly economical and affordable health insurance plans for all Indian citizens. Together India can be healthy and prosperous.

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Ref. No. KLI/22-23/E-BB/2435


- A Consumer Education Initiative series by Kotak Life

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