Rashtriya Swasthya Bima Yojana: Eligibility, Coverage, Benefits

The Rashtriya Swasthya Bima Yojana (RSBY) is a health insurance scheme funded by the government to provide affordable healthcare to low-income or Below Poverty Line (BPL) families in India.

13,504 Views | Updated on: Mar 03, 2025

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India has witnessed rising medical costs and expensive healthcare in the past few years, and now, they have become a concern for many. This makes you wonder, “How do families who can barely afford daily necessities manage high medical expenses?” The good news is that the Indian government has thought about this problem and introduced a healthcare insurance plan to help such families. It is called the Rashtriya Swasthya Bima Yojana (RSBY).

What is Rashtriya Swasthya Bima Yojana?

To understand the scheme better, let us start from its origin. The Rashtriya Swasthya Bima Yojna is a government-funded program introduced in 2008 by the Ministry of Labour and Employment. The goal of the RSBY scheme was to provide affordable healthcare to economically disadvantaged families, especially those living below the poverty line. This scheme is now available in every state and union territory across India.

By 2015, RSBY was brought under the Ministry of Health and Family Welfare, expanding its reach and coverage. Though the scheme initially only targeted BPL families, it has now extended to include other groups, such as street vendors, domestic workers, and construction workers. Essentially, it is meant to help anyone who is struggling to afford medical care.

The scheme can protect you from any financial obligation that may develop due to healthcare-related expenses, such as planned or unplanned hospital stays. It offers coverage up to ₹30,000, which can be shared among family members under one policy.

How Does Rashtriya Swasthya Bima Yojana (RSBY) Work?

RSBY operates in a simple yet effective manner. You, as a member of a BPL family, receive a card that is like a debit card but for healthcare. It is called the RSBY card, and it allows you to avail yourself of medical services at affiliated hospitals without any cash transactions. Whenever you or any of your family members need medical treatment or hospital care, all you have to do is show this card to the hospital, and they will take care of the expenses.

The best part is that you do not need to pay anything out of pocket or do any tiresome paperwork. Add to this the additional relief of not carrying a hefty sum of money. So, no hassle, no safety risks.

You or your family members can use the money from the scheme for various treatments, whether a surgery or a hospital admission. Once the hospital verifies your card, you can receive cashless treatment. The insurance company then later settles the bills directly with the hospital.

What is Covered in the RSBY Scheme?

Rashtriya Swasthya Bima Yojana is one of the world’s most extensive and 100% state-sponsored plans, which provides health insurance coverage to individuals for:

Hospitalization Expenses

If you or your family needs to stay in the hospital (whether for surgery or treatment), the RSBY scheme covers you. However, only expenses incurred at a licensed hospital or a nursing home by an official doctor or other medical practitioner are considered. The following hospitalization costs are specifically covered by RSBY:

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

Pre-Hospitalization Costs

Did you know that before you are even admitted to a hospital, there are various other expenses like doctor consultations, tests, and scans? This scheme covers any pre-hospitalization charges, such as diagnostic tests, medicines, imaging tests, etc., performed or issued a day before your admission to the hospital.

Post-Hospitalization Costs

When you get hospitalized for medical care, the expenses do not end right after discharge. Once you leave the hospital, you might still need to take medicines or go for follow-up consultations, right? RSBY covers these costs for up to five days after discharge. This way, you can focus on getting better without worrying about extra bills.

Maternity Benefit

RSBY also helps expecting mothers by covering maternity costs, whether for a normal delivery or a C-section. The coverage offers ₹2,500 for standard delivery, whereas for a cesarean birth delivery, you get coverage of ₹4,500. Pre-delivery complications are also included. RSBY also funds involuntary termination of pregnancy because of an accident.

Newborn Coverage

Now, consider the scenario that four people in your family have already been considered as beneficiaries under this policy. What happens if you have a newborn in your family? In such cases, the insurance immediately covers an infant born within the policy period. From the moment they are born, babies get coverage under RSBY, ensuring their health needs are taken care of, which is a massive relief for new parents.

Transportation Expenses

Medical trips can be costly, especially if you live far away from medical facilities or hospitals. Thankfully, RSBY offers coverage of up to ₹100 per visit, with a maximum of ₹1,000 per year to cover transportation expenses to and from the hospital.

Dental Treatment

If you need dental work due to an accident, RSBY will provide the necessary coverage. However, know that this coverage is specifically for accident-related dental issues and does not include general dental care.

Daycare Treatments

This program also provides various daycare treatments. Sometimes, medical procedures do not need an overnight stay at the hospital. For things like chemotherapy, minor surgeries, or cataract operations, RSBY also provides coverage under “daycare treatments.” This means you are covered for multiple medical services that can be done on an outpatient basis.

What are the Features of the RSBY Scheme?

What do you think makes the RSBY scheme unique? Well, this program has great features that aim to benefit the economically underprivileged class significantly, such as:

A comprehensive sum insured of ₹30,000 for the family on a floater basis.
Cashless treatment facility of up to ₹30,000 at the authorized hospital or nursing home.
The central government pays all premiums.
Easy registration and renewal of the policy. As the policyholder, you have to pay only ₹30 for registration or renewal.
There is no waiting period for the inclusion of any defined benefits.
You get comprehensive medical coverage with limited exclusions.
The benefit is extended to all pre-existing diseases. This applies even if you 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 ₹1,000.
Portability of the scheme. This allows you to enroll 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 your biometric data.

You can also avail of other health insurance plans, public or private, to enhance your financial protection against rising medical costs.

RSBY Benefits

Rashtriya Swasthya Bima Yojana benefits make it an enticing option for BPL or low-income families. This program has already enrolled and helped millions of families all over India.

Sum Insured

Under this policy, you or your family can claim up to ₹30,000 for a variety of medical treatment expenses. This means if someone in the family gets sick or injured and needs hospital treatment, the policy will pay for it up to that amount.

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. A new baby may be added as a beneficiary until the policy expires.

No Waiting Period

For some healthcare plans, you need to wait for a certain period before you can use your insurance. But, with RSBY, you do not need to wait. You can start using the insurance right after enrolling. If someone in your family falls sick or needs medical attention immediately, the scheme will cover the costs.

Pre-existing Diseases

Now, what if you or your family already had some illness before you took the insurance? Such pre-existing health problems or illnesses before getting the insurance are usually not covered right away. These types of conditions mostly have a waiting period of 2 to 4 years for most policies. But with RSBY, all pre-existing diseases are covered from the start. This means if a family member already has an illness like diabetes or heart disease, the insurance will still help pay for their treatment.

Enrollment Procedure of Rashtriya Swasthya Bima Yojana (RSBY)

If you wish to benefit from this health insurance scheme and avoid unnecessary hassle, you should know about the registration process. The process for the Rashtriya Swasthya Bima Yojana enrollment is made easy and accessible so that eligible families can join the plan without any difficulties. To sign up, you need to visit your nearest RSBY enrollment center and provide a few necessary documents to get started.

Aadhaar card
Ration card
Income certificate
BPL card
Proof of residence

The enrollment process is free of charge. When you apply, the center will first check your documents and issue you an RSBY smart card. As soon as you are enrolled in the scheme, you can use your RSBY smart card to receive free medical care at affiliated hospitals and medical facilities.

What is the Eligibility Criterion for RSBY?

We know by now that RSBY was launched to provide health services to the country’s underprivileged population. As per the rules, this will include BPL-eligible unorganized sector employees and their families (a family including five members). But how is it decided who is eligible to be a beneficiary under this policy?

To enroll in the Rashtriya Swasthya Bima Yojana, you and your family must meet specific eligibility requirements. These criteria ensure that the scheme benefits the intended low-income population.

If you are someone who is working in the unorganized sector or doing jobs that are not formal, you can qualify for this policy.
If you and your family live below the poverty line, this scheme is for you. The state government decides who is on that list, and 5 members of a BPL household can join the scheme.
Registered members of the welfare boards are also included.

How to Avail of the RSBY Scheme? What is an 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. You can reach the enrollment center on the date and time specified in the schedule issued by the insurance companies.

The registration process is generally 10-15 minutes long, after which you will get the RSBY card. This card will contain your biometric details and RSBY customer care details. To receive the scheme benefits, eligible families must provide Rashtriya Swasthya Bima Yojana card details during hospital visits. An extensive number of hospitals are available in the enrollment center.

What is the RSBY Claim Settlement Procedure?

You must have already understood that the scheme is designed to be highly accessible and convenient to the beneficiaries. This includes a hassle-free and cashless claim settlement of up to ₹30,000. This means you are not liable to pay any charges to the authorized hospital up to an upper limit of ₹30,000 on a floater basis.

So, when you or your family needs medical care, you present your RSBY smart card at the hospital to receive the benefit. The hospital will then verify your identity, family details, and available insurance coverage. After this, you can receive treatment without paying anything upfront. The treatment provided is cashless under RSBY. The insurance will cover all hospitalization expenses, including room charges, doctor fees, surgery, medications, and more, up to the available balance

Once you are discharged, the hospital sends an electronic claim report to the insurance company. If everything is in order, the insurance company will settle your claim directly with the hospital and reimburse you for the treatment costs.

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 governments of the respective states. You just need to pay ₹30 per annum for registration or renewal. This is done to help 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 is Not a Part of RSBY?

While the primary purpose of the Rashtriya Swasthya Bima Yojana is to provide comprehensive health insurance coverage and offer various benefits, it has its limitations and exclusions. 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
HIV/AIDS
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

Conclusion

Rashtriya Swasthya Bima Yojana is an excellent and affordable insurance plan designed to help financially struggling people by providing them with affordable healthcare. Forward-thinking programs like RSBY are committed not only to making insurance accessible to you but also to empowering vulnerable families by providing financial protection, improving healthcare access, and reducing the burden of medical expenses. Take a step towards ensuring a healthier and more secure future for all.

FAQs on Rashtriya Swasthya Bima Yojana (RSBY)

Is the RSBY policy still valid?

Yes, you can still benefit from RSBY. However, it is now known as the Ayushman Bharat Yojana.

How do I check my RSBY card validity?

All you have to do is log in to the official website RSBY, select your ‘State’ under “Scheme Status, and click “Submit” after entering the RSBY scheme in the portal. Your screen will show the status of the RSBY scheme.

Can I avail of RSBY benefits if I am not below the poverty line but have a low income?

You cannot benefit from RSBY if you are above the poverty line. Only the family that adheres to the RSBY’s eligibility requirements is allowed to enroll in the program..

Is there any age limit to avail of the benefits of RSBY?

No, there is no maximum age limit for receiving the benefits of the RSBY policy.

Which medical treatments are covered under the RSBY scheme?

The RSBY scheme covers hospitalization for illnesses or accidents, surgery, medicines, diagnostics, pre-hospitalization, post-hospitalization care, maternity benefits, newborn coverage, transportation costs, and specific daycare treatments.

What is the insurance coverage limit in RSBY?

The insurance coverage limit under the RSBY scheme is ₹30,000 on a floater basis per family.

Can a family have more than one RSBY card?

No, a family is issued only one RSBY card, which covers up to five members, including the head of the family, spouse, and three dependents. Newborns born during the policy period are automatically covered under the existing card.

Is there a premium that beneficiaries need to pay for RSBY?

You need to pay a nominal registration or renewal fee of ₹30 per year. The remaining premium is funded by the central and state governments, making the scheme highly affordable for economically weaker sections.