Rashtriya Swasthya Bima Yojana : Coverage, Eligibility and 4 Benefits

Launched for Indians, the Rashtriya Swasthya Bima Yojana is a national health insurance program by GOI. It provides cover to families and individuals who feature below the poverty line or are part of the unorganized sectors [1]. The Swasthya Bima Yojana provides financial coverage to safeguard those against the high costs of healthcare. This is applicable, be it for planned procedures or in case of an emergency. The policyholders and their family members can receive proper healthcare without facing financial challenges. Read on to know more about this Swasthya Bima Yojana.

Eligibility criteria for availing of the RSBY

Here are the eligibility parameters you need to meet to avail the RSBY scheme. 

• Members of a family listed below the poverty line list created by the state government can enroll in this scheme  
• Applicant must be an unorganized sector worker

Things that are covered under Rashtriya Swasthya Bima Yojana

This scheme offers wide coverage and many benefits that allow for better healthcare for those who need it [2]. The coverage includes:

Dental treatment

The cost of dental treatments required as a result of an accident is financed under this scheme. 

Hospitalization expenses

Beneficiaries can enjoy hospitalization coverage for the following: bed charges in a general ward, boarding charges, doctor visits, doctor’s consultation fee, blood, medicines, foods for the patient, oxygen, nursing, OT charges, surgeon charges, implants, prosthetic devices, anesthesia, anesthetist’s fee, and diagnostic tests. 

Pre-hospitalization

This scheme will pay for all costs of diagnostics medicines and tests up to one day before hospitalization. 

Post-hospitalization

The expenses associated with surgery or ailment for which the beneficiary was hospitalized will be covered for five days since the patient gets discharged. 

Transportation expenses

Policyholders are eligible for getting a transport compensation of Rs.100 for every visit to the hospital, with an annual cap of Rs.1000. 

Daycare treatments

Daycare treatments are surgical procedures that do not need prolonged hospitalization and can be completed on the same day. These are also covered by the scheme. 

Maternity benefits

The Swasthya Bima Yojana covers both cesarean and natural deliveries. The beneficiary can avail of compensation of Rs.4500 for cesarean and Rs.2500 for a natural delivery. The expenses of involuntary termination of pregnancy will be covered when it is a result of an accident or performed in situations where saving the mother’s life is the priority. 

Things not covered under the Rashtriya Swasthya Bima Yojana

The following features are excluded from the RSBY scheme: 

• Cost of the tonics or vitamins, unless you take it as part of your doctor’s prescription 
• AYUSH treatments
• Abortion, when it is done voluntarily
• Corrective cosmetic dental treatments which are not prescribed by a doctor
• Any illness caused by substance abuse like excessive use of drugs or alcohol
• Sex reassignment surgery
• Congenital external diseases
• Fertility treatments
• Cosmetic or plastic surgery, unless done as a part of covered treatment
• AIDS/HIV
• Vaccinations
• Hormone replacement therapy
• Suicide
• Pre-natal expenses
• War

 Benefits of availing of the Rashtriya Swasthya Bima Yojana

Coverage for your family

This scheme covers the head of the family, along with the spouse and three dependents. So, the coverage is applicable to your whole family, and there is no need to buy separate plans for each family member. 

Sum insured

Beneficiaries can make a maximum claim of Rs.30,000 for the different healthcare expenses included in the policy

No age limits

You can opt for this swasthya bima at any age

No waiting period

In most health policies, one usually needs to bear the expenses of treatment from their own pocket during the waiting period. Thankfully, RSBY does not have any waiting period, and you can enjoy the full coverage benefits from day one.

If you are eligible for Rashtriya Swasthya Bima Yojana, you can avail of this scheme via different health insurers. However, if you are not eligible or want more options in health insurance plan, you can check out the plans under Aarogya Care on Bajaj Finserv Health. Choose from a wide range of packages and avail of benefits like online doctor consultation, preventive healthcare, and lab test discounts. You can also sign up for a health card to finance healthcare more affordably!