Rashtriya Swasthya Bima Yojana (RSBY), Benefit and Eligibility

Rashtriya Swasthya Bima Yojana, or RSBY, is an Indian health insurance program that primarily aims to give health benefits to families under the poverty line (BPL). The Indian government’s Ministry of Labor and Employment introduced this program. RSBY provides cashless hospitalization coverage up to ₹30,000 per family annually. Union territories and state governments carry out the plan’s implementation.

RSBY is a significant topic for the UPSC Exam, particularly in General Studies Paper 2 of the UPSC CSE Mains. It falls under the category of ‘Welfare Schemes for Vulnerable Sections’ and holds importance for both UPSC Prelims and Mains Exams. This comprehensive coverage will delve into the scheme’s objectives, intricacies, coverage, and associated issues.

Rashtriya Swasthya Bima Yojana

The RSBY scheme is a National Health Insurance Programme administered by the Government of India. It endeavors to offer cashless insurance for hospitalization to those below the poverty line (BPL), encompassing both public and private hospitals. The Rashtriya Swasthya Bima Yojana commenced on April 1, 2008, under the purview of the Ministry of Labour and Employment. Subsequently, on April 1, 2015, it was transferred to the Ministry of Health and Family Welfare. As of February 2014, records indicate the enrollment of a total of 36 million families under the RSBY Scheme.

Benefits of RSBY Scheme

Candidates can find here the benefits of Rashtriya Swasthya Bima Yojana. Check the following benefits for Rashtriya Swasthya Bima Yojana:

• Beneficiaries receive insurance coverage up to Rs. 30,000 per annum on a family floater basis, extending to a maximum of five family members, including the head of the household, spouse, and up to three dependents.
• Biometric-enabled smart cards are provided to beneficiaries.
• The Central Government of India contributes 75% of the estimated annual premium, with a 90% contribution for Jammu and Kashmir and the North-eastern states.
• State Governments contribute 25% of the total annual premium, with a 10% contribution for Jammu and Kashmir and the North-eastern states.
• Cashless insurance coverage is provided for all health services and hospitalizations.
• One-day prior pre-hospitalization expenses and five days post-hospitalization expenses, along with transport allowances, are covered.

Features of RSBY Schemes

The RSBY scheme stands out from other government initiatives in several ways:

• Utilization of Information Technology (IT): Extensive use of IT applications facilitates the issuance of biometric-enabled smart cards to every beneficiary family enrolled in the RSBY Scheme. These smart cards store their fingerprints and photographs. Furthermore, hospitals participating in RSBY are equipped with IT infrastructure and are interconnected with a server at the district level.
• Empowerment of Beneficiaries: BPL households are empowered to choose between public and private hospitals, providing them with greater freedom and control over their healthcare decisions.
• Nationwide Accessibility: A notable feature of RSBY is that beneficiaries enrolled under the Rashtriya Swasthya Bima Yojana Scheme in a specific district of any state can utilize their smart card at any RSBY empanelled hospital across the country.
• Enhanced Security: The adoption of biometric-enabled smart cards and a key management system ensures the safety and integrity of the RSBY scheme. The key management system guarantees that the card is provided to the correct beneficiary, ensuring accountability in terms of issuance and usage of the smart card. With the biometric-enabled Smart Card, the system ensures that only the genuine beneficiary can utilize the smart card.
• Business Model Design: The scheme is structured as a business model for a social sector initiative, incorporating incentives for each stakeholder. This design fosters both the expansion of the scheme and its long-term sustainability.

RSBY Smart Card

The smart card serves multiple purposes, including beneficiary identification through photographs and fingerprints, as well as patient information storage. Its primary function is to facilitate cashless transactions at empanelled hospitals and ensure the portability of benefits nationwide. The authenticated smart card is provided to the beneficiary at the enrollment station itself.

Objectives of RSBY Schemes

The primary objectives of the Rashtriya Swasthya Bima Yojana are outlined below:

• Mitigation of Financial Burden: In an era where healthcare costs have surged, especially impacting the marginalized, the Government’s insurance scheme offers crucial protection against exorbitant medical expenses. It serves as a shield for vulnerable sections, shielding them from the financial strain associated with costly treatments and medical assistance.
• Universal Access to Quality Healthcare: Upholding the ideals enshrined in the Directive Principles of State Policy (DPSP) within the Constitution of India, the Government endeavors to extend welfare services across diverse segments of society. The Constitution mandates the State to ensure access to quality healthcare for all citizens. Through RSBY, the Government aims to enhance accessibility to superior healthcare services for various strata of society.

Eligibility for RSBY Scheme

The eligibility criteria for individuals to apply for a health insurance scheme under RSBY are as follows:

• Citizenship: The applicant must be a citizen of India.
• Below Poverty Line (BPL) Status: The applicant should be listed under the Below Poverty Line (BPL) list with the Government of India. Workers from unorganized sectors who are listed are also eligible under this category.
• Welfare Board Membership: The applicant must be registered with the welfare board.
• Required Documents: To register for RSBY, the applicant must submit the following documents: Ration Card, Aadhar Card, BPL Certificate, Income Certificate, Passport-size photograph, and Address proof.

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