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Rashtriya Swasthya Bima Yojana Explained

Updated On Oct 18, 2020

All About Rashtriya Swasthya Bima Yojana: Eligibility, Coverage, Benefits

Health is Wealth. However, with increasing healthcare costs, it is getting difficult for everyone to keep up with the charges. Especially the low-income group, which suffers a lot due to the charges and many treatments in the Government hospitals are not free, which make it tough for these families.

Rashtriya Swasthya Bima Yojana (RSBY), also called the National Health Insurance Program, is a government-sponsored scheme for low-income or Below Poverty Line (BPL) families who are citizens of India. It aims at providing the entire cost for a medical emergency to low-income families. Thus, it is a family health insurance program for low-income groups.

Rashtriya Swasthya Bima Yojana Eligibility

The following are eligible for Rashtriya Swasthya Bima Yojana:

  • The families who come under the Below Poverty Line are eligible for the Rashtriya Swasthya Bima Yojana.
  • Families mentioned on the list prepared by the State government.
  • Daily wage labourer and workers of non-governmental organizations.
  • Individuals or families who are members of welfare boards can also enrol for RSBY scheme.

Rashtriya Swasthya Bima Yojana Coverage

The Rashtriya Swasthya Bima Yojana provides more benefits when compared to other health care plans in the market. These are some of the areas covered under the plan:

1. Hospitalization Expenses

Treatment for various illnesses, accident recovery expenses are covered under the RSBY scheme. 
Hospitalization expenses related are also covered under the scheme.
Nursing & Boarding, surgeons & anaesthesia expenses are covered under the scheme.
Doctor visits, consultation fee, blood tests, Oxygen supply etc. expenses are covered under the scheme.
Surgical appliances, medicines, Prosthetic devices, implants etc. expenses are covered under the scheme.

2. Medical Tests 

Expenses related to various diagnostic tests, medicines, pathology tests and tests done one day before the hospitalization are covered under the scheme.

3. Post Hospitalization Expenses 

The charges related to the surgery, miscellaneous expenses for five days after discharge from the hospital are covered under the scheme.

4. Ambulance Charges

Transportation charges up to Rs.100/- per visit can be claimed under the scheme, and each individual has a maximum limit of Rs. 1000 under the plan.

5. Dental Treatment

Dental treatment due to accidents is covered under Rashtriya Swasthya Bima Yojana scheme.

6. Daycare Procedure Expenses

Expenses related to daycare treatments are covered under the RSBY scheme. These charges are the ones that do not require surgical procedures which can also be referred to as out-patient treatment expenses. 

7. Maternity Benefits

Delivery charges, both natural and caesarean, are covered under this scheme. Maternity benefits of Rs. 2500 for natural, Rs. 4500 for caesarean delivery can be claimed under this scheme. Complications during delivery are also covered under this scheme. Expenses related to involuntary termination of pregnancy caused due to accidents etc. are covered under the plan.

8. Expenses related to Newborn 

The medical expenses of a newborn baby related to the policyholder of the RSBY scheme will be added automatically to the scheme. The policyholder can renew the membership for the newborn baby after the expiry of the policy.

Rashtriya Swasthya Bima Yojana Benefits

 Following benefits are available under the RSBY scheme:

1-Wide coverage 

An individual under the RSBY scheme can claim up to Rs. 30,000 -.

2- Family coverage

The scheme provides coverage for up to five members which include the member, spouse and three dependents. A newborn baby in the family can also be added to the scheme.

3. Zero Waiting Period

The waiting period is zero, for the member under the scheme to claim for the treatments under the scheme.

4. Expenses For Pre-existing Diseases

A member under this scheme is covered for ailments which are existing before the purchase of the policy.


The policy was a dream of the Honorable Prime Minister to insure the unorganised sector and create a healthy country. With so many benefits, Rashtriya Swasthya Bima Yojana is considered as a boon to anyone belonging to below poverty line. 

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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