Approximately 93% of India’s workforce is employed in the unorganised sector, where only a small fraction is covered by existing social security schemes. Most of these workers have no access to formal social protection, and rising medical expenses remain a major burden. Implementing health insurance in rural and underserved regions also poses significant logistical challenges. To address this critical gap, the Central Government launched the Rashtriya Swasthya Bima Yojana—RSBY —a targeted health insurance scheme designed to provide essential medical coverage and financial protection to workers in the unorganised sector and their families.
What is the Rashtriya Swasthya Bima Yojana (RSBY)?
Before knowing about the scheme and its objectives, first understand what is RSBY. The full form of RSBY is Rashtriya Swasthya Bima Yojana. The Ministry of Labour and Employment, Government of India launched the Rashtriya Swasthya Bima Yojana (RSBY) to offer health insurance coverage to Below Poverty Line (BPL) families. RSBY's primary goal is to safeguard BPL households from the economic burdens associated with hospitalisation due to health emergencies. In this article, we will discuss the benefits, coverage, inclusions, and exclusions of RSBY.
Features of Rashtriya Swasthya Bima Suraksha (RSBY)
Given below are the unique benefits of Rashtriya Swasthya Bima Yojana (RSBY):
- Empowering the beneficiary:
RSBY allows BPL households to choose between public and private hospitals, making them attractive clients for hospitals due to potential revenues. - Business model for all stakeholders:
Designed as a business model with incentives for each stakeholder, facilitating scheme expansion and long-term sustainability. - Insurers:
Insurers are paid premiums for each enrolled household, motivating them to enroll more BPL households for better coverage. - Hospitals:
Hospitals receive payment per beneficiary treated, incentivizing treatment of more beneficiaries, including public hospitals which receive funds directly. - Intermediaries:
Inclusion of NGOs and MFIs aids in reaching BPL households, with intermediaries compensated for their services. - Government:
With a maximum annual payment of Rs. 750 per family, the government provides quality healthcare access to BPL populations, fostering competition and improving public healthcare providers' performance. - Information Technology (IT) intensive:
Biometric-enabled smart cards ensure smooth data flow and IT-enabled hospitals facilitate service utilisation tracking. - Security:
Biometric-enabled smart cards and key management systems ensure safety and accountability, with only the rightful beneficiary able to use the card. - Portability:
Beneficiaries can use their smart cards in any RSBY empanelled hospital nationwide, facilitating access for migrant families. - Cashless and paperless transactions:
Beneficiaries enjoy cashless benefits with smart cards and fingerprint verification, while providers submit online claims for electronic payment, making it a paperless process. - Robust monitoring and evaluation:
RSBY implements a comprehensive monitoring and evaluation system, tracking transactions nationwide and providing analytical reports for scheme improvement and competition among insurers.
Benefits of Rashtriya Swasthya Bima Yojana (RSBY)
The recipient will qualify for in-patient health insurance benefits as determined by the respective State Governments, tailored to the needs of the population/geographical region. However, State Governments are encouraged to include at least the following minimum benefits in the package/scheme:
Coverage for the unorganised sector worker and their family (comprising up to five members).
A total sum insured of Rs. 30,000 per family per year on a family floater basis.
Cashless access to medical treatment for all covered conditions.
Hospitalisation expenses, covering most common illnesses with minimal exclusions.
Inclusion of all pre-existing conditions in the coverage.
Reimbursement for transportation costs (actual expenses with a maximum limit of Rs. 100 per visit) within an overall limit of Rs. 1000.
Eligibility criteria for the scheme
Unorganised sector workers and their family members, who belong to the Below Poverty Line (BPL) category. Maximum 5 people from a family are covered.
Implementing agencies are tasked with verifying the eligibility of unorganised sector workers and their family members who are intended to benefit from the scheme. Smart cards will be issued to beneficiaries for identification purposes.
