Rashtriya Swasthya Bima Yojana is a social security scheme started by the Government of India for unorganized workers in the country. Unorganised workers in the country get exposed to various health risks including old age, disability, general ailments, maternity etc. This health insurance scheme ensures that these workers are protected from these health hazards. This scheme was originally started in the year 2008 to provide coverage for below poverty line families. It was later expanded to include unorganized workers who belong to marginally above poverty line families.
In order to enroll in this scheme, potential members must meet the following eligibility criteria:
Some of the notable features of Rashtriya Swasthya Bima Yojana can be given as follows:
The range of the benefits offered by Rashtriya Swasthya Bima Yojana can be given in this table:
|Benefits||Extent of coverage|
|Hospitalisation expenses||Up to Rs.30,000 per annum based on predetermined package rates|
|Transport expenses||Rs.100 per hospitalisation subject to a maximum of Rs.1,000 per year|
There are no specific exclusions listed out under this scheme. However, it is understood that this coverage only applies to emergency situations faced by the insured. Any kinds of cosmetic treatments will not be covered under this scheme. For certain conditions, the coverage will apply only when there is an actual medical emergency.
This is a cashless treatment scheme offered by the Government of India. The government has effectively used information technology to issue smart cards for all beneficiaries. During the time of hospital admission, a beneficiary must provide the smart card to the hospital. Upon verification of the biometric details, the network hospital will initiate treatment for the insured person.
Claim request and settlement happens between the network hospital and the insurer. One of the significant advancements made in this scheme is the implementation of paperless initiative for all participating service providers. All claim details of the insured person can be sent to the company online. The network hospital must provide various documents including medical bills, diagnostic reports, physician certificate, prescriptions, cash memos, etc. to the insurer. Upon verification of these details, the insurer will transfer the claim amount (package rate) to the network hospital.
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