The Government of India launched the Rashtriya Swasthya Bima Yojana (RSBY) as a means of providing health insurance to workers in the unorganised sector who fall under Below the Poverty Line (BPL). The government social security scheme was developed after the Unorganised Workers Social Security Act was passed in 2008. According to the Act, the Central Government is required to provide social security schemes that would decrease the ill effects of the occupational hazards that most individuals in the unorganised sector are likely to face.
The scheme was launched in 2008 and was developed so as to cater to the health needs of the BPL section of society. However, the scheme has since widened the scope of its coverage to include individuals who earn their living from employment in the unorganised sector.
The cost of the premium for the scheme is borne by the Government of India and the State governments. Beneficiaries of the scheme are entitled to receive cashless treatment at hospitals empanelled with the scheme. These cashless services are based on predetermined package rates listed in the scheme.
As part of the government’s mission of providing affordable health insurance to all citizens of the country, the RSBY was implemented in all states. One of these states is Nagaland where the scheme has been in effect since 2015.
Features and Benefits:
The following are the features and benefits of the scheme:
The scheme provides health insurance coverage for individuals from BPL families. Those enrolled in the scheme have the option of choosing between private and public hospitals to seek treatment.
Beneficiaries who are enrolled in the scheme can avail healthcare services in any RSBY empanelled hospitals across the country by swiping their smart cards. Verification is done through a fingerprint scan.
The scheme provides beneficiaries with a cover of up to Rs.30,000 for hospitalisation expenses per family. An additional Rs.30,000 is provided to a family if one of the dependents is a senior citizen.
The RSBY scheme covers pre-existing illnesses and provides coverage for over 1,800 medical treatments including surgeries.
The scheme also provides the beneficiaries with coverage for transportation to the maximum amount of Rs.1,000. The amount spent on transportation is reimbursed to the beneficiary upon discharge from the hospital.
Packages also include the cost for pre-hospitalisation and post-hospitalisation for up to 5 days after discharge.
Procedure to Avail the Services:
All hospitals empanelled with the scheme have an RSBY desk where the beneficiary should verify their identity. If diagnosed with any ailments covered by the scheme, the corresponding packages are chosen. In instances where the treatment is not present among the packages offered under the scheme, the line of treatment to be followed is decided after consultation with the insurance provider about pricing.
Once treatment is completed, the smart card is swiped at the hospital and the cost of the treatment is deducted from the card. The hospital also verifies the beneficiary’s identity through means of a fingerprint scan.
The hospital is required to send an electronic copy of the hospitalisation claim along with the patient data to the insurance company. The same is forwarded by the insurance provider to the concerned government official. On verification, the cost of the treatment is reimbursed to the hospital in one month’s time.
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I taken a health insurance from STAR HEALTH on last 6 months back which was taken via online. It covers my whole family of 3 members for the total amount of 5. The premium amount need to pay of 12K. The tenure period of 1 year. I have not used this card much. I haven't done any claim yet.
I have taken a health insurance policy from Bajaj Allianz which was taken for my mother. Policy coverage value was Rs. 1L and the premium its a one time payment, i got a offer because i am maintain CREDIT SCORE good. Still there is a no claim and i paid 3 years back, during renewal time i am not getting any calls from insurance company. This policy covers 200 hospital 30-50% in all hospital can get a claim.
My personal need I taken health insurance from RELIGARE on 2 years back. Actually my previous company taken health insurance got lapse, hence for better option I continued with same need to pay the premium of 5K. It covers up to myself. The coverage amount of 5L, since there is no claim yet I got bonus of 10% so as of now 5.5L. They tied up with many hospitals and cash less treatment is applicable.
This is an individual policy, cover fro myself and this is from Max Bupa. Yearly i am paying premium of Rs. 3000 and the coverage value of Rs. 5L and still there is a no claim. Every year i am getting 5% no claim bonus and this is a life long policy. Its a tax benefit plan for major and listed hospitals can avail a cash less, if non listed have to pay then we can reimburse.
My employer has given me a health insurance policy from ROYAL SUNDARAM and they have provided me a coverage amount of Rs. 3L. It covers myself and my spouse are covered in this policy.The premium amount need to pay of 7.5K on yearly basis. They have a cashless facility with many hospital.
I have taken health insurance from STAR HEALTH on last year for my personal use, it covers my whole family of 4 members. The sum average value is 5L. I am renewing the policy by paying the premium amount of 14K on yearly. Many hospitals are tied with them and they provide cashless treatment as well.
For my personal purpose, I have taken a health insurance from TATA AIG on 3 years back. On yearly, I use to renew the policy which I need to pay the premium amount of 20K via online. It covers up to myself. The sum assured amount is 2.4L. They tied up with limited hospitals only and there is no cashless treatment.
My company provides me a health policy from ORIENTAL insurance and this is a group insurance. Annual premium i am paying Rs. 4840 and still there is no claim and the coverage value is Rs. 2 lakhs. During the renewal time, i use to get reminder call from the support team.
I am paying about Rs. 20k yearly for health insurance to PARAMOUNT. This is group policy and the coverage of Rs. 10L since 5 years i am using this health insurance. I went for a claim which was reimbursed. The main factor is they are asking lots of documents which they need to make it simple.
I have received the Bajaj Allianz mediclaim policy from Bajaj Finserv on EMI basis. Cashless facility is available and am paying Rs.640 for a month. This policy is not available in the market. I wish if their executive were more polite and helpful. Its a self policy which covers 5L. Am renewing this policy from last 3years.
Health insurance policy which i have taken from STAR HEALTH and this is a family floater policy. I am using since 4 years still there is no claim and this insurance will cover all types of critical illness. Annually i am paying premium Rs. 13000 and its a Tax benefit policy.
ICICI offered me a health insurance and this is a group policy which covered for Rs. 4L. This insurance will cover all types of critical illness and day care treatment, still there is no claim with ICICI Lombard. I can avail cashless treatment with the listed hospitals.
From United India Insurance, i have taken a health insurance. This is a group insurance and i am paying premium per annum Rs. 4900. This policy covers all critical illness and there is a no age criteria, I can use this policy for life long. It covers Tax benefit under sec 80D also network of hospitals are good.
This is a group health policy which was taken through TATA AIG and the coverage value of Rs. 3L. I am paying premium yearly Rs. 6000. Its been one year and still there is no claim and this policy covers day care treatment and this can be used till life long.
From Apollo Munich, i have taken a health insurance and this is a joint policy. The policy coverage value is Rs. 5L for a life long. I am paying the premium yearly Rs. 16k and still there is no claim on this policy. It covers all network of hospitals.
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From my company side, they have provided me a health insurance from TATA AIG. I can do a cashless treatment facility in a network hospital hence i have fixed the appointment also. This policy covers only for myself. They have given me a coverage value of Rs. 3 lakhs. I don't have any claim experience till now.
I love the way they communicate everything. Inclusions and exclusions were explained in a right way to help me choose right product at right pricing. i got a healthcare for my whole family without burning a hole in my pocket. recommended to all
My friend has suggested to apply health insurance, so for my personal need I had taken a health insurance from STAR HEALTH on 10 months before. They tied up with many hospitals and it covers all city. There is cash less treatment and the policy includes 4 family members, need to pay the premium amount of 12K on yearly basis.
My health insurance policy is running with Aditya Birla Health Insurance. This is a family floater policy and i am paying premium around Rs. 14k yearly. Still there is no claim and this insurance covers all network of hospitals. This policy has some TAX benefits.