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Medical Procedures

What is this concept of hospitalization?
Hospitalisation means admission to hospital for 24 hours or more. RSBY applies to such hospitalization. However, it includes such day care treatments entailing less than 24 hours as are listed out.
What is meant by day care surgeries?
Day care surgeries are the procedures which require a surgical intervention but patient need not be admitted to hospital after the surgery. A list of day care surgeries is provided below:
Parenteral Chemotherapy
Eye Surgery
Lithotripsy (kidney stone removal)
Dental surgery following an accident
Surgery of Hydrocele
Surgery of Prostrate
Few Gastrointestinal Surgery
Genital Surgery
Surgery of Nose
Surgery of Throat
Surgery of Ear
Surgery of Urinary System
Treatment of fractures/dislocation (excluding hair line fracture), Contracture releases and minor reconstructive procedures of limbs which otherwise require hospitalisation
Laparoscopic therapeutic surgeries that can be done in day care
Identified surgeries under General Anesthesia
Any disease/procedure mutually agreed upon.
Are pre-existing diseases covered under RSBY?
Any disease that was present at any time in the past (including any disease, which the insured person may not have been aware of) is treated as pre-existing. Pre-existing diseases are covered under RSBY from day one itself. There is no discrimination with respect to the pre-existing diseases.
What is not covered?
RSBY does not cover OPD expenses, or expenses in hospitals which do not lead to hospitalisation. Other Exclusions to RSBY can be seen by clicking here.
Is OPD Covered?
OPD is not covered in RSBY. Therefore, medicines and tests which are not related or do not lead to hospitalization need to be paid by the beneficiary.
How are day care surgeries different from hospitalization of less than 24 hours?
Hospitalisation can be for both medical and surgical procedures. Therefore, in all the surgical cases, whether there is a need for hospitalization or can be handled on a day care basis, are covered but medical procedures which need hospitalization for more than 24 hours are covered.
Are maternity benefits covered?
Yes, in case of smart cards issued from 1st April 2009, maternity benefits are covered.
What is covered under maternity expenses?
All expenses related to the delivery of the baby in the hospital are covered and hospital will be reimbursed by the insurer.
What all types of deliveries are covered?
Both normal and caesarean deliveries are covered under RSBY. A hospital will be paid Rs. 3500 for normal and 6900 for caesarean delivery.
Is there any provision to take care of the new-born?
A new-born is covered under RSBY since birth automatically for the remaining period of the health insurance policy.
If there are five members already covered in a family under RSBY, will the new-born be covered?
Yes. Even if the new-born is sixth member, he/she will be covered.
For how long will the new-born be covered?
The new-born will be covered for the remaining RSBY policy period. However at the time of renewal of the policy, the household will have to take a decision whether to include the new born for the following year.
Is there any provision for payment of transportation charges?
Transportation charges are covered in RSBY. For every case of hospitalisation, beneficiary is paid Rs. 100/- per hospitalization as the transportation charge subject to a maximum of Rs. 1000/- during the policy period.
Is there any proof, like ticket etc. required to claim transportation charges?
There is no proof required to claim transportation charge benefits
When will the beneficiary get the transportation charge, at the time of hospitalisation or discharge?
The beneficiary will be paid transportation charge at the time of discharge.
Who will give this Rs. 100/- at the time of discharge?
The hospital which has provided the treatment will give this Rs. 100/- at the time of discharge to the beneficiary.
Is the food for family members also covered?
Food only for the person who is hospitalized is covered in the package rate.
If there are less than five persons, will the coverage amount be reduced?
Coverage amount of Rs. 30,000 is on a floater basis. Therefore, the total amount will remain Rs. 30,000 even if the family consists of only one.
Will each person in the household who is covered with RSBY get coverage of Rs. 30,000 separately or it is total Rs. 30,000 for the family?
The policy is on a family floater basis. Therefore, total cover is Rs. 30,000 for a family and not for an individual.
Senior citizens (aged 60 years and above) within enrolled RSBY families will be eligible to get a separate financial cover of Rs. 30,000/- per senior citizen, per year. (valid from 1st April, 2016)
What is meant by on “floater basis”?
Floater basis means that total amount can be used by one person or jointly with other members of the family.
After the issuance of smart cards when will the benefits start accruing?
For the districts where smart cards have been issued in the first phase (Tendered in 2008) benefits will start accruing from the 1st of the month after the month in which the first set of cards was issued in a district. For the cards which are distributed after 1st April 2009, the policy will commence from the next month from which the 1st smart card is issued in the district. For all the subsequent issued smart cards, the policy start date will remain the same as in case of first smart card issued.





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