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.

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:

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.

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.

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.

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.

Yes, in case of smart cards issued from 1st April 2009, maternity benefits are covered.

All expenses related to the delivery of the baby in the hospital are covered and hospital will be reimbursed by the insurer.

Both normal and caesarean deliveries are covered under RSBY. A hospital will be paid Rs. 2500 for normal and 4500 for caesarean delivery.

A new-born is covered under RSBY since birth automatically for the remaining period of the health insurance policy.

Yes. Even if the new-born is sixth member, he/she will 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.

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.

There is no proof required to claim transportation charge benefits

The beneficiary will be paid transportation charge 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.

Food only for the person who is hospitalized is covered in the package rate.

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.

The policy is on a family floater basis. Therefore, total cover is Rs. 30,000 for a family and not for an individual.

Floater basis means that total amount can be used by one person or jointly with other members of the family.

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.