Rashtriya Swasthya Bima Yojana scheme details and Benefits

 

Approximately 93% of the entire workforce is made up of workers in the unorganised sector. For some industries, the government has introduced social security provisions, although overall coverage is minimal. Most people in the workforce are still not covered by Social Security. The frequent illness of workers and their families, as well as the subsequent need for medical treatment and hospitalization, is a major source of anxiety for those who earn their living in the informal economy. Although medical care has improved, their illness is still a major contributor to poverty in India.

Health insurance is widely acknowledged as a technique of shielding low-income families from health risks that exacerbate poverty by way of out-of-pocket costs. The high cost of coverage and unsatisfactory coverage options discourage low-income persons from purchasing health insurance. It is notoriously difficult to get and implement health insurance in rural areas. The government of India has instituted Rashtriya Swasthya Bima Yojana to give health insurance to its citizens.

Publication of the National Health Insurance Program

The government has made previous attempts to provide health insurance coverage to designated individuals, both on the state and federal levels. However, most of these plans fell short of their goals. Typically, there were problems with the plans' conception or execution.

Because of this context, the Government of India has devised a health insurance programme that not only makes up for the shortfalls of its predecessors, but also serves as a model for the rest of the world to follow. Best practises in health insurance were analysed critically, with insights drawn from the goals and blunders of current and historical schemes. RSBY developed after taking all of these factors into account and studying other health insurance models that have been successful in similar contexts around the world. The initiative launched on April 1, 2008.

RSBY Scheme

The Government of India's Ministry of Labor and Employment has initiated the Rashtriya Swasthya Bima Yojana (RSBY) to ensure that families living below the poverty line have access to affordable health care. The purpose of the RSBY is to safeguard BPL families from the economic consequences of unforeseen medical emergencies.

Eligibility

Benefits will be provided to BPL workers in the unorganised sector and their families (up to a maximum of five people per family).

Verifying the eligibility of workers in the unorganised sector and their family members who are proposed to get benefits under the scheme will be the responsibility of the implementing agencies.

For identification purposes, beneficiaries will be given smartcards.

 

 

Beneficiaries will be eligible for the said internal health care insurance benefits which will be prepared by the respective State Governments based on the need of the people/geographical area. Whereas, the State Governments have been advised to include the following minimum benefits in the package/scheme:

• Workers in the unorganised sector and their families (unit of five) will be covered.

• The total sum assured will be Rs.30,000/- per family per annum on family floater basis.

• Cashless attendance for all covered ailments.

• Some evictions are possible, including hospital expenses, care for all common ailments.

• All pre-existing diseases should be included.

• Transport cost (actual with a maximum of Rs.100 per visit) plus an overall limit of Rs.1000.

Funding pattern

• Contribution by the Government of India: 75 percent of the estimated annual premium of Rs.750, subject to a maximum of Rs.565 per family per year. The cost of the smart card will be borne by the central government.

• Contribution by the respective State Governments: 25% of the annual premium plus any other additional premium.

• The beneficiary will be paid Rs.30 as annual registration/renewal fee.

• The administrative and other related costs for implementing the scheme will be borne by the respective State Governments.

Enrolment Process

The insurer will be given an electronic list of eligible BPL families using a pre-specified data format. The insurance company with the help of district level officers will prepare an enrolment schedule for each village. As per the schedule, before enrolment, the list of families living below poverty line of each village will be put up at the enrolment station and prominent places and the date and place of enrolment in the village will be publicised in advance. Mobile enrolment stations are built in local centres in each village (e.g. public schools).

At these stations, the insurer to obtain the biometric information (fingerprints) of the family members involved and hardware required to take photographs and print smart cards with photographs provides a printer. After payment of thirty rupees by the beneficiary and after attestation of smart card by the concerned officer an information pamphlet containing the details of the scheme and the list of hospitals along with the smart card is given to them. This process usually takes less than 10 minutes. The card is given in a plastic cover.

Smart card

 

Smart cards are used in many activities, such as picture of the patient and identification of the beneficiary through fingerprinting. The most important function of the smart card is that it enables cashless transactions in the enrolled hospitals and these benefits can be availed anywhere across the country. The authenticated smart cards will be handed over to the beneficiary at the enrolment station itself. The photograph of the head of the household on the smart card can be used for identification purpose, in case the biometric information fails.

 

Service delivery

A list of hospitals (both public and private) (External website that opens in a new window) will be provided at the time of enrolment. A help line number will also be given along with the smart card. Based on the qualifying criteria, both public and private hospitals will be empanelled by the insurance company. The beneficiary will have the option to visit the hospital as per his wish.

The hospital will not have to make any payment for the treatment up to Rs.30000/-.

In case of cashless service, no amount will have to be spent for the treatment and hospitalisation of the patient. It is the responsibility of the hospital to claim the same from the insurer.

Highlights of RSBY

The RSBY scheme is not the first attempt by the Government of India to provide health insurance to low-income workers. Whereas the RSBY scheme differs from these schemes in several important ways.

• Empowerment of the beneficiary

• Business model for all stakeholders

• Safe and error free

• Portability

• Cashless and paperless transactions

• Robust monitoring and evaluation

Central Grievance and Grievance Redressal System

The Central and Grievance Redressal System (External website that opens in a new window) (CGRS) ensures that complaints relating to RSBY are resolved using ICTs, which automatically monitor and track the status. All the stakeholders can make online complaint(External website that opens in a new window) about the scheme. Online tracking of complaints is also available. Users can view the detailed information regarding CGRS Manual - PDF file that opens in new window.