About The Rashtriya Swasthya Bima Yojana
Unorganized sector workers make up about 93% of the country’s total workforce.The government has implemented some social security measures for some professional groups but the coverage is very low, Most workers are still without any social security coverage. Major insecurity for workers in the unorganized sector is the occurrence of frequent illnesses and for this the need for medical care and hospitalization is necessary for such workers and their family members. Despite the expansion of health facilities, the disease is one of the most common causes of deprivation in India.
It is clearly recognized that health insurance is a way to protect poor families against the risk of health expenses. The poor people are unable or unwilling to take out health insurance because of its cost, or lack of perceived benefits. It is also difficult to organize and manage health insurance, especially in rural areas. Recognizing the need to provide social security to these workers, the central government has launched the State Health Insurance Scheme (RSBY).
As of March 25, 2013, 34,265,738 smart cards and 5,096,127 hospital admissions have been made in this project.
Objectives Of The Scheme
- The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization
- Ensuring the Health Protection Insurance of the Unorganised workers community of the Country
Features of Rashtriya Swasthya Bima Yojana
Rashtriya Swasthya Bima Yojana is a beneficial health insurance product. Following are the features of the policy that you must know:
1. Easy Access to Healthcare Facilities
Rashtriya Swasthya Bima Yojana is specially designed for people who fall in the Below Poverty Line category in India. As they do not usually get the required treatment in case of accidental injuries or treatments, therefore the policy does its bit by eliminating such situations to a great extent.
2. Affordable Premium
The premium for Rashtriya Swasthya Bima Yojana is very less. Any person who meets the eligibility criteria can avail of the policy benefits by paying a registration fee of Rs 30. The Central Government and the respective state governments pay the rest of the amount i.e. Rs 750 jointly.
3. No Limit on Maximum Entry Age
Unlike regular health insurance plans, there is no limit on maximum entry age to apply for Rashtriya Swasthya Bima Yojana. This means an eligible can enroll under the policy no matter what his/her age is.
4. Option to Choose
The policyholders of RSBY can avail of the required treatment in any impaneled hospital of their choice. It is not mandatory to avail of treatment at a public hospital
5. Technology and Security Enabled
As RSBY health insurance scheme uses robust monitoring and evaluation with IT-enabled applications and chips on the smart card. The cards have biometric information of the policyholders and ensure quick data exchange as they are connected to the servers at the local level. With the help of a high-security system, it is easy to keep track and report on a frequent basis.
6. Beneficial For All Stakeholders
RSBY is designed in such a manner that not only the beneficiary and his/her family benefit from it, but the stakeholders benefit from it too. The stakeholders receive incentives, including MFIs and NGOs.
Eligibility
- Unorganized sector workers belonging to BPL category and their family members (a family unit of five) shall be the beneficiaries under the scheme.
- It will be the responsibility of the implementing agencies to verify the eligibility of the unorganized sector workers and his family members who are proposed to be benefited under the scheme.
Benefits
The beneficiary shall be eligible for such in-patient health care insurance benefits as would be designed by the respective State Governments based on the requirement of the people/ geographical area. However, the State Governments has advised incorporating at least the following minimum benefits in the package/scheme:
- The unroganised sector worker and his family (unit of five) will be covered.
- Total sum insured would be Rs 30,000/- per family per annum on a family floater basis.
- The beneficiaries will be issued smart cards for the purpose of identification.
- Cashless attendance to all covered ailments
- Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible
- All pre-existing diseases to be covered
- Transportation costs (actual with maximum limit of Rs 100 per visit) within an overall limit of Rs 1000
Funding Pattern
- Contribution by Government of India: 75% of the estimated annual premium of Rs 750, subject to a maximum of Rs 565 per family per annum. The cost of smart card will be borne by the Central Government.
- Contribution by respective State Governments: 25% of the annual premium, as well as any additional premium.
- The beneficiary would pay Rs 30 per annum as registration/renewal fee.
- The administrative and other related cost of administering the scheme would be borne by the respective State Governments
SMART CARD
A smart card is used for a variety of activities like identification of the beneficiary through photographs and fingerprints, information regarding the patient. The most important function of the smart card is that it enables cashless transactions at the impaneled hospital and the portability of benefits across the country. The authenticated smart card shall be handed over to the beneficiary at the enrollment station itself. The photograph of the head of the family on the smart card can be used for identification purposes in case biometric information fails.
Beneficiaries are issued a biometric-enabled smart card for identification purposes. The smart card has the following uses:
- Identification of beneficiaries through photograph and fingerprints
- Information related to the patient
- Enables cashless transactions at empanelled hospitals
- Ensures portability of benefits of the scheme across empanelled hospitals anywhere in the country
- In case the biometric information fails to authenticate, the photograph of the head of the family is used for identification purposes
- Ensures that the scheme is safe and tamper-proof as only the beneficiary can use the smartcard
- Provides accountability for the scheme
- The smart card can be split in the case of migrant workers so that each can carry a share of the coverage with them separately
The smart card is provided to the beneficiary at the enrolment station as soon as the application process is completed and
Inclusions under the RSBY
The following expenses are covered under the RSBY:
- Pre-hospitalisation: Any diagnostic tests done up to one day before hospitalisation
- Post-hospitalisation: Expenses related to the surgery or illness will be covered for up to 5 days after the date of discharge
- Hospitalisation: The following are covered:
- Anesthetist’s fee
- Anaesthesia
- Bed charges (General Ward)
- Blood
- Boarding Charges
- Consultation fee
- Doctor visits
- Expenses related to the use of Surgical Appliances
- Food for the patient
- Implants
- Medicines
- Nursing
- OT Charges
- Oxygen
- Prosthetic Devices
- Surgeons charges
- X-Ray and Diagnostic Test
- Daycare treatments: Ear surgery,Dental surgery required due to an accident, Eye surgery,Genital surgery,Contracture release of a tissue,Gastrointestinal surgeries,Hydro surgery,Haemo-dialysis surgery,LithotripsyThroat surgery
- Maternity benefits: Natural childbirth, Cesarean, and any complications before either are covered. A claim of up to Rs.4,500 for Cesarean and up to Rs.2,500 for natural delivery can be made by the policyholder.
- Medical termination of pregnancy: Costs will be covered if the procedure is required to save the mother’s life or if caused due to an accident
- Newborns: Even if the number of beneficiaries has been exceeded in the family unit, newborns are automatically added as a beneficiary. This will be valid till the policy ends. After that, the baby will continue to be a beneficiary only if chosen by the policyholder at the time of renewal of the policy.
Exclusions
The following are the expenses not included in the scheme:
- AYUSH treatments
- Congenital external diseases
- Vitamins or tonics unless prescribed as treatment by a certified medical practitioner
- Dental treatments that are cosmetic or corrective in nature
- Fertility, sub-fertility or assisted conception procedures
- HIV/AIDS
- Hormone replacement therapy
- Illnesses arising out of substance abuse
- Physical changes for resembling the opposite sex
- Plastic or cosmetic surgery unless required due to accidents or as a part of a disease
- Suicide
- Vaccinations
- War
- Treatments availed at a convalescent home/hospital or nature care clinic
- Maternity: Voluntary termination of pregnancy, prenatal expenses, and hospitalization after 48 hours of delivery or related operations
Enrolment Process
The RSBY has a very simple and streamlined process for enrolment which is as follows:
- The insurer is provided with an electronic list of eligible BPL households
- The insurance company prepares an enrolment schedule along with dates with the help of the officials at the district level
- The location and date of the enrolment is publicized
- The BPL list is put up at the enrolment station, which is usually the public schools in the village
- Each enrolment station is equipped with the required machinery to collect biometric information, photographs, and printouts
- When the fee of Rs30 has been paid by the beneficiary, the smart card (in a plastic cover for protection) and an information booklet with the names of the empaneled hospitals, details of the scheme, and the helpline number is handed over to the beneficiary
- The smart card is authenticated by a government official on the spot
Hospital List and Addresses
CHECK HOSPITAL NAME UNDER RSBY (STATE&DISTRICT WISE)