Rashtriya Swasthya Bima Yojana (RSBY)

Overview

Rastriya Swasthya Bima YojanaRashtriya Swasthya Bima Yojana (RSBY) has been launched to provide health insurance coverage for Below Poverty Line (BPL) families in Gujarat. The objective of RSBY is to provide protection to households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/‐ for most of the diseases that require hospitalization. Government has even fixed the package rates for the hospitals for a large number of interventions. Pre‐existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family which includes the head of household, spouse and up to three dependents. Beneficiaries need to pay only Rs. 30/‐ as registration fee while Central and State Government pays the premium to the insurer selected on the basis of a competitive bidding.

Every beneficiary family is issued a biometric enabled smart card containing their fingerprints and photographs. All the hospitals empanelled under RSBY are IT enabled and the IT platform is used for authentication, verification and for creating transactions at the grass root level. This ensures a smooth data flow regarding service utilization periodically. The beneficiary of RSBY gets cashless benefit in any of the empanelled hospitals. He/ she only need to carry his/ her smart card and provide verification through his/ her fingerprint. Health Service Providers send online claims to the insurer and get paid electronically.

In Gujarat, Department of Health and Family Welfare is implementing the RSBY scheme since 2008.In the year 2013-14, the RSBY policy has been extended to Western Railway Porters and MGNREGA Workers (worked for atleast 15 days in previous year), in addition to the eligible BPL families of Urban & Rural areas and Building & other Construction Workers.

Objective

Recognizing the diversity with regard to public health infrastructure, socio-economics conditions and the administrative network, the health insurance scheme aims to facilitate launching of health insurance projects in all the districts of the States in a phased manner for BPL workers. The definition of BPL is the one prescribed by the Planning Commission.

Salient Features of The Scheme

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.

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.
  • The beneficiaries will be issued smart cards for the purpose of identification.

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 are advised to incorporate at least the following minimum benefits in the package / scheme:

  • The unorganized sector worker and his family (unit of five) will be covered.Total sum insured would beRs.30,000/- per family per annum on a family floater basis.
  • Cashless attendance to all covered ailments.
  • Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible.
  • All preexisting diseases to be covered.
  • Transportation costs (actual with maximum limit of Rs.100 per visit) within an overall limit ofRs.1000.

Selection of Insurance Provider

The selection of the health insurance provider shall be done by the state/implementing agency through tendering process inviting both Public and Private Insurers for better terms of reference. The State Government would formulate the projects and determine the implementing agency such as Insurance Trust/ Insurance Cell/ Mother NGO etc. to monitor/supervise the scheme and integrate with insurance company. This would be further monitored at State and Central level.

Release of Funds

On the approval of the project, the State Government will, from time to time, intimate the Central Government about the payment of the premium to the Insurance Company. The Central Government, on receipt of this information, shall release its share of premium.

You Can also Refer

Website Link

Important Document and Guideline Related this Scheme

Tenders and Related Documents

Presentation

Go to Navigation