The Government of India in collaboration with the state governments has rolled out Rashtriya Swasthya Bima Yojna for providing health benefits to the Below Poverty Line (BPL) families on 1st April 2008 throughout the country. The scheme entails providing cashless treatment up to Rs. 30000/- to a BPL family per annum. Under this scheme, the definition of BPL family is a unit of five members which includes head of the family, spouse and three dependents. As per the scheme provisions, each enrolled BPL family is issued a smart card entitling the family to avail treatment from empanelled public as well as private hospitals. The scheme is being implemented through the duly selected Insurance Companies. The scheme is being funded on the sharing basis between centre and the states in the ratio of 75:25. A BPL family has to pay only Rs. Thirty towards registration fee. (www.rsby.gov.in for detail provisions)
Main features:
- Smart card based health insurance cover of Rs. 30,000/- per family (a unit of five) per annum on a family floater basis.
- All pre-existing diseases to be covered.
- Hospitalization expenses, taking care of most of the illnesses, including maternity benefits.
- Transport cost of Rs. 100/- per visit with an overall limit of Rs. 1,000/- per annum.
- The use of smart card, makes the scheme truly cashless and providing portability to facilitate use by migrant labour.
- Issue of smart card to the beneficiary on the spot in the village itself.
- Provision for issue of split cards enabling migrant worker to carry one card alongwith him/her to his/her work place.
- Use of Information Technology (IT) applications for the poorest of the poor.
- Using both public and private service providers for delivering a wide package of series.
- Seeking contribution by way of registration fee, from the BPL beneficiary with a view to inculcating a sense of ownership in them.
- Allowing registration of BPL family members irrespective of their age.
Funding pattern:
Under this scheme, the contribution of Government of India is 75% of the premium payable. Additionally, the cost of smart card, estimated at Rs.60 is borne by the Central Government. The remaining 25% will be borne by the State Government. Rs. 30 is being paid by the beneficiary as registration fee per annum and this is retained by the state Nodal Agencies to administer the scheme.
Enrolment procedure:
After procuring BPL data from the district authorities, data is provided through GoI web site to the insurance company selected through competitive bidding. The company prepares enrolment plan in consultation with district authorities and enrolls the listed BPL families at village level enrolment camps as per plan. At enrolment stations, Photograph and finger print of each of five members of a listed BPL household gets captured through enrolment kit consisted of a laptop, printer, thumb reader and a camera and smartcard gets printed then and there at enrolment site and handed over to the family by collecting registration fee of Rs. 30/- per card. A prior hand publicity is carried out by the company as well as district functionaries to reach out to the BPL families for enrolment.
Usage of services:
A beneficiary (card holders) can avail free indoor treatment by producing his card to an empanelled hospital, anywhere in the state or the country. Almost all illness has been packaged and rates have been fixed and agreed by the Company as well as the hospitals.