Tuesday, 22 April 2014 08:24





Rashtriya Swasthya Bima Yojana has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of the scheme is to protect these families from shocks related to catastrophic expenditures on health by improving access to health and reducing out of pocket expenditure.

Main Features of RSBY:

• It is a Smart Card based cashless and paperless social health insurance scheme.

• Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization.

• Transportation expenses up to Rs. 1,000 per year are provided in cash for travelling to the hospital.

• 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 by the State Government on the basis of a competitive bidding.

• The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enroll as many households as possible from the BPL list. This will result in better coverage of targeted beneficiaries.

• The programme is already covers street vendors, beedi workers, domestic workers, building and other construction workers and MGNREGA workers who have worked more than 15 days during the previous year.

• Now GOI has decided to extend the Rashtriya Swasthya Bima Yojana (RSBY) scheme to taxi drivers, rickshaw pullers and rag pickers along with mine and sanitation workers.

• A key management system has been evolved by National Informatics Centre to ensure that the smart cards are fully secure. There would be no scope of cards being duplicated or being misused. The smart card also envisages use of biometrics (finger print verification).

In view of the numbers and the fund involved, there are business opportunities for all the key players, like Insurance Companies, Hospitals, Smart Card Service Providers and the Intermediaries. Thus RSBY operates on a business model. On an average, around Rs.50 million is being pumped in each district every year.

The State Governments are required to select one or more health insurance service providers on a periodic basis according to a tender process which would take account of both the price of the insurance package and technical merit of the proposal. The tender is open to both public and private insurers who meet the standards fixed by Insurance Regulatory Development Authority (IRDA).

The selected insurance company has to have back to back arrangement with:

a) Health service providers

b) Smart card service providers

c) Intermediaries

Only such health service providers are empanelled by the insurance company as are able to meet the predefined criteria. The hospitals have also to agree to a predetermined package of medical and surgical procedures and the costs thereof to obviate subjectivity. No preauthorization is required in case of predetermined packages. Majority of the ailments falls within these packages. However, in case the ailment does not fall in such packages, the procedure for preauthorization has been prescribed.


Last Updated on Wednesday, 23 April 2014 07:13