RASHTRIYA SWASTHYA BEEMA YOJANA

The workers in the unorganized sector constitute about 93% of the total work force in the country. The Government has been implementing some social security measures for certain occupational groups but the coverage is miniscule. Majority of the workers are still without any social security coverage. One of the major insecurities for workers in the unorganized sector is the frequent incidences of illness and need for medical care and hospitalization of such workers and their family members.

It has been clearly recognized that health insurance is one way of providing protection to poor households against the risk of health spending leading to poverty. The poor are unable or unwilling to take up health insurance because of its cost, or lack of perceived benefits. Organizing and administering health insurance, especially in rural areas, is also difficult. Recognizing the need for providing social security to these workers, the Central Government has introduced the Rashtriya Swasthya Bima Yojana (RSBY). Till March 25, 2013, the scheme had 34,285,737 Smart Cards and 5,097,128 hospitalization cases.

In the past, the Government had tried to provide a health insurance cover to selected beneficiaries either at the State level or National level. However, most of these schemes were not able to achieve their intended objectives. Often there were issues with either the design and/ or implementation of these schemes.

Keeping this background in mind, Government of India decided to design a health insurance scheme which not only avoids the pitfalls of the earlier schemes but goes a step beyond and provides a world class model. A critical review of the existing and earlier health insurance schemes was done with the objective of learning from their good practices as well as seeks lessons from the mistakes. After taking all this into account and also reviewing other successful models of health insurance in the world in similar settings, RSBY was designed. It has started rolling from 1st April 2008.

RSBY- THE SCHEME

RSBY 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 RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization.

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 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.
  • 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

Enrolment Process

An electronic list of eligible BPL households is provided to the insurer, using a pre-specified data format. An enrollment schedule for each village along with dates is prepared by the insurance company with the help of the district level officials. As per the schedule, the BPL list is posted in each village at enrollment station and prominent places prior to the enrollment and the date and location of the enrolment in the village is publicized in advance. Mobile enrollment stations are set up at local centres (e.g., public schools) in each village.

These stations are equipped by the insurer with the hardware required to collect biometric information (fingerprints) and photographs of the members of the household covered and a printer to print smart cards with a photo. The smart card, along with an information pamphlet, describing the scheme and the list of hospitals, is provided on the spot once the beneficiary has paid the 30 rupee fee and the concerned Government Officer has authenticated the smart card. The process normally takes less than ten minutes. The cards shall be handed over in a plastic cover.

SMART CARD

Smart card is used for a variety of activities like identification of the beneficiary through photograph and fingerprints, information regarding the patient. The most important function of the smart card is that it enables cashless transactions at the empanelled hospital and 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 purpose in case biometric information fails.

Service Delivery

list of the hospitals (both public and private)(External website that opens in a new window) will be provided at the time of enrollment. A helpline number will also be provided 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 choose hospitals where they want to go.

No payment for the treatment cost up to Rs. 30000/- would be paid to the hospital.

In case of Cashless service, the patient will not have to spend any amount for taking the treatment and hospitalization. It is the job of hospital to claim from the insurer.

RSBY Rashtriya Swasthya Beema Yojana

UNIQUE FEATURES OF RSBY

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

Central Complaints and Grievance Redressal CellCentral Complaint and Grievance Redressal System(External website that opens in a new window) (CGRS) ensures that the grievance relating to RSBY is disposed by the use of ICT which automatically tracks and pursues the status. All the stake holders can file an online complaint(External website that opens in a new window) about the Scheme. Online tracking facility of the complaint is also available. Users can refer the manual(External website that opens in a new window) for detailed information related to CGRS.

Insure your health and be at ease. Life of farmer depends on timely rain. Life of a Man on safety of his or her health

April is the first month in a financial year and good time to apply for Beema Yojana

April is a month of vibrant celebrations in India, marking the arrival of spring, the start of a new financial and academic year, and a time for new beginnings as we prepare to sow the seeds of success for the coming year.
April also brings with it a rich tapestry of cultural and religious festivals. Vaisakhi/Vishu/Meshadi, Vaisakhadi, Bahag Bihu associated with the harvest season are celebrated. Mahavir Jayanti, Good Friday, Easter Sunday, Jamat-Ul-Vida, Eid-ul-Fitr are also observed in this month.

Take advantage of Rashtriya Swasthya Beema Yojana at the earliest.

Schemes

Rashtriya Swasthya Bima Yojana (RSBY) is a government-run health insurance scheme for the Indian poor and unorganized sector workers who are not covered by any of the existing health insurance schemes. The scheme provides cashless insurance cover up to Rs. 30,000/- per annum on a family floater basis for hospitalization expenses in public as well as private hospitals. The scheme was launched by the Ministry of Labour and Employment in 2008 and has since been transferred to the Ministry of Health and Family Welfare.

Rashtriya Swasthya Bima Yojana (RSBY) is a government-run health insurance scheme for the Indian poor and unorganized sector workers who are not covered by any of the existing health insurance schemes. The scheme provides cashless insurance cover up to Rs. 30,000/- per annum on a family floater basis for hospitalization expenses in public as well as private hospitals. The scheme was launched by the Ministry of Labour and Employment in 2008 and has since been transferred to the Ministry of Health and Family Welfare.

Rashtriya Swasthya Bima Yojana (RSBY) is a government-run health insurance scheme for the Indian poor and unorganized sector workers who are not covered by any of the existing health insurance schemes. The scheme provides cashless insurance cover up to Rs. 30,000/- per annum on a family floater basis for hospitalization expenses in public as well as private hospitals. The scheme was launched by the Ministry of Labour and Employment in 2008 and has since been transferred to the Ministry of Health and Family Welfare.

ligibility Criteria :
** The beneficiary is any Below Poverty Line (BPL) family, whose information is included in the district BPL list prepared by the State government.
** The eligible family needs to come to the enrollment station, and the identity of the household head needs to be confirmed by the authorized official.

Age Limit :
** There is no age limit in RSBY and anybody can be enrolled if they are in the BPL list.

Insurance Coverage in RSBY :
** Rashtriya Swasthya Bima Yojana provides cover for hospitalization expenses upto Rs. 30,000/- for a family of five on a floater basis.

** Transportation charges are also covered upto a maximum of Rs. 1,000/- with Rs. 100/- per visit.

Premium for RSBY :
** The premium for RSBY is different in different set of districts.
** State Governments select insurance companies through open tendering process and technically qualified lowest bid is selected.

Purpose of smart card :
** Smart card is used for a variety of activities like identification of the beneficiary through photograph and fingerprints, information regarding the patient. The most important function of the smart card is that it enables cashless transactions at the empanelled hospital and portability of benefits across the country.

How to apply for RSBY Smart Card?

RSBY Smart Card Enrollment

** An electronic list of eligible BPL households is provided to the insurer, using a pre-specified data format.
** An enrollment schedule for each village along with dates is prepared by the insurance company with the help of the district level officials.

** As per the schedule, the BPL list is posted in each village at enrollment station and prominent places prior to the enrollment and the date and location of the enrolment in the village is publicized in advance.

** Mobile enrollment stations are set up at local centers (e.g., public schools) in each village.

** These stations are equipped by the insurer with the hardware required to collect biometric information (fingerprints) and photographs of the members of the household covered and a printer to print smart cards with a photo.

** The smart card, along with an information pamphlet, describing the scheme and the list of hospitals, is provided on the spot once the beneficiary has paid the 30 rupee fee and the concerned Government Officer has authenticated the smart card.

** The process normally takes less than ten minutes. The cards shall be handed over in a plastic cover.
** Each enrolment team in the villages is accompanied by a Field Key Officer (FKO) who identifies the beneficiaries at the time of enrollment.

** FKO is also provided with a smart card and his job is to identify the beneficiary and authenticate their smart card by his FKO card and finger print.
** Without FKO’s authentication the smart card with the beneficiary will not work.

** The detail of each family which is authenticated by the FKO also gets copied in the FKO card and insurance company is paid based on the number of beneficiaries obtained from the FKO card.

Time Period

For New Card :
** In case of new policy, the Scheme shall commence operation from the 1st of the succeeding month in which the smart card is issued.

** Thus, for example, if the initial smart cards are issued anytime during the month of April in a particular district the scheme will commence from 1st of May.

** The scheme will last for one year till 30th of April of next year.
** This would be the terminal date of the scheme in that particular district.

** However, in the same example, if the card is issued in the month of May, June and July then the insurance will immediately start from the next day itself for the beneficiaries and policy will be over on 30th April of next year.

** Thus, all cards issued in the district in May will also have the Policy start date as 1st of May (even if issued subsequent to the date) and terminal date as 30th April of the following year.

For Renewal :
** In the case of renewal, the policy will start from first of the next month in which the earlier policy will expire.

** Therefore, for example, if the earlier policy is getting over on 30th April and card is renewed in the month of April then the new policy will start only from the 1st May and will finish on 30th April of next year.

** However, in the same example, if the card is issued in the month of May, June and July then the insurance will immediately start from the next day itself for the beneficiaries and policy will be over on 30th April of next year.

Registration Fee :
** Beneficiaries need to pay Rs. 30 per family at the time of enrollment.

How to check RSBY application status?

Go to the above link click on the “Scheme Status” option to check RSBY Application Status.

State wise

Go to the official website,click on the “Scheme Status” tab in main menu, drop down list will be displayed,click on the “state wise” option.

Then Select your state in track box result will be displayed on the Screen.

Apna Samaaj

Our mission at Apna Samaaj is to connect underprivileged communities in India with the resources and opportunities they need to thrive. We aim to create a comprehensive platform that provides access to welfare schemes from government bodies and NGOs, as well as private organizations, helping to bridge the gap between those in need and those who can provide support. Through our efforts, we strive to empower individuals and communities, drive economic growth, and make a positive impact on society.