Understanding Rashtriya Swasthya Bima Yojana (RSBY)

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With a population of over 1.4 billion people, India faces significant healthcare disparities and financial barriers that hinder a majority of its population from receiving adequate healthcare. In this context, government-run health insurance schemes have emerged as essential tools for improving healthcare affordability, reducing out-of-pocket expenses, and extending coverage to marginalized communities. These schemes alleviate the burden of medical expenses, promote preventive care, enhance healthcare infrastructure, and contribute to the overall well-being of the nation.

Unfortunately, a majority of such schemes do not perform well and fail to reach their goals. Taking into consideration all these factors and finding solutions to the practical problems faced in the success of these health insurance schemes, the Central Government of India came up with the Rashtriya Swasthya Bima Yojana (RSBY) in 2008.

About Rashtriya Swasthya Bima Yojana (RSBY)

Rashtriya Swasthya Bima Yojana (RSBY) is a flagship social security program introduced by the Government of India. Launched in 2008, RSBY aims to provide affordable health insurance coverage to vulnerable and economically disadvantaged populations across the country. The scheme primarily targets workers in the unorganized sector and their families, who are often deprived of quality healthcare and face financial hardships in times of medical emergencies. With its comprehensive coverage and cashless hospitalization facilities, Rashtriya Swasthya Bima Yojana has been instrumental in bridging the healthcare gap and ensuring financial protection for millions of underprivileged individuals in India.

Eligibility Criteria for Rashtriya Swasthya Bima Yojana

The beneficiary should be a citizen of India.
The beneficiary should have a BPL card. The scheme aims to provide benefits to workers of the unorganized sector and their families who are classified as belonging below the poverty line (BPL). A family unit consisting of five individuals is eligible for the program.
Concerned official agencies are tasked with confirming the eligibility of the beneficiaries.
If the beneficiary wants to avail of the cashless benefit, they need to get the RSBY Smart card upon payment of Rs. 30.

Funding of the RSBY scheme

The Government of India contributes 75% of the estimated annual premium for RSBY scheme, which is Rs. 750, with a maximum limit of Rs. 565 per family per year. The Central Government covers the expenses of the smart card.

Respective State Governments contribute 25% of the annual premium and any additional premium required.

Beneficiaries are responsible for a registration/renewal fee of Rs. 30 per year.

Administrative and other associated costs of implementing the scheme are covered by the State Governments.

Rashtriya Swasthya Bima Yojana Benefits

State governments have a final say in deciding the inpatient facilities for the beneficiaries according to the needs of the population or geographical area. It is recommended that the State Governments must give a minimum of the following essential benefits:

Coverage for the unorganized sector worker and their family consisting of five members.
The total insured amount is Rs. 30,000/- per family annually, provided on a family floater basis.
Hospitalization expenses should cover the majority of common illnesses, minimizing exclusions.
Cashless medical treatment for all covered illnesses.
All pre-existing diseases should be included in the coverage.
Transportation costs for hospital visits are reimbursed based on actual expenses, with an upper limit of Rs. 100 per visit and a total limit of Rs. 1000.

How to Enroll in the Rashtriya Swasthya Bima Yojana (RSBY) Scheme?

Following are the steps involved in Rashtriya Swasthya Bima Yojana Registration:

Insurance companies receive an electronic record of BPL households that are eligible, following a specific data format.
In collaboration with district-level officials, insurance companies prepare a schedule for enrollment in each village, mentioning the dates.
According to this schedule, the list of BPL households is displayed at the enrollment center and popular locations within each village before the enrollment process begins. The location and date of the enrollment session are publicized in advance.
Enrollment stations are established in locations such as public schools within the town/village.
The insurer makes the necessary arrangements for computers and other equipment at these stations to obtain fingerprints for the biometric data and to take photographs of members covered under the scheme.
A printer is also made available at the center for printing smart cards that include a photo.
Upon payment of Rs. 30 and verification by a designated government officer, the beneficiary is issued the smart card. An informational pamphlet containing details about the scheme and a list of empanelled hospitals is given along with the smart card. This entire process is fast and is completed within 10 minutes.

Swasthya Bima Yojana Online Registration can also be done. For RSBY online registration, visit the official website www.rsby.gov.in

What is the Smart Card for Rashtriya Swasthya Bima Yojana (RSBY)?

Eligible families need to enrol in the scheme through the above-mentioned process to obtain a smart card under RSBY.

RSBY Smart cards are designed to store and retrieve beneficiary information electronically. These cards are equipped with a microchip or magnetic stripe that contains the individual’s identification and health insurance details. The card is swiped or inserted into a card reader at healthcare facilities to authenticate the policyholder and facilitate cashless transactions. The photograph on the smart card is utilized for identification purposes if the biometric data fails to load, due to a technical glitch.

Service Delivery

Insurance companies furnish the hospital list, including both private and public facilities, for the purpose of enrolment. The Rashtriya Swasthya Bima Yojana helpline number is provided along with the smart card to enquire about Rashtriya Swasthya Bima Yojana Card Status, Rashtriya Swasthya Bima Yojana Card Validity Check, or any other assistance. The insurance company assesses and approves private and public hospitals based on specific qualifying criteria. Beneficiaries have the choice to select the hospital.

When utilizing the cashless service, patients are not required to personally cover any expenses for treatment, including hospitalization. Instead, the hospital has the responsibility to claim reimbursement from the insurance agency.

Overall, service delivery in RSBY aims to ensure that eligible beneficiaries have access to good healthcare services without facing financial burdens. The scheme leverages technology, such as biometric identification and cashless transactions, to streamline the process and improve the overall healthcare experience for beneficiaries.

Unique Features of Rashtriya Swasthya Bima Yojana (RSBY)

Though many government health insurance services have been started in the past for the economically weak population, RSBY differs from the rest on account of its unique features:

Cashless benefits: Under RSBY, beneficiaries were entitled to cashless benefits at empanelled hospitals. This means that they did not have to pay for their hospitalization expenses while availing treatment. Instead, the expenses were settled between the hospital and the insurance provider.
Choice of public or private hospitals: RSBY grants the BPL household participating in the program the autonomy to choose either private or public hospitals, transforming them into valuable clients who hospitals actively seek to serve, due to the substantial revenue opportunities presented by the scheme.
Smart card-based system: RSBY utilizes a smart card-based system to manage health insurance coverage. Beneficiaries are issued smart cards that have their biometric details, personal information, and health insurance details. This card is presented at empanelled hospitals to avail of cashless benefits. Use of a biometric system ensures that the right person is getting the benefits.
Portability: One of the best features of RSBY was its portability across locations. The scheme allowed beneficiaries to avail of the insurance benefits across the country. If a beneficiary moved to a different district or state, they could still use their smart card to access healthcare services.
Coverage for the whole family: RSBY provides health insurance coverage not just to the beneficiary, but also to the entire family. The scheme covers not only the head of the household but also dependent family members, including the spouse and children.
Coverage of pre-existing conditions: RSBY did not exclude pre-existing conditions from the health insurance coverage. Beneficiaries receive treatment for pre-existing illnesses, subject to the terms and conditions of the RSBY Scheme.
Premium subsidy: The premium for RSBY was shared between the central and state governments. BPL households were required to pay a nominal registration fee, while the remaining premium amount was subsidized by the government.
Beneficial for insurance agencies: The insurance agency receives a payment for every household that signs up for RSBY, hence, it is incentivized to register as many households as it can from the BPL roster. Increased efforts by the insurer make it possible for the scheme to reach out to many beneficiaries.
Conveyance cost covered: Transportation expenses amounting to a max of Rs. 100 per visit are included with an overall cap of Rs. 1000.
Good business opportunity for hospitals: The hospital is motivated to offer treatment to a significant number of individuals, as it receives payment for each person treated. Government hospitals are interested in treating a large number of beneficiaries under the RSBY program, as they directly receive funds from the insurance agency for utilization. Furthermore, this fosters healthy competition between public and private healthcare providers, consequently enhancing the performance of public healthcare providers.
Reduces the risk of malpractices: Insurers actively oversee participating hospitals to avoid unnecessary medical procedures or fraudulent activities that lead to excessive insurance claims.
Excellent business model: The business model aims to incorporate all stakeholders in a social sector scheme by providing incentives tailored to each party involved. This design promotes the growth and long-term viability of the scheme, benefiting both its expansion and sustainability.
Inclusion of intermediaries: The involvement of NGOs and MFIs, who have a significant interest in supporting households below the poverty line (BPL), is also incorporated in the scheme. These intermediaries receive compensation for their services.

Conclusion

In conclusion, the Rashtriya Swasthya Bima Yojana (RSBY) has emerged as a transformative healthcare initiative in India, aimed at providing financial protection and access to high-quality medical care services for the vulnerable sections of society. Since its launch, RSBY has made significant strides in reducing the burden of healthcare expenses on marginalized communities, ensuring that they receive timely medical attention and treatment.

Within 5 years of inception, by March 25, 2013, 34,285,737 RSBY Smart Cards were issued and 5,097,128 hospitalization cases were covered under the scheme. By leveraging technology and innovative approaches, RSBY has managed to streamline the delivery of healthcare services, improving efficiency and transparency. The extensive coverage provided by the scheme, which covers hospital costs, pre-existing conditions, and transportation benefits, has been crucial in preserving the health of millions of beneficiaries. Furthermore, RSBY’s integration with public and private healthcare providers has expanded the reach and availability of quality healthcare services across the country.

Overall, the Rashtriya Swasthya Bima Yojana stands as a beacon of hope, highlighting the potential of inclusive healthcare schemes to uplift vulnerable members of society and pave the way towards a healthy and equitable India.

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