The Government of India launched the Rashtriya Swasthya Bima Yojana (RSBY) as a means of providing health insurance to workers in the unorganised sector who fall under the Below the Poverty Line (BPL). The government social security scheme was developed after the Unorganised Workers Social Security Act was passed in 2008.
According to the Act, the Central Government is required to provide social security schemes that would decrease the ill effects of the occupational hazards that most individuals in the unorganised sector are likely to face.
The scheme was launched in 2008 and was developed so as to cater to the health needs of the BPL section of society. However, the scheme has since widened the scope of its coverage to include individuals who earn their living from employment in the unorganized sector.
The cost of the premium for the scheme is borne by the Government of India and the State governments. Beneficiaries of the scheme are entitled to receive cashless treatment at hospitals empanelled with the scheme. These cashless services are based on predetermined package rates listed in the scheme.
As part of the government's mission of providing affordable health insurance to all citizens of the country, the RSBY was implemented in all states. One of these states is Nagaland where the scheme has been in effect since 2015.
The following are the features and benefits of the scheme:
All hospitals empanelled with the scheme have an RSBY desk where the beneficiary should verify their identity. If diagnosed with any ailments covered by the scheme, the corresponding packages are chosen. In instances where the treatment is not present among the packages offered under the scheme, the line of treatment to be followed is decided after consultation with the insurance provider about pricing.
Once treatment is completed, the smart card is swiped at the hospital and the cost of the treatment is deducted from the card. The hospital also verifies the beneficiary's identity through means of a fingerprint scan.
The hospital is required to send an electronic copy of the hospitalisation claim along with the patient data to the insurance company. The same is forwarded by the insurance provider to the concerned government official. On verification, the cost of the treatment is reimbursed to the hospital in one month's time.
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