Nagaland Health Insurance Scheme

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 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 unorganised 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.

RSBY Nagaland:

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.

Features and Benefits:

The following are the features and benefits of the scheme:

  • The scheme provides health insurance coverage for individuals from BPL families. Those enrolled in the scheme have the option of choosing between private and public hospitals to seek treatment.
  • Beneficiaries who are enrolled in the scheme can avail healthcare services in any RSBY empanelled hospitals across the country by swiping their smart cards. Verification is done through a fingerprint scan.
  • The scheme provides beneficiaries with a cover of up to Rs.30,000 for hospitalisation expenses per family. An additional Rs.30,000 is provided to a family if one of the dependents is a senior citizen.
  • The RSBY scheme covers pre-existing illnesses and provides coverage for over 1,800 medical treatments including surgeries.
  • The scheme also provides the beneficiaries with coverage for transportation to the maximum amount of Rs.1,000. The amount spent on transportation is reimbursed to the beneficiary upon discharge from the hospital.
  • Packages also include the cost for pre-hospitalisation and post-hospitalisation for up to 5 days after discharge.

Procedure to Avail the Services:

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.

Claim Settlement:

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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