Rashtriya Swasthya Bima Yojana - Health Insurance for Poor

The Rashtriya Swasthya Bima Yojana provides a health insurance cover to individuals or families who are below the poverty line and workers belonging to unorganised sectors. The scheme offers a sum insured of Rs.30,000 on a floater basis.

The Rashtriya Swasthya Bima Yojana (RSBY) was introduced in 2008 by the Ministry of Labour and Employment, with the aim of providing health insurance coverage to individuals/ families that belong to the BPL (Below Poverty Line) category. Currently, this scheme also provides health insurance cover to workers belonging to unorganized categories such as construction and building workers who are registered under Welfare Boards, Street Vendors, Licensed Porters (railway), Beedi workers, MNREGA workers, Sanitation workers, Domestic workers, Mine workers, Rag pickers, Rickshaw pullers and Taxi/ Auto drivers.

Aim of the RSBY Scheme:

The Rashtriya Swasthya Bima Yojana (RSBY) aims to provide health insurance coverage to individuals/families that belong to the BPL (Below Poverty Line) category and workers belonging to unorganized work categories. The premium is paid out by the Government of India as well as the concerned State Government. With this scheme, eligible individuals can avail health care from private hospitals and government hospitals of their choice, , and so on. The main objectives of this scheme are:

  • Helping the BPL households and workers belonging to the uncategorized sectors to avail protection against medical expenses in the event of a health risk.
  • To provide the eligible individuals ease of access to better health care facilities with affordable hospitalization expenses.

Features and Benefits of RSBY:

Insurance Coverage:

This scheme offers a sum assured/ cover of up to Rs. 30,000 on a floater basis for a family consisting of 5 members. This health insurance scheme also provides a cover for transportation charges of Rs. 100 per visit to the hospital, up to a maximum of Rs. 1000.

Benefits to the Beneficiary:

The Rashtriya Swasthya Bima Yojana (RSBY) empowers the beneficiary, i.e., the BPL households and workers in the uncategorized sectors, to choose health care options from private hospitals and public hospitals. The beneficiary will attract hospitals/ health care providers since significant revenue can be availed through the scheme for their treatment.

Incentives for Stakeholders:

This scheme has been built as a business model with incentives offered to every stakeholder in the scheme. This has been incorporated in order to ensure the sustainability of the scheme and for its expansion. The stakeholders in the Rashtriya Swasthya Bima Yojana would be the Government, Hospitals, Insurance Providers and Intermediaries.

  • Government – By offering health care facilities to Below Poverty Line Households and workers in uncategorized sectors at a maximum cost of Rs. 750 per family per annum, the Government can ensure healthy competition among the private sector and public sector health care providers. This will help to improve the long term functioning of the health care system in the country.
  • Hospitals – Hospital are paid in accordance to each beneficiary who avails its facilities. There is no additional procedure in screening a hospital and making payments to the same, under this scheme. Bill payments are done directly to the hospital, as required.
  • Insurance Provider – The insurance provider will receive a regular premium from the state government as well as the central government.
  • Intermediary – Intermediaries such as MFIs and NGOs are also included in the scheme so as to help in the assistance of BPL households. These intermediaries will receive payment from the Government for the services rendered.

Use of Information Technology:

This scheme utilizes information technology in order to bring this social sector scheme to the concerned individuals on a wider scale. Beneficiaries will receive a smart card which is biometric-enabled and it also contains the photo and fingerprint of the individual. This helps minimize any misuse or fraud from being carried out. The hospitals and health care providers that are empanelled under the Rashtriya Swasthya Bima Yojana are IT enabled and connected to a server at the district level. Data is stored methodically and this ensures smooth flow of data in relation to service utilization.

Secure Scheme:

This is a secured scheme since the use of information technology ensures that misuse or fraud is eliminated from the equation. The Rashtriya Swasthya Bima Yojana has an efficient management system that ensures that only the beneficiaries receive the card and is highly accountable for card issue and use as well.

Cashless Transactions:

This scheme provides the benefit of paperless and cashless transaction to its beneficiaries. At any authorized hospital, the beneficiary will receive cashless treatment as long as he/she has his/her smart card and provides fingerprint verification. This is a paperless scheme since insurance providers need not collect any documentation from the beneficiary, related to the treatment. Claims can be sent online and payment is made electronically.

All India Validity:

The beneficiary can use his/her smart card to avail benefits under this scheme in any part of India. The beneficiary may be enrolled under a particular district but the benefits can be availed from any hospital that is empanelled with this scheme, across India.

Monitoring and Evaluation:

The Rashtriya Swasthya Bima Yojana has incorporated an efficient system for monitoring and evaluating the transactions made by beneficiaries. Analytical reports are made periodically and information is provided to the government which is then reported publicly. Insurers can also use this information to disseminate data and reports.

Eligibility Criteria for Rashtriya Swasthya Bima Yojana:

Beneficiary Criteria The beneficiary should belong either to a BPL (Below Poverty Line) household; Or Should be workers belonging to unorganized categories such as construction and building workers who are registered under Welfare Boards, Street Vendors, Licensed Porters (railway), Beedi workers, MNREGA workers, Sanitation workers, Domestic workers, Mine workers, Rag pickers, Rickshaw pullers and Taxi/ Auto drivers.
Age Limit No age limit.
Number of family members covered A family unit of up to 5 members are covered under this scheme.

How to Enroll in the Rashtriya Swasthya Bima Yojana?

The eligible household members should report to the enrolment station and provide an identity proof of the head of the household to the authorities. An authorized government official should confirm the identity and eligibility of the BPL households or families that fall under the category of uncategorized workers. They will then have to pay Rs. 30 (per family) in order to enroll in the Rashtriya Swasthya Bima Yojana.

A list of eligible households is made by the concerned authorities and this is given to the insurance providers, who then make a schedule for each district and publicize the date and location for enrollment. Local centres will have mobile enrollment stations. The insurance provider will then collect biometric information and photos of the beneficiaries. Once the enrollment fee of Rs. 30 is paid by the beneficiary, the smart card is handed over to them instantly after the authorized government official authenticates the card.

This scheme is really beneficial to the households that are below poverty line since it protects them against financial expenses for hospitalization and medical treatments which they would not be able to afford otherwise. It brings equality of healthcare benefits to workers in uncategorized sectors, BPL families, etc. and provides them better social security.

Frequently Asked Questions (FAQs):

  1. How soon will the scheme be in effect once an eligible household enrolls for the scheme?

    The scheme will be in effect from the 1st of the next month. E.g. If a beneficiary enrolls in the month of January, the policy will be in effect from 1st February.

  2. Who has to pay the premium for this scheme?

    The premium for the Rashtriya Swasthya Bima Yojana will be paid out to the insurance provider by the State and Central Government together. Central Government pays 75% of the premium amount and State Government pays the balance amount. The exception are the North East states and Jammu & Kashmir, in which case the Central Government pays 90% of the insurance premium.

  3. When will I get my smart card?

    The smart card is handed over to the beneficiary at the time of enrollment.

  4. Should I pay the registration fee at the time of policy renewal?

    Yes, you need to pay Rs. 30 every year, i.e., each time the policy is renewed.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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