- 1 Rashtriya Swashtya Bima Yojana Insurance Coverage
- 2 Benefits to the Beneficiary
- 3 Eligibility Criteria to Enroll in the Rashtriya Swasthya Bima Yojana Scheme
- 4 Claim Settlement Procedure
- 5 Portability of Smart Card
- 6 Financing for Rashtriya Swashtya Bima Yojana
- 7 Utilisation of Services by Beneficiaries
- 8 Monitoring and Evaluation
- 9 FAQs
Rashtriya Swasthya Bima Yojana is a helpful government made and financed health insurance scheme which promises to provide protection to all the families that fall in the list of Below Pthe overty Line (BPL) category. One have to pay certain amount of premium which makes them eligible to enjoy all the mentioned and promised benefits of the scheme. Also, there is absolutely no maximum age to enroll yourself to be protected under this scheme.
Rashtriya Swashtya Bima Yojana Insurance Coverage
The approximate promised amount value ranges up to Rs. 30,000 on a family floater type which can provide up to 5 members of the BPL household. This medical insurance scheme also offers a coverage for all sort of transportation charges which is ranges between Rs. 100 to Rs. 1000 as per a single visit to the hospital. The scheme comes into action once your plan completes one month being enrolled.
Benefits to the Beneficiary
Rashtriya Swasthya Bima Yojana is an extremely beneficial health insurance scheme. Listed below are the features and benefits of the policy that you must be aware of:-
- Easy Access to Healthcare Facilities – Rashtriya Swasthya Bima Yojana is exclusively made for the group of people who stand in the list of Below Poverty Line Zone in India. This is done because usually it seen that people of this category do not get the proper treatment amenities needed in their hard times and this becomes the biggest reason of their deaths. So, to make sure they too receive all the benefits of treatment as all the other groups do, this scheme comes into picture.
- Affordable Premium – The amount of premium is very less than expected for the Rashtriya Swasthya Bima Yojana. People who catches up with all the basic eligibility list mentioned can enjoy all benefits offered along with the policy and to make this happen, you just have to pay a registration fee of Rs. 30. The rest of the premium amount which is approximately Rs. 750 is taken care of the Central Government and the respective state governments.
- No Limit on Maximum Entry Age – This plan is not like all the other regular health insurance plans, here in the Rashtriya Swasthya Bima Yojana have no limit on the maximum age of entry to register. This clearly means that anyone and everyone who is eligible can enroll under the scheme any time of their age.
- Option to Choose – The policy owners of RSBY are all able to register in any of the empanelled hospitals of for the required treatment. It is not necessarily needed to avail of treatment at a public hospital.
- Technology and Security Enabled – As RSBY Health Insurance Scheme uses powerful monitoring and analysis process with IT professionals and applications which stores all the important information in the smart card. The cards have information about the policy owner in the biometric format just to make sure quick data exchange as they are connected to the servers at the local level. With the help of a high-tech security system, it becomes very easy to keep track.
- Beneficial For All The Stakeholders – RSBY is made in such a manner that not only the beneficiary and his/her family benefit from it, but the stakeholders benefit from it too. The stakeholders are eligible to receive incentives which includes MFIs and NGOs.
Eligibility Criteria to Enroll in the Rashtriya Swasthya Bima Yojana Scheme
The eligibility criteria to avail the health benefits of the Rashtriya Swasthya Bima Yojana Scheme are mentioned below:-
1. The individual willing to enroll in the scheme should be working in an unorganized organization that should be a part of the BPL household.
2. Individuals who are enrolled under the welfare boards are also eligible to enter this scheme.
3. There is no maximum age limit to enroll in the RSBY scheme.
4. All the members of a family, irrespective of their age can avail this policy’s benefits.
Claim Settlement Procedure
Once the individual is admitted and the treatment process is done for the patient, the network hospital will share the pateint’s report electronically to the Third Party Administrator, generally called the TPA desk or the policy provider.
The TPA or the insurance provider will then verify and cross-check all the information mentioned in the records and accordingly make the payments to the hospital within a certain mentioned and promised time frame.
Portability of Smart Card
After the policy is Being issued to the beneficiary, the individual will get a smart health card that can be used to avail health care services in any of the enlisted hospitals who are registered with RSBY all over India. All the network hospitals falling under this scheme provides the benefit of cashless hospitalization to the insured members.
Financing for Rashtriya Swashtya Bima Yojana
The Rashtriya Swashtya Bima Yojana Scheme is a funded by the Government of India and is made especially for the people standing in BPL zone of India. Major funding is made by the Government of India which is approximately 75%, and the percentage which is left is added by the respective state governments. In the North-eastern states and in Jammu and Kashmir, there around 90% of the contribution done by the Government of India and the remaining 10% is paid by the respective state Governments to fullfill the insurance premiums. And the policy owner have to pay the registration fees of Rs. 20 only. And this amount can be used for the administrative expenditure that might occur under the scheme.
Utilisation of Services by Beneficiaries
The dealing process begins when the policy owner visits the impanelled hospital. Once the policy owner reaches the TPA help desk at the enlisted hospital, individual’s identity will be cross checked with his smart card, biometrics and a photograph. In the case of hospitalization, the executive at the TPA help desk will go through all the mentioned procedure for the specified package and simultaneously will also check the prices amount from the health insurance company.
After the policy owner leaves after the discharge from the hospital, his smart card will be again swiped and the biometrics will be checked and the pre-determined cost of the medical treatment will be taken from the smart card. The refundable amount provided by the insurance company includes the transportation charges ranging from Rs. 100 to the maximum limit of up to Rs. 1000. Each and every year approximately Rs. 30,000 is refundable. The highlight is one is not needed to provide any proof to avail of the transportation assistance.
Monitoring and Evaluation
All the information which is related to the hospital dealings is shared via phone line to the district server. The information is generated in the pre-made tables for the government and the insurance company respectively. This way the insurance company can transfer treatment amount to the particular hospital, can also track claims, and investigate in the case of any clumsyclaim patterns.
Q1. What is the process of Selection of the Health Insurance Provider?
Ans – A competitive public auction procedure is done by the state governments to elect a public or private insurance provider that will holds IRDA license to serve health insurance in India. Then the insurance company with the lowest financial auction is selected as the health insurance provider in the state or the set of districts. This financial auction is the annual premium for each and every enrolled household. The health insurance company have to agree with the coverage benefit that is made by the Government of India through cashless hospitalization by using smart cards. Only one insurance company is allowed to operate in one district. However, more than one insurance provider company can function in a particular state.
Q2. What is the process of preparation of the BPL Data?
Ans –Rashtriya Swashtya Bima Yojana collects figures from each state from the Union Planning Commission. RSBY offers insurance coverage to enroll BPL households from each district. The State Government have to make a list and submit the BPL data in a specific electronic format as given by the Government of India which includes all the basic details of the family members such as their names, age, information of the head of the family members, relationship with the head of the household. For the implementation the Below Poverty Line data should be prepared in a special format for the scheme.
Q3. How is the Enrollment of Beneficiaries Done?
Ans –The health insurance company recieves an electronic list of all the eligible, Below the Poverty Line Individuals in a pre-specified data format. The insurance company creates an enrollment schedule with dates for each village (based on the data and with the help of the district officials). This list is then circulated in each village at the prominent enrollment centres.
The insurance company then collects the biometric information based on the fingerprints and photographs of the BPL families. The policy owner only have to pay Rs. 30 as fees and they are provided with the smart card and an information booklet that contains all the details of RSBY enlisted network hospitals. A Field Key Officer or a government officer and a representative from the insurance company representative should be present to authenticate the legitimacy of the enrolment. A combined list is then sent to the state nodal agency.
The BPL household list is prepared centrally and the amount of funds that it transferred by the Central Government and the State Government depends directly on this list.
Q4. How is the Empanelment of Health Insurance Companies Done?
Ans – After the selection of insurance company is done, the network hospitals should be also be added along with it. The health insurance company should ensure that there are large number of network hospitals in the district that offers them to avail the treatment in the nearest hospital. The listed network hospitals should have a separate Rashtriya Swashtya Bima Yojana (RSBY) or a TPA desk with a trained members or executives. The hospital list can be made by including both the private and public hospitals that are volunteering to be a part of such a noble cause. The health insurance company should also make the list of RSBY network hospitals avail to the policy members at the time of enrollment.