Rashtriya Swastiya Bima Yojana - RSBY

All about RSBY Scheme , its benefits and its Statitics

1. Business environment RASHTRIYA SWASTIYA BIMA YOJANA

2. INTRODUCTION

3. Rashtriya Swasthya Bima Yojana Rashtriya Swasthya Bima Yojana (RSBY, literally "National Health Insurance Programme" is a government-run health insurance programme for the Indian poor. The scheme aims to provide health insurance coverage to the unrecognised sector workers belonging to the BPL category and their family members shall be beneficiaries under this scheme. It provides for cashless insurance for hospitalisation in public as well as private hospitals. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 36 million families have been enrolled as of February 2014. In the starting RSBY is a project under the Ministry of Labour and Employment . Now it is transferred to Ministry of Health and family welfare from April 1, 2015.

4. What is RSBY? Ministry of Labour and Employment, Government of India has launched a health insurance scheme for BPL families which is called Rashtriya Swasthya Bima Yojana (RSBY).

5. Who is eligible? The beneficiary is any Below Poverty Line (BPL) family, whose information is included in the district BPL list prepared by the State government. The eligible family needs to come to the enrolment station, and the identity of the household head needs to be confirmed by the authorized official.

6. What is the insurance coverage in RSBY? Rashtriya Swasthya Bima Yojana provides cover for hospitalization expenses upto Rs. 30,000/- for a family of five on a floater basis. Transportation charges are also covered upto a maximum of Rs. 1,000/- with Rs. 100/- per visit.

7. What is the premium for RSBY? The premium for RSBY is different in different set of districts. State Governments select insurance companies through open tendering process and technically qualified lowest bid is selected

8. Who pays the premium for RSBY? Government pays the premium for RSBY. Central Government pays 75% of the total premium (90% in case of Jammu & Kashmir and North east States) while State Government pays the remaining premium.

9. Will beneficiaries have to pay anything to get the policy? Beneficiaries need to pay Rs. 30 per family at the time of enrolment.

10. ABOUT RSBY Social Security and healthcare assurance for all has been the motto of Government of India, and it has taken various steps in this regard. One of the most important policy milestones is the Unorganized Workers Social Security Act (2008) enacted by the Central Government to provide for the social security and welfare of the unorganized workers. This act recommends that the Central Government provide social security schemes to mitigate risks due to disability, health shocks, maternity and old age which all unorganized workers get exposed to and are likely to suffer from. continued

11. In India more than two thirds of expenditure on health is through Out of Pocket (OOP) which is the most inefficient and least accountable way of spending on health. Supply side financing on health alone has not been found to be successful in reducing OOP expenditure on health substantially and therefore, to test the demand side financing approach, Government of India, decided to introduce Rashtriya Swasthya Bima Yojana (RSBY) a Health Insurance Scheme for the Below Poverty Line families with the objectives to reduce OOP expenditure on health and increase access to health care.

12. RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households , but has been expanded to cover other defined categories of unorganised workers, covering: Building and other construction workers registered with the Welfare Boards Licensed Railway Porters Street Vendors MNREGA workers who have worked for more than 15 days during the preceding financial year Beedi Workers Domestic Workers

13. Sanitation Workers Mine Workers Rickshaw pullers Rag pickers Auto/Taxi Driver continued

14. The premium cost for enrolled beneficiaries under the scheme is shared by Government of India and the State Governments. The program has the target to cover 70 million households by the end of the Twelfth Five Year Plan (2012-17). Its main service delivery model remained as demand financing, freedom of choice among accredited government and private hospitals, and cashless service reimbursable to provider on a pre-determined package rates on family floater basis, could become a strong pillar for the universal health care system laid down by Government of India

15. Since 1st April, 2015, the Scheme Rashtriya Swasthya Bima Yojana (RSBY) has been transferred to Ministry of Health & Family Welfare on “as is where is” basis. Ministry of Health & Family Welfare is administering and implementing the scheme through a decentralized implementation structure at the State level.

16. OBJECTIVE OF RSBY To provide financial protection against catastrophic health costs by reducing out. To improve access to quality health care for below poverty line households of pocket expenditure for hospitalization and other vulnerable groups in the unorganized sector.

17. DETAILS OF THE SCHEME The beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- per annum on family floater basis, for most of the diseases that require hospitalization. The benefit will be available under the defined diseases in the package list. The government has framed indicative package rates for the hospitals for a large number of interventions. Pre- existing conditions are covered from day one and there is no age limit. The coverage extends to maximum five members of the family which includes the head of household, spouse and up to three dependents. Additionally, transport expenses of Rs. 100/- per hospitalisation will also be paid to the beneficiary subject to a maximum of Rs. 1000/- per year per family. continued

18. The beneficiaries need to pay only Rs. 30/- as registration fee for a year while Central and State Government pays the premium as per their sharing ratio to the insurer selected by the State Government on the basis of a competitive bidding. At every state, the State Government sets up a State Nodal Agency (SNA) that is responsible for implementing, monitoring supervision and part-financing of the scheme by coordinating with Insurance Company, Hospital, District Authorities and other local stake holders.

19. FEATURES OF THE SCHEME The RSBY scheme is not the first attempt to provide health insurance to low income workers by the Government in India. The RSBY scheme, however, differs from these schemes in several important ways. Empowering the beneficiary Business Model for all Stakeholders Information Technology (IT) Intensive Safe and fool proof Portability Cash less and Paperless transactions Robust Monitoring and Evaluation

20. Who is the Beneficiary The beneficiary is any Below Poverty Line (BPL) family, whose information is included in the district BPL list prepared by the State government and the family falling into any of the above defined (point number 1) eleven categories are eligible. The eligible family needs to come to the enrolment station, and the identity of the household head needs to be confirmed by the authorized Government official.

21. HOW RSBY WORKS RSBY involves a set of complex and inter-related activities. The broad sets of activities are given as follows: Insurance agencies selection Hospital empanelment Preparation of Beneficiary data Enrolment process How Services are availed by the Beneficiary

22. Claim settlements Financing of the scheme Policy Extension

23. STATITICS OF RSBY

24. Enrolment of Beneficiaries     Number of Districts In Districts with Enrollment S.No.   State Selected Enrollment  Complete Enrollment in Progress Total BPL Families BPL Families  Enrolled Till Date 1 Assam 23 23 - 2371950 1421104 2 Bihar 38 38 - 13921372 7028409 3 Chhattisgarh 27 27 - 4869167 4146227 4 Gujarat 26 26 - 4653237 2691497 5 Himachal Pradesh 12 12 - 877763 480588 6 Karnataka 30 30 - 10031663 6206620 7 Kerala 14 14 - 2275554 2060802 8 Manipur 6 6 - 120237 70925 9 Meghalaya 11 11 - 479743 256138 10 Mizoram 8 8 - 243407 194886 11 Nagaland 11 - 11 518476 255314 12 Orissa 30 30 - 6158498 4462959 13 Tripura 8 8 - 768359 481331 14 Uttarakhand 13 13 - 728216 285229 15 West Bengal 21 21 - 11100347 6290446   Total 278 267 11 59117989 36332475 Rajasthan is only implementing the RSBY for Categories other than BPL, therefore only NREGA enrolments included in this data.

25. Empanelment of Health Care Providers   Source : www.rsby.gov.in

26. CONCLUSIONS & RECOMMENDATIONS State Governments feel that while the objective of the scheme is excellent , the implementation machinery is not up to the mark. Enrollment too slow – only 44% of eligible beneficiaries enrolled in first two years of implementation ( till April 2010 ). Enrollment being done by private agencies – no transparency or grievance redressal mechanisms. 37% of respondents had above five members in their family – whom to leave out ?

27. Only 25% aware of card validity period. At the time of enrollment they should explain everything properly. No Extra Travel cost provided. Average days taken to receive the smart card is 29 Days , it should be more fast and efficient in sending smart cards. More awareness should be done. Include more healthcare facilities. More counters and staff should be provided in Hospital. Extend the list of empaneled Hospitals. Improve and include more health facilities.

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