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The Government of India is taking strong interest to provide social security and healthcare assurance for which various steps are been taken.
For instance, Central Government started Unorganized Workers Social Security Act (2008) to provide social security and welfare for the unorganized workers. It was initiated to mitigate risks due to disability, medical emergencies, maternity and old age that unorganized workers may suffer from.
Ministry of Labour and Employment, Government of India, has introduced Rashtriya Swasthya Bima Yojana (RSBY), a Health Insurance Scheme. RSBY was launched in 2008 and is meant for all the families living below poverty line. The objective of RSBY is to cut down the medical expenditure on health which they have to shell out of their pocket. Moreover, this has helped to create awareness while increasing the access to health care.
RSBY has been expanded to cover other defined categories of unorganised workers.
Choice of Hospital – RSBY offers freedom of choice between public and private hospitals to the below poverty line family participating in RSBY.
Safe and Secure – It is for the first time that IT applications are being used for social sector scheme on such a large scale. RSBY scheme issues with biometric enabled smart card with insured’s fingerprints and photographs. All the registered hospitals under RSBY are IT enabled with the facility to use biometric enabled smart card and connected to the server at the district level. This makes this scheme safe and secure from fraud claims.
The key management system of RSBY make sure that the smart card reaches to the right insured person. It is also, responsible for accountability in terms of issuance of the smart card and its usage. The biometric ensures that only the real beneficiary can use the smart card.
Backed by Network of Hospital – The smart card provided under RSBY can be used in any RSBY empaneled hospital across India. It makes RSBY scheme, a truly unique and highly beneficial scheme for the below poverty line family, especially, to the poor families that migrate from one place to the other because of work. RSBY smart card is not restricted to the district under which the card was issued. RSBY smart cards can be used across the network of empaneled hospital in India. Moreover, also provides the split for migrant workers to carry a share of the coverage with them separately.
Cashless Claim Settlement – Because of the smart card provided to the insured under RSBY, one doesn’t have to worry about money or reimbursement. One can avail cashless benefit in any of the authorised hospitals. But to avail cashless benefit, the beneficiary needs to carry and show the smart card, which is then verified through the help of finger prints.
Paperless – No paper work is involved. The participating network hospital does not need to collect all the papers or documents manually. It is send to the insurer online. The payment of expenses is done electronically by the insurer.
RSBY has two fold objectives:
To provide financial protection against catastrophic health costs by reducing out the financial burden
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 .
Registration Fee: The registration fee to be paid is only Rs.30 year while Central and State Government pays the premium as per their sharing ratio to the insurer. The insurer is selected by the State Government on the basis of a competitive bidding.
Registration Process: The State Government sets up a State Nodal Agency (SNA). The SNA is responsible for implementing, monitoring supervision and part-financing of the RSBY scheme. The SNA is also responsible for coordinating with insurance company, hospitals, district authorities, and other local stake holders.
There are many hospitals registered under the Rashtriya Swasthya Bima Yojana. To access this list of hospitals, kindly visit rsby.gov.in the official website of the scheme.
There are several enrolment centres set up across the country so that people can easily sign up for RSBY. In order to enrol, an individual must present proof of being the head of the household and other members must provide detailed information that identifies them as part of the household. The charge for a cumulative family to register/renew for Rashtriya Swasthya Bima Yojana is merely Rs. 30, and is collected to ensure the smooth processing of enrolment of the family. Once registered, each family member gets a SMART Card for them to prove that they are part of this scheme.
Every enrolment centre has a list of families in the local area who qualify to enrol in the scheme. This ensures that the right person in each household becomes eligible to be a part of the scheme, thereby simplifying the process of enrolment and registration.
Eligibility of Rashtriya Swasthya Bima Yojana
To be eligible for availing the health benefits by the Rashtriya Swasthya Bima Yojana, an individual will have to first meet these standards,
According To The Official Website, Following Is The Process Of Claim Settlement Of RSBY:
After rendering the service to the patient, the hospitals need to send an electronic report to the insurer/ Third Party Administrator (TPA). The Insurer/ TPA after going through the records information will make the payment to the hospital within a specified time period which has been agreed between the Insurer and the hospital.
Document Required To Process The Claim RSBY
In order to claim the health benefits offered by the Rashtriya Swasth Bima Yojana, all you need to do is present the Smart Card issued to you at the time of enrolment.
Rashtriya Swasthya Bima Yojana (RSBY) Scheme is based on strong pillars of cost-effective health care plan, freedom of choice of hospitals – private and public, smart card facility, network of hospitals across the country, cashless claim service, family floater plan, and so on. This truly makes RSBY one of the unique health care system laid down by Government of India.
What Is SMART CARD?
Smart card is a card provided on enrolment that holds vital records stored into co-ordinated circuits. It is used for a variety of activities like identification of the beneficiary through photograph and fingerprints, information regarding the patient etc.
Who Has To Pay The Premium For RSBY scheme?
The head of the household has to pay the premium for this scheme.
When Will I Get My Smart Card?
Once your enrolment and registration process under RSBY is successfully completed, you shall receive your Smart Card.
What Is Meant RSBY?
RSBY is the short form or abbreviation for Rashtriya Swasth Bima Yojana which is a government run health scheme for poor people in India.
What Is The Funding Pattern?
The Funding pattern of the Scheme, as per the official website, is as follows: