RASHTRIYA SWASTHYA BIMA YOJANA

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RASHTRIYA SWASTHYA BIMA YOJANA
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INDIAcomposition of workforce
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CHARACTERSTICS OF UNORGANIZED SECTOR WORK FORCE

• Poor
• Self-Employed
• Employers not identifiable
• Illiterate
• Migratory
• Lack of skills

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WHY HEALTH INSURANCE?

• Lack of financial capability amongst the poor
• Inadequate Health infrastructure

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RSBY Goals

• Major insecurity for unorganized workers
  relates to
• Inability to deal with medical emergencies
  without facing a financial crisis
• Heavy expenditure on medical care and
  hospitalization
• Recourse to adequate and competent treatment

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SWASTHYA BIMA YOJANABenefits

• Total sum insured of Rs 30,000 per BPL family on
  a family floater basis
• Pre-existing diseases to be covered
• Coverage of health services related to
  hospitalization and services of surgical nature
  which can be provided on a day-care basis
• Cashless coverage of all eligible health
  services.
• Provision of Smart Card.
• Provision of pre and post hospitalization
  expenses.
• Transport allowance _at_ Rs.100 per visit upto
  maximum of Rs 1000

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IMPLEMENTATION OF THE SCHEME

• Identification of Insurance agency
• BPL data base
• Enrollment of Beneficiaries and Delivery of Smart
  Card to commence
• Empanelment of Government and private
  institutions
• Payment of insurance premium to the insurance
  service provider.
• Delivery of health services

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QUALIFICATION OF INSURANCE COMPANY

• Registered with IRDA
• Should have full-fledged establishment with
  experience in conceptualizing, designing and
  implementing large health care schemes
• Atleast one year experience in catering Health
  Insurance of 50,000 families or more under one
  group insurance policy in 2005-06 or 2006-07

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WHO CAN PROVIDE HEALTH SERVICES?

• Both public, including ESI, and private health
  providers could offer services
• The service providers should possess specified
  basic facilities, like-
• Atleast 10 inpatient medical beds
• Medical Surgical facilities alongwith
• Diagonistic facilities i.e. Pathological
  test,
• X-Ray, ECG, etc.

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FUNDING

• Contribution by GOI 75 of the estimated annual
  premium of Rs 750, subject to a maximum of Rs.
  565 per family.
• Contribution by the State Governments 25 of the
  annual premium and any additional premium beyond
  Rs 750.
• Beneficiary to pay Rs. 30 per annum as
  Registration Fee/ Renewal Fee
• Administrative cost to be borne by the State
  Government will come from Rs 30 received from
  beneficiary
• Cost of Smart Card to be borne by the Central
  Government. An additional amount of Rs.60 per
  beneficiary would be available for this purpose.

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SMART CARD
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Enrolment
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Smart Card Registration Process
RSBY CARD
RSBY CARD
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Key Management System

• Cryptographic keys for encryption of Data
• Provided by Government National Informatics
  Center
• To prevent generation issuance of fake cards
• To implement Address PKI
• On Smart Card Transactions
• On Network Data exchange
• To ensure security authenticity of Data

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How To Use Card
Go To Hospital
Patient
Go To Doctor
Shows Card
Advise Hospitalization
After Treatment Again Thumb Impression is
Taken and updated in System
RSBY COUNTER
Verifies Thumb Impression Check Limit and issue
Slip
Process Card
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Process Overview
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Progress so far

• Scheme being implemented in 6 districts viz.
  Bilaspur, Bastar ( including Narayanpur), Durg,
  Raipur, Rajnandgoan and Sarguja .
• Smart Card Enrollment has commenced in Durg and
  Rajnandgoan , scheduled in Sarguja from 16th July
  and in Bilaspur around 20th . July
• Tenders floated for remaining districts
• Nodal Agency being set up
• Process for identification of Insurance agency
  completed. Oriental Insurance company has been
  selected for implementation in First phase 6
  districts

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..let us make it work