Organization : Ministry of Health and Family Welfare (MoHFW)
Service Name : National Health Insurance Schemes
Website : http://www.nhp.gov.in/national-health-insurance-schemes_pg
National Health Insurance Schemes:
1.Rashtiya Swasthiya Bima Yojana (RSBY):
** RSBY ( Rashtriya Swasthiya Bima Yojana) has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families.
Related :
RSBY Smart Card Status Online : www.statusin.in/8447.html
** The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization.
** Government has even fixed the 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. Coverage extends to five members of the family which includes the head of household, spouse and up to three dependents.
** Beneficiaries need to pay only Rs. 30/- as registration fee while Central and State Government pays the premium to the insurer selected by the State Government on the basis of a competitive bidding.
Unique Features of RSBY:
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– RSBY provides the participating BPL household with freedom of choice between public and private hospitals and makes him a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme.
** Business Model for all Stakeholders– The scheme has been designed as a business model for a social sector scheme with incentives built for each stakeholder. This business model design is conducive both in terms of expansion of the scheme as well as for its long run sustainability
** Insurers– The insurer is paid premium for each household enrolled for RSBY. Therefore, the insurer has the motivation to enroll as many households as possible from the BPL list. This will result in better coverage of targeted beneficiaries.
** Hospitals– A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per beneficiary treated.
** Even public hospitals have the incentive to treat beneficiaries under RSBY as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes.
** Insurers, in contrast, will monitor participating hospitals in order to prevent unnecessary procedures or fraud resulting in excessive claims.
Read more:- http://www.rsby.gov.in/
2.Employment State Insurance Scheme (ESIS):
Employees’ State Insurance Scheme of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependants covered under the scheme.
Coverage:
Applicability:
** The Act is applicable to non-seasonal factories employing 10 or more persons.
** The Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatres, road-motor transport undertakings and newspaper establishments employing 20* or more persons.
** The Scheme has been extended to Private Medical and Educational institutions employing 20 or more persons in certain States/UTs.
*Note: 14 State Govts. / UTs have reduced the threshold limit for coverage of shops and ther establishments from 20 to 10 or more persons. Remaining State Governments/UTs are in the process of reducing the same. The existing wage limit for coverage under the Act is Rs. 15,000/- per month ( w.e.f. 01/05/2010)
Areas covered:
The ESI Scheme is being implemented area-wise by stages. The Scheme has already been implemented in different areas in the following States/Union Territories of Indian Union.
States :- All the States except Manipur, Sikkim, Arunachal Pradesh and Mizoram.
Union territories :- Delhi and Chandigarh
Read more :- https://www.esic.nic.in/
3.Central Government Health Scheme (CGHS):
The “Central Government Health Scheme” (CGHS) provides comprehensive health care facilities for the Central Govt. employees and pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954, Central Govt.
The main components of the Scheme are:
** The dispensary services including domiciliary care
** F. W. & M.C.H. Services
** Specialists consultation facilities both at dispensary, polyclinic and hospital
** level including X-Ray, ECG and Laboratory Examinations.
** Hospitalization
** Organization for the purchase, storage, distribution and supply of medicines and other requirements
** Health Education to beneficiaries
Read more :- http://msotransparent.nic.in/cghsnew/index.asp