Status Check, Procedures, Facilities

Organization : Department of Health & Family Welfare, West Bengal
Facility : Rashtriya Swasthya Bima Yojona

Home Page :http://www.rsbywb.gov.in/home/about_rsby

Rashtriya Swasthya Bima Yojona :

RSBY has been launched by Ministry of Labour and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families.

Related : ESI MB Scheme West Bengal : www.statusin.in/10153.html

The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalisation. Beneficiaries under RSBY are entitled to hospitalisation coverage up to Rs. 30,000/- for most of the diseases that require hospitalisation. 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

Genesis of RSBY :
In the past Government have tried to provide a health insurance cover to selected beneficiaries either at the State level or National level. However, most of these schemes were not able to achieve their intended objectives. Often there were issues with either the design and/ or implementation of these schemes.

Health Insurance for the Poor :
For people living below poverty line, an illness not only represents a permanent threat to their income earning capacity, in many cases it could result in the family falling into a debt trap.

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.

How it works- :
RSBY involves a set of complex and inter-related activities. These activities are shown in the form of a flow chart. The broad sets of activities are given as follows :

Financing for RSBY :
RSBY is a Government sponsored scheme for the BPL population of India. The majority of the financing, about 75 percent, is provided by the Government of India (GOI),

Enrollment of Beneficiaries :
An electronic list of eligible BPL households is provided to the insurer using a pre-specified data format. An enrollment schedule for each village, along with dates, is prepared by the insurance company with the help of the district level officials.