Articles from General Knowledge Today

Rashtriya Swasthya Bima Yojana

2012-01-31 05:01:00 Suresh Soni
Rashtriya Swasthya Bima Yojana (RSBY) is a centrally
sponsored health insurance scheme started in 2008 by
Ministry of Labour and Employment, Government of
India to provide health insurance coverage for Below
Poverty Line (BPL) families.
The majority of the financing, about 75 percent, is
provided by the Government of India (GOI), while
the remainder is paid by the respective state
government.
Government of India's contribution is 90 percent
in case of North-eastern states and Jammu and Kashmir and respective
state Governments need to pay only 10% of the premium.
Objectives
The objective of RSBY is to provide protection to BPL households from
financial liabilities arising out of health shocks that involve hospitalization.
Features
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.
Provides the participating BPL household with freedom of choice between
public and private hospitals and can avail any hospitalization facility.
Every BPL family holding a yellow ration card can pay INR 30 as registration
fee to get a biometric-enabled smart card containing their fingerprints and
photographs.
A beneficiary of RSBY gets cashless benefit in any of the empanelled
hospitals. He/ she only needs to carry his/ her smart card and provide
verification through his/ her finger print.
A beneficiary who has been enrolled in a particular district can use his/ her
smart card in any RSBY empanelled hospital across India.
The beneficiary is also paid by the hospital Rs. 100 as transportation expense
at the time of the discharge. However, total transportation assistance cannot
exceed Rs. 1000/- per year and it is part of Rs. 30,000/- coverage. No proof is
required to be submitted by the beneficiary to get the transportation
assistance.
Recent updates on RSBY:
In the Union Budget for 2012-13, the government made a total allocation of `
1096.7 crore towards RSBY. Although meant to cover the entire BPL
population, (about 37.2 per cent of the total Indian population according to the
Tendulkar committee estimates) it had enrolled only around 10 per cent of the
Indian population by 2011.
At present, there are 39 government-sponsored schemes including Rashtriya
Swasthya Bima Yojana (RSBY) but they are not so effective when it comes to
the basics. And like many other government schemes, there are overlaps in
these schemes, are without any clear mandate, and there's hardly any
awareness among the beneficiaries.
Apart from the ignorance issue, some of these hospitalization schemes can't
be used at all, given that many villages do not even have hospitals. Most
villages have only primary health centers where people take medicines to treat
an ailment instead of getting hospitalized, which explains the fewer number of
claims.
In 2012, it came to light that over 16,000 uterus surgical operations had been
conducted on women from BPL families in private hospitals in Bihar,
Chhattisgarh and some other states. The operations were allegedly
conducted to fleece insurance funds available under the government's
Rashtriya Swasthya Bima Yojna (RSBY). Thus, weak monitoring and action
against ill practices has paralysed the scheme up to large extent in remote
and rural areas.