A BRIEF PAMPHLET DETAILING ON RASHTRIYA

SWASTHYA BIMA YOJANA

Submitted by:
Ankita Bal
Batch 2021-26, BBA LLB. Div. A
PRN: 21010224203

Symbiosis Law School, NOIDA

Symbiosis International (Deemed University), Pune

In
June 2022
 Rashtriya Swasthya Bima Yojana – An Introduction

Rashtriya Swasthya Bima Yojana is a government implemented healthcare

insurance scheme targeted at the workers of the unorganized sector belonging to
the below poverty line section which constitutes 93% of the workforce. It seeks to
provide access to healthcare in rural areas and providing social security to these
workers who cannot afford or do not wish to avail proper healthcare due to the
exorbitant cost of treatment and lack of understanding regarding the benefits of
such medical aid. It promotes and creates awareness about healthcare facilities
amongst the marginalized sections of the society and emphasizes government
accountability to its economically stunted population. The scheme was launched on
April 1, 2008 and was executed in working in 25 states. In February 2014, it saw
36 million families registered and enrolled for this programme. Initially, this
programme fell under the jurisdiction of Ministry of Labour and Employment but
it got transferred to Ministry of Health and Family Welfare on April 1, 2015.

As per protocol, every family falling under the below poverty line with a yellow
ration card is obligated to pay ₹30 (39¢ US) registration fee to get a biometric
updated smart card with their fingerprint and photograph details. This procedure
allows for cashless transactions at the responsible hospitals and allows for
portability of stipulated benefits. Under this programme, the registered families are
empowered to claim for inpatient medical care of up to ₹30,000 on an annual basis
in any of the hospitals falling in the list of hospitals provided at the time of
enrollment. In its later stages, the insurance coverage was raised to Rs. 1 lakh per
annum.

Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (PMJAY) has currently
taken over the operations of RSBY and provides an insurance cover of upto 5 lakhs
each to 10 crore families.1

1
https://en.wikipedia.org/wiki/Rashtriya_Swasthya_Bima_Yojana
Benefits of RSBY this scheme pay Rs. 30 as
provided that per registration/renewal fees
visit transportation
costs are limited to
The beneficiary shall be Rs. 100 and Rs.
eligible for such in-patient
Enrollment
1000 overall.
health care insurance Process
benefits as would be
designed by the respective
State Governments based
Funding Pattern
An electronic list of
on the requirement of the
eligible BPL households is
people/ geographical area.
provided to the insurer,
However, the State The Central Government is using a pre-specified data
Governments are advised obligated to contribute format. An enrollment
to incorporate at least the 75% of the estimated schedule for each village
following minimum annual premium of Rs. along with dates is
benefits in the package / 750, subject to a maximum prepared by the insurance
scheme: of 565 per family per company with the help of
annum. The cost of the the district level officials.
smart card is also to be As per the schedule, the
 The unorganized borne by the Central BPL list is posted in each
sector worker and Government.2 village at enrollment
their family of five station and prominent
are to be covered places prior to the
under this The respective State enrollment and the date
insurance scheme. Government must and location of the
 The insured amount contribute the remaining enrolment in the village is
provided under this 25% of the annual publicized in advance.
scheme would be premium as well as any Mobile enrollment stations
30,000 per annum additional premium. The are set up at local centres
given on a family costs relating to the (e.g., public schools) in
floater basis. administration of this each village.
 Cashless scheme is also to be borne
attendance to all by the responsible State These stations are
covered illnesses. Government. equipped by the insurer
 All pre-existing with the hardware required
diseases are to be to collect biometric
covered. However, the beneficiary information (fingerprints)
 Inclusion of themselves are liable to and photographs of the
hospitalization members of the household
expenses and 2 covered and a printer to
transportation fees https://www.india.gov.in/spotli print smart cards with a
under the ambit of ght/rashtriya-swasthya-bima- photo. The smart card,
yojana#rsby3
along with an information
pamphlet, describing the
scheme and the list of
hospitals, is provided on
the spot once the
beneficiary has paid the 30
rupee fee and the
concerned Government
Officer has authenticated
the smart card. The process
normally takes less than
ten minutes. The cards
shall be handed over in a
plastic cover.
Grievance
Redressal
Central Complaint and
Grievance Redressal
System (CGRS) ensures
that any grievance relating
to RSBY is disposed by
the use of ICT which
automatically tracks and
pursues the status of the
pending complaint. The
stakeholders can file an
online complaint as per
their discretion with
regards to the scheme.
Online tracking facility of
the complaint is also
available. Users are
requested to refer to the
provided manual for
detailed information
related to CGRS.
Government
allocation
In the Union Budget for
2012-13, the government
allocated in total an
amount of Rs. 1,096.7
crores towards RSBY.
Although it was meant to
cover the entire BPL
population (about 37.2% of
the total Indian population
according to the Tendulkar
committee estates) it had
enrolled only 10% of the
Indian population by
March 31, 2011. During
March 2012, a calculated
estimate for the budget
rolled out valuing the costs
for this programme to be
3,350 crores per year.
International
Interest & Big
Changes
The scheme won plaudits
from the World Bank, UN
and ILO as one of the
world’s best healthcare
insurance schemes.
Germany has shown
interest in adopting the
smart card based model for
revamping its own social
security system, the oldest
in the world, by replacing
its current, expensive,
system of voucher based
benefits for 2.5 million
children. The Indo-German
Social Security
Programme, created as part
of a co-operation pact
between the two countries
is guiding this
collaboration.
Glocal Healthcare
Systems, a company based
out of Kolkata and funded
by Tier I Capital Funds
like Sequoia Capital and
Elevar Equity has shown
an interest in aligning itself
with RSBY to create
modernize and elevate the
healthcare facilities in
semi-urban areas.
Shortcomings and
the hysterectomy
scam
As per reports dating back
to 2016, the state
government of Bihar
promised to compensate
702 women for unsolicited
hysterectomies which were
a result of unfair medical
practices. The medical
practitioners and doctors
empowered under this
scheme carried out
hysterectomy for minor
issues in relation to the
women’s uteruses in order
to pocket the insurance
payouts without properly
informing or educating the
insured women.
Hysterectomy is applicable
in cases relating to
fibroids, cancer or
dysfunctional bleeding but
it should not be the first
line of treatment. 3

It was found that RSBY

had been inadequate in
reducing the burden of out-
of-pocket spending on
poor households. RSBY
was also noted to have
increased household non-
medical spending by 5%
and the likelihood of
incurring out of pocket
spending increased by
30%. There is a delay in
reimbursing empanelled
hospitals for their services
due to flaws in the
management of the funds
regarding the same. 4
3

https://scroll.in/pulse/816202/b
ihar-women-who-lost-their-
wombs-to-needless-surgeries-
suffer-while-doctors-thrive
4
tudy-highlights-shortcomings-
https://www.livemint.com/Poli of-governments-health-
tics/dU1NjIPr8p7cyRfMOihiIO/S schemes.html