Rashtriya Swasthya Bima Yogna

State Institute of Health & Family Welfare, Jaipur

Why RSBY: Need
Ø Inadequate public health infrastructure Ø Socioeconomic conditions Ø Inability to deal with medical emergencies due to financial crisis Ø Heavy expenditure on medical care and hospitalization Ø Recourse to adequate and competent treatment • •
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Source of Health Spending in India

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Health Financing in India

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India: Composition of Workforce
7%

Characteristics of unorganized sector ØPoor ØSelf Employed ØIlliterate ØMigratory ØLack of Skills

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RSBY: Objective
To provide protection & health insurance to BPL households from financial liabilities arising out of health shocks that involve hospitalization.

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Eligibility
• Ø Unorganized sector workers Ø Ø BPL category and their family members ( Max. five)

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Benefits
Ø Rs 30,000 per BPL family Ø Coverage of hospitalization Ø Surgeries Ø Cashless Ø Provision of Smart Card Ø Provision of pre and post hospitalization expenses Ø Transport allowance @ Rs.100 per visit maximum of Rs 1000

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Unique Features of the Scheme
Ø Empowering the beneficiary Ø Safe and foolproof Ø Portability Ø Cash less and Paperless transactions Ø Robust Monitoring and Evaluation Ø Business Model for all Stakeholders Ø Insurers Ø Hospitals Ø Intermediaries Ø Government
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Approval and Monitoring Committee
i) Joint Secretary/Director General Labour Welfare, Convener

ii)

Ministry of Labour & Employment Representatives of Ministry of Finance Member

iii) Representatives of Ministry of Health Member and Family Welfare iv) Representatives of Planning Commission
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Member

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Release of Funds
Ø GoI Contribution: 75% of the estimated annual premium of Rs.750 Ø Smart card cost-Central Government Ø State Contribution: 25% of the annual premium Ø Beneficiary Contribution: Rs. 30 per annum as registration/renewal fee Ø The administrative and other related cost -State Governments


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Selection of Insurance Provider
Ø Registered with IRDA Ø Ø Should have full-fledged establishment and experience Ø Ø Atleast one year experience in catering Health Insurance of 50,000 families or more


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Implementing Agency

 

The State Government is determine the implementing agency. It can be:ØAutonomous body ØState Government Department ØA Cooperative Society ØAn NGO

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Formulation of the Projects
ØIdentification of Insurance agency ØBPL data base ØEnrollment of Beneficiaries and Delivery of Smart Card to commence ØEmpanelment of Government and private institutions ØPayment of insurance premium to the insurance service provider ØDelivery of health service
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Setting up of Technical Cell
Ø To plan the insurance scheme Ø Workout financial implication and other details Ø Assist in the preparation of pilot projects Ø Assist in the effective implementation Ø Monitor and evaluate the implementation of the project •
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Operationalizing the Scheme
Ø Signing of MOU between the Central and the State Govt. Ø Contract between the State Govt. and the Insurance Provider Ø Delivery of Smart Card to commence Ø Defining a process for system conformance Ø Setting up of a Central KMS Ø Development of a Uniform application Ø Availability of a Robust Backend system for data transmission & MIS Ø Designate a Central Nodal officer
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Smart Card

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Features of Smart Card
Ø Unique Identification Ø Claims Processing Ø Enable product innovation Ø Stores Ø Supports •

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Enrolment

Photograph of the Head of the Family

KFO Confirmation

Thumb Impression of all members

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Smart Card Registration Process

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Key Management System

KMS is the basic requirement for implementing smart card security. It provides following: ØAuthenticity of card ØProtection against un-authorized tampering of data

 

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• abc
Go To Hospital

How to Use Card Ho

Patien t
Shows Card

Go To Docto r

After Treatment Again Thumb Impression is Taken and updated in System

Advise Hospitalization

RSBY COUNTER

Verifies Thumb Impression Check Limit and issue Slip
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Process Card

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Process Overview

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Monitoring and Evaluation
Ø The State Government placed a well defined mechanism for monitoring and evaluation at the time of project implementation Ø Ø At the Central Government level, the Cell constituted for this purpose

Ø

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Progress so far
Scheme being implemented in 4 districtsØ Bikaner Ø Barmer Ø Jhalawar Ø Rajsamand •

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Thank You

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