Rashtriya Swasthya Bima Yojana Budget 2016 Updates
It cannot be denied that the motto of Indian Government has been social security and healthcare of all Indian citizens and the government has taken up a lot of steps in these aspects. While some of the steps have been really effective in developing India, other steps have not been a huge success. Now, before we delve deep into the details of Rashtriya Swasthya Bima Yojana (RSBY), it is essential to know a few things about the origin of RSBY. Before the formation of RSBY, a major proportion (read two-thirds here) of the health expenditure was carried through the process of Out of Pocket (OOP) method. But that proved to be really inefficient and it was also the least accountable way for spending money on the healthcare sector of India.
The categories within RSBY
It is a fact that supply side financing through the OOP procedure was a failure and thus, the government initiated a new scheme known as RSBY for testing the demand side financing approach. Now this was the scheme which was initially specifically designed for the BPL community. And its objectives were to increase access in healthcare and reduce the OOP expenditure on health. With the generation of RSBY in the year 2008, it was targeted towards the BPL community, but gradually, with its continuation, it was shifted for specific other categories as well. The other categories that were covered by RSBY are as follows:
Street vendors, Railway Porters who are licensed, Domestic Workers, Sanitation Workers, Rickshaw Pullers, Rag Pickers, Auto/Taxi Drivers, Mine Workers and Beedi Workers.
MNREGA workers who have been working for more than 15 days from the previous year are also included in this scheme if they do possess the BPL registration and are enlisted within the District list of BPL families.
The objectives of RSBY
There are two primary objectives of the RSBY and they are, first, for providing a financial help for the people who are not able to afford a huge amount of money for their treatment in case of health issues and hospitalization. And second is to improve the quality of healthcare for the people of BPL, improve hospitalization features, and other valuable groups of unorganized sector. Now, let us delve deep into the factual details of the RSBY.
The enrollment process:
The enrollment process comprises of an electronic process in which the list of eligible BPL households list shall be given to the insurer. The eligibility of BPL shall be determined through a pre-specified data. The insurance company shall prepare the enrollment schedule for every village along with specifically mentioned dates and district level officials are going to help the insurance company. According to the schedule, the BPL list shall be posted within every village. There are certain specific places where the BPL list is posted, for instance they are placed in enrollment stations and other prominent places so that people are notified easily. The location and date of enrollment are publicized in advance so that people do not miss them. The best part is the establishment of mobile enrollment centers that are placed at local centers in every village.
The place where RSBY registration is done, are provided with certain equipments like fingerprint scanners, cameras and many other hardware for gathering the biometric information of the BPL individuals. On the spot you are going to receive a smart card and an information pamphlet that describes schemes and list of hospitals that will provide RSBY support. TO get this smart card, the beneficiary has to pay an amount of 30 INR on the spot. After that the government officials authenticate the smart card and you can officially use that card in case of any health related issues or you need to get admitted in hospitals. The overall process of enrollment for an individual generally takes less than 10 minutes.
The eligibility criteria to be enrolled within RSBY
To be enrolled within the RSBY, the basic criteria is to be registered within the BPL and your information should be formally recorded within the District BPL list that is prepared by the state government. Also, the families that are under the other categories that have been mentioned above are within the RSBY eligibility, provided they have the formal record of their categories within the District List authorized by the state government.
How many family members are covered within this RSBY?
The coverage extends to a maximum of five members of a family that comprises of head of the household/the card holder, the spouse of card holder, and up to three dependants on the cardholder.
The premium amount:
According to the RSBY scheme, it is clear that the individuals within this scheme do not have to pay any monthly or yearly premium apart from the registration fee of 30 INR during the time of getting the RSBY card. All the other expenses and premiums are handled by the central and state government depending on the sharing ratio of the insurer selected by the state government on competitive bidding.
The total coverage
Considering the overall benefit of the RSBY scheme, the individuals are going to have coverage of Rs 1 lakh per year on the basis of family floater, for the majority of diseases that require hospitalization. The benefit shall be available for certain defined disease that is mentioned under RSBY smart card. Rs 30,000 would be given extra for the senior citizen of the family
The benefits of RSBY
The benefits of RSBY comprise of a lot of features and they are as follows:
There are indicative packages framed by the government and there is completely no age limit in utilizing this RSBY card after it is correctly authorized.
Apart from the fact that the coverage extends to five family members the additional transport expenses shall of RS 100 shall be covered by the government, for every individuals admitted to hospitals and also the beneficiary shall be paid a maximum amount of Rs 1000 per family ever year for transportation.
There is no premium that need to be paid by the beneficiaries apart from the registration fee and that is undoubted a great factor for the RSBY scheme.
This RSBY scheme provides options for several BPL and other category individuals to select between private and government hospitals.
Portability is a major benefit of this scheme. If an individual has been enrolled within the RSBY scheme in a certain district, that person shall be allowed to use the RSBY card on any other districts or cities of India. This is a great feature which was necessary for huge number of individuals because a lot of people have to face issues with hospital admission in other states and districts without proper documentation.
The beneficiary of RSBY shall be treated cashless within the coverage amount and all the individuals need is to carry the RSBY smart card for attaining immediate treatment after being admitted in hospitals. It is a paperless scheme for the participating providers and for the beneficiaries; they only need to make the fingerprint verification procedure.
Can we treat cashless in private hospitals?
Yes, you can treat cashless in private hospitals. But there are certain factors that need to be remembered in this process. You can opt for the private hospitals only if the name of the hospital is mentioned within the card and details of scheme that can be availed from that private hospital is mentioned in the information brochure. There are certain private hospitals that have participated in this RSBY scheme and from those hospitals you can opt for the cashless treatment. But without the name of a private hospital being enlisted in the card, you cannot avail cashless treatment.
Is Non-BPL covered in the RSBY scheme?
No, the non BPL is not covered within this RSBY scheme. The basic criteria to be enrolled within the RSBY scheme is to be enlisted within the state government authorized list of BPL individuals and families. Without being enlisted within the authorized BPL list, you are not eligible for the utilization of RSBY scheme or card.
Can husband wife make separate RSBY cards?
In the same family, only the head of the family is eligible for the RSBY card. Within the same family, the husband and wife is not entitled for the RSBY card separately. Since RSBY card comprises of five members within a family, that includes the cardholder, the spouse of card holder, and other three dependants. This is the reason; husband and wife cannot opt for the RSBY card separately.
What is the purpose of the smart card?
The purpose of the smart card given to the individuals who register for RSBY scheme is it acts as the identification proof that you are authorized to attain the benefits of RSBY scheme and coverage of RS 30000 shall be provided by the government as a part of the healthcare expenses incurred by the individual. The most important function of the smartcard is it helps individuals to enable the cashless transactions within empanelled hospitals and offers the portability feature for the people using it.
Why is the photograph of all family members taken when there is only the photo of only card holder on the smart card?
Though the card comprises of photo of only the card holder, but the photo of all the family members are stored within a chip so that incase of any necessity, the photos can be used for verification purposes.
How does the government make sure that the right beneficiary is attaining smart card?
This is a very important factor that has been considered by the government while the RSBY scheme was being implemented. Every enrollment team within the village is provided with certain Field Key Officers (FKO). The duty of a field officer is to make identification of the beneficiaries whether they are enlisted within the BPL category. Basically the authentication power of a smart card of RSBY lies within the hands of FKO. Without the authentication of FKO, the smart card shall not work at all. Every individual’s detail is authenticated by the FKO and the FKO is provided with an a list of all BPL individuals and their family which is checked and compared during the time of RSBY registration. This is how it is ensured that only BPL individuals get the RSBY card and the right person gets it.
Whys is the beneficiary is paying RS 30 when the government is paying all the premiums?
The amount of Rs 30 is a registration fee which is paid by the beneficiary and the rest expenses of premium are paid by the government. The amount is actually used by the Nodal Agency for taking care of the administrative expenses.
What happens in case there are more than three dependants apart from the card holder and his/her spouse?
In case of more than three dependants, then the card holder has to decide which three dependants shall be included in the RSBY scheme.
In case there are less than five members in the family, can there be the inclusion of the extended families?
No, you cannot add extended family members in the RSBY cards if there are less than five members within a family. Only the direct family members shall be insured and covered. But, if the extended family members are listed on the BPL list then, they can be included and covered within the RSBY scheme.
What shall happen if the head of the family has to travel in different districts?
Firstly, the smart card of RSBY has portable option feature that permits its holder to use it while staying in other districts. Secondly, if the family decides to retain a card for the health and safety issues when the card holder is away, then a split card shall be offered to the card holder, in which the overall coverage amount shall be split in two cards. This ensures that the family retains one card and the card holder (who has a transferable work) gets another card with the amount split in two cards. The way in which the amount is split, can be decided by the beneficiary family. But a card can be split in two parts only. In case, the smart card or both the smart cards (for the families opting for the split feature) are lost, then, the beneficiary has to go to the district kiosk for attaining a new card issued and also the person have to pay an amount of fee.
Can the existing members be changed in midway?
Yes, it can be changed in case of death of the cardholder or any other individual included within the RSBY card of a family, another person, belonging to the family can be included in the RSBY card. And in absence of the card holder, the second person of the family shall be entitled as the cardholder of RSBY.
The Drawbacks of RSBY scheme
Though the RSBY scheme has been targeted for the benefit of the BPL families and individuals, there are certain factors that limit the benefit of the RSBY card. They are as follows:
Apart from the private and government hospitals that are mentioned within the information brochure of RSBY card, you shall not be offered the facilities in other hospitals.
If the healthcare and medical expenses are more than Rs 30000, then you will not be covered with the excess amount.
The RSBY scheme shall be applicable for only the specifically mentioned diseases and illness that are stated within the RSBY information brochure. Apart from that, individuals shall not be provided with the RSBY facilities.
How can we renew this?
There is no need for the renewal of the RSBY card, since it has been mentioned earlier that there is no age limit and in case of death, the second member of the family shall be allotted as the cardholder. Also another individual belonging to the family (not extended family) shall be added within the card if that person is enlisted within the authorized district BPL list.
There are no major documents required for attaining the RSBY scheme smart card, apart from the verified proof that you are enlisted within the District BPL list. You need to bring the document or slip that you have been provided during the authentication of the BPL enlistment.
A tabular over view of the features of RSBY scheme
|SL NO||Features||Brief Description|
|1.||Empowering the beneficiary||The RSBY offers complete freedom to the beneficiary by giving them an opportunity to select between private and public hospitals. This also makes them a potential client which in turn generates revenue for hospitals through this scheme.|
|2.||Information technology||This is the first time IT applications have been used for the development of a social sector in such a massive stage. All the hospitals are enabled with connection to district servers ensuring smooth data flow so that patients can get quick verification and instant treatment.|
|3.||Portability||This is one of the best features of RSBY card. If you need to travel to any other district or state within India, the RSBY card can be used in any hospitals of other states that are empanelled under RSBY scheme and are mentioned in RSBY information brochure.|
|4.||Government||With the RSBY scheme it has become easier for the government to provide for the poor families that are not able to take up their health care expenditures. This also shall lead to a healthy competition in between the different healthcare organizations that shall increase the functioning of health care providers.|
|5.||Intermediaries||With the inclusion of intermediaries like MFI’s and NGO’s, there is a greater stake involved. The intermediaries shall be offered with a certain amount of money if they are more functional towards serving needy people.|
|6.||Cashless and paperless transactions||If you are registered with RSBY, you shall be allowed to have the cashless treatment instantly, only after a fingerprint verification. The person only needs to carry the RSBY card and just provide the verification of his/her fingerprint.|
|7.||Robust monitoring and Evaluation||The RSBY has developed a robust monitoring technology and evaluation system that is an elaborate backend data management system and it can track any form of data transaction across India.|
|8.||Safety and Foolproof||The technology used in this RSBY scheme is completely fool proof because of the use of biometric enabled smart card and a key management system. The management system ensures that it reaches to the exact beneficiary and also accountability is maintained considering the issuance of smart card and usage.|