Rashtriya Swasthya Bima Yojana
Encyclopedia
Rashtriya Swasthya Bima Yojana (RSBY, literally "National Health Insurance Programme", Hindi: राष्ट्रीय स्वास्थ्य बीमा योजना) is a government-run health insurance
scheme for the Indian
poor. It provides for cashless insurance for hospitalisation in public as well private hospitals. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011.
Every "below poverty line" (BPL) family holding a yellow ration card pays 30 (less than US$0.7) registration fee to get a biometric
-enabled smart card
containing their fingerprints and photographs. This enables them to receive inpatient medical care of up to 30,000 (approx US$670 as of March 2011) per family per year in any of the empanelled hospitals. Pre-existing illnesses are covered from day one, for head of household, spouse and up to three dependent children or parents.
The scheme is run on shared financial contribution by both central and state governments: 75% of the 600 (approx US$13) premium (per person per year) is borne by the central government, and the rest by the state governments. There is profit motive for all parties involved. Private insurance companies provide the risk coverage, while private third-party administrators empanel hospitals and manage claims. Fixed rates have been prescribed for a long list of interventions.
The scheme is unique in the fact that it is heavily IT-enabled. Enrolment of families into the scheme, smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically.
Fraud
is common, but regular monitoring has led to early detection of fraud and resultant dis-empanelment of several hospitals. Another problem is low awareness of benefits among card holders, leading to under-utilization. People need to be registered as BPL in their home state, making this scheme out of reach of migrant workers who are far from home.
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
scheme for the Indian
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
poor. It provides for cashless insurance for hospitalisation in public as well private hospitals. The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011.
Every "below poverty line" (BPL) family holding a yellow ration card pays 30 (less than US$0.7) registration fee to get a biometric
Biometrics
Biometrics As Jain & Ross point out, "the term biometric authentication is perhaps more appropriate than biometrics since the latter has been historically used in the field of statistics to refer to the analysis of biological data [36]" . consists of methods...
-enabled smart card
Smart card
A smart card, chip card, or integrated circuit card , is any pocket-sized card with embedded integrated circuits. A smart card or microprocessor cards contain volatile memory and microprocessor components. The card is made of plastic, generally polyvinyl chloride, but sometimes acrylonitrile...
containing their fingerprints and photographs. This enables them to receive inpatient medical care of up to 30,000 (approx US$670 as of March 2011) per family per year in any of the empanelled hospitals. Pre-existing illnesses are covered from day one, for head of household, spouse and up to three dependent children or parents.
The scheme is run on shared financial contribution by both central and state governments: 75% of the 600 (approx US$13) premium (per person per year) is borne by the central government, and the rest by the state governments. There is profit motive for all parties involved. Private insurance companies provide the risk coverage, while private third-party administrators empanel hospitals and manage claims. Fixed rates have been prescribed for a long list of interventions.
The scheme is unique in the fact that it is heavily IT-enabled. Enrolment of families into the scheme, smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically.
Fraud
Insurance fraud
Insurance fraud is any act committed with the intent to fraudulently obtain payment from an insurer.Insurance fraud has existed ever since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions...
is common, but regular monitoring has led to early detection of fraud and resultant dis-empanelment of several hospitals. Another problem is low awareness of benefits among card holders, leading to under-utilization. People need to be registered as BPL in their home state, making this scheme out of reach of migrant workers who are far from home.