rashtriya swasthya bima yogna

8/14/2019 Rashtriya Swasthya Bima Yogna

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Why RSBY: Need

Inadequate public health infrastructureSocioeconomic conditions

Inability to deal with medical

emergencies due to financial crisisHeavy expenditure on medical care and

hospitalization

Recourse to adequate and competent

treatment

SIHFW: an ISO 9001: 2008 certified institution


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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

Characteristics ofunorganized sector

PoorSelf EmployedIlliterateMigratory

Lack of Skills

7%



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RSBY: Objective

To provide protection & healthinsurance to BPL households fromfinancial liabilities arising out of healthshocks that involve hospitalization.



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Eligibility

Unorganized sector workers

BPL category and their familymembers ( Max. five)

SIHFW: an ISO 9001: 2008 certified Institution


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Benefits

Rs 30,000 per BPL family

Coverage of hospitalization

Surgeries

Cashless

Provision of Smart Card

Provision of pre and posthospitalization expenses

Transport allowance @ Rs.100 pervisit maximum of Rs 1000



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Unique Features of the Scheme

Empowering the beneficiary

Safe and foolproof

Portability

Cash less and Paperless transactions

Robust Monitoring and Evaluation

Business Model for all Stakeholders

Insurers

Hospitals Intermediaries

Government



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Approval and Monitoring Committee

i) Joint Secretary/Director GeneralLabour Welfare,

Ministry of Labour & Employment

Convener

ii) Representatives of Ministry of Finance Member

iii) Representatives of Ministry of Healthand Family Welfare

Member

iv) Representatives of PlanningCommission

Member



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Release of Funds

GoI Contribution: 75% of theestimated annual premium of Rs.750

Smart card cost-Central Government

State Contribution: 25% of the annual

premiumBeneficiary Contribution: Rs. 30 per

annum as registration/renewal fee

The administrative and other relatedcost -State Governments



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Selection of Insurance Provider

Registered with IRDA

Should have full-fledged

establishment and experience

Atleast one year experience incatering Health Insurance of 50,000families or more



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Implementing Agency

The State Government is determine theimplementing agency. It can be:-

Autonomous body

State Government Department

A Cooperative Society

An NGO



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Formulation of the Projects

Identification of Insurance agencyBPL data base

Enrollment of Beneficiaries and

Delivery of Smart Card tocommence

Empanelment of Government andprivate institutions

Payment of insurance premium tothe insurance service provider

Delivery of health service



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Setting up of Technical Cell

To plan the insurance scheme

Workout financial implication andother details

Assist in the preparation of pilotprojects

Assist in the effective implementation

Monitor and evaluate the

implementation of the project



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Operationalizing the Scheme

Signing of MOU between the Central and the

State Govt.Contract between the State Govt. and the

Insurance Provider

Delivery of Smart Card to commence

Defining a process for system conformance

Setting up of a Central KMS

Development of a Uniform application

Availability of a Robust Backend system fordata transmission & MIS

Designate a Central Nodal officer



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Smart Card



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Features of Smart Card

Unique Identification

Claims Processing

Enable product innovation

Stores

Supports



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Enrolment

humb mpressionf allmembershotographf the Headf theFamily



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Smart Card Registration Process



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Key Management System

KMS is the basic requirement forimplementing smart card security.

It provides following:Authenticity of card

Protection against un-authorizedtampering of data



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How to Use CardHo abc

RSBY COUNTER

Process Card

Verifies Thumb

Impression

Check Limit and issue Slip

Advise

Hospitalization

After

TreatmentAgain Thumb

Impression is

Taken and

updated inSystem

Patient

o ToHospital

howsCardo ToDoctor



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Process Overview



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Monitoring and Evaluation

The State Government placed a welldefined mechanism for monitoringand evaluation at the time of projectimplementation

At the Central Government level, theCell constituted for this purpose



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Progress so far

Scheme being implemented in 4districts-

Bikaner

Barmer

Jhalawar

Rajsamand



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Thank You


rashtriya swasthya bima yogna

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