What is RSBY?
RSBY has been launched by Ministry of Labor and Employment, Government of India to provide health insurance coverage for Below Poverty Line (BPL) families. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled to hospitalization coverage up to Rs. 30,000/- for most of the diseases that require hospitalization. Government has even fixed the package rates for the hospitals for a large number of interventions. Pre-existing conditions are covered from day one and there is no age limit. Coverage extends to five members of the family which includes the head of household, spouse and up to three dependents. Beneficiaries need to pay only Rs. 30/- as registration fee while central and State Government pays the premium to the insurer selected by the State Government on the basis of a competitive bidding.
Key Feature of RSBY
Empowering the beneficiary- RSBY provides the participating BPL household with freedom of choice between public and private hospitals and makes him a potential client worth attracting on account of the significant revenues that hospitals stand to earn through the scheme.
Business Model for all Stakeholder - The scheme has been designed as a business model for a social sector scheme with incentives built for each stakeholder.
- Insurers - The insurer is paid premium for each household enrolled for RSBY.
- Hospitals - A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per beneficiary treated. Even public hospitals have the incentive to treat beneficiaries under RSBY as the money from the insurer will flow directly to the concerned public hospital which they can use for their own purposes.
- Intermediaries - The inclusion of intermediaries such as NGOs and MFIs which have a greater stake in assisting BPL households. The intermediaries will be paid for the services they render in reaching out to the beneficiaries.
- Government - By paying only a maximum sum up to Rs. 750/- per family per year, the Government is able to provide access to quality health care to the below poverty line population.
Enrollment Process for Beneficiaries
- An electronic list of eligible BPL households is provided to the insurer using a pre-specified data format.
- An enrollment schedule for each village, along with dates, is prepared with the help of the district level officials.
- As per the schedule, the BPL list is posted in each village at enrollment station and prominent places prior to the enrollment and the date and location of the enrolment in the village is publicized in advance.
- Mobile enrollment stations are set up at local centers (e.g., public schools) at each village. These stations are equipped with the hardware required to collect biometric information (fingerprints) and photographs of the members of the household covered and a printer to print smart cards with a photo.
- The smart card, 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. The process normally takes less than ten minutes. The cards are handed over in a plastic cover.
- A government officer (called Field Key Officer – FKO) needs to be present and must insert his/ her own, government-issued smart card to verify the legitimacy of the enrolment. (In this way, each enrollee can be tracked to a particular state government official).
- In addition to the FKO, an insurance company representative/ smart card agency representative must be present. At the end of the each day of enrolment, the list of households which have been issued smart cards is sent to the state nodal agency. This list of enrolled households is maintained centrally and is the basis for financial transfers from the Government of India to the state governments.
- This list of enrolled households is maintained centrally and is the basis for financial transfers from the Government of India to the state governments.
RSBY has a provision whereby an insurer has to hire intermediaries (e.g. NGOs, MFIs, etc.) to provide grassroots outreach and assist members in utilizing the services after enrollment.
For more information, kindly visit government of India website - http://www.rsby.gov.in/about_rsby.aspx