RSBY Health Insurance Scheme

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Rashtriya Swasthya Bima Yojana (RSBY) is a government scheme to provide health insurance for poor families in India. PACS is working to increase the number of Below Poverty Line (BPL) households, especially those from socially excluded groups, who are signed up to the scheme and to support them to access non-discriminatory health care services under it.

What is RSBY?

Launched by the Ministry of Labour and Employment in 2008, the RSBY scheme provides health insurance coverage for BPL families.

For just 30 rupees per year, BPL families can register for a RSBY smart card. The smart cards allow the holders (the head of household, spouse and up to three dependents) to access hospitalisation for most diseases up to the value of 30,000 rupees per year. For a large number of common illnesses, the Government has fixed treatment rates.

Pre-existing conditions are covered by the scheme from day one and there is no age limit.

How can families access treatment under RSBY?

Every beneficiary family is issued with a biometric smart card. On reaching a RSBY-empanelled hospital, the beneficiary should visit the RSBY help desk where his/her identity is verified by their photograph and fingerprints that are stored on their smart card.

If a diagnosis leads to hospitalisation, the assistant at the RSBY help desk checks whether the procedure required is on the list of pre-specified packages. If the procedure is on the list, the prescribed package is selected from a menu. If the procedure is not on the package list, the assistant should check with the insurer regarding the price for that procedure.

Once the beneficiary has received treatment, their card should be swiped and their fingerprints verified, and the pre-specified cost of the procedure should be deducted from the amount available on the card. The beneficiary should also be paid 100 rupees by the hospital for transportation expenses at the time of the discharge.

Beneficiaries can use their RSBY smart cards in any RSBY empanelled hospital across India, making the scheme beneficial to poor families who migrate from place to place. The system is also completely cash-less and paper-free: all claims are paid online.

Why is health insurance important?

For people living below the poverty line, an illness can be catastrophic. An illness can permanently threaten their income earning capacity but it is the short-term treatment expenses that can also be ruinous. To pay for health care, many poor families are forced to use their savings, sell their assets or borrow money. As a result, a single illness, accident or health emergency can draw an entire family into years of debt-ridden life.

It is therefore common for poor families to ignore an illness or wait until it’s too late. Ignoring the treatment may lead to unnecessary suffering and even death, while selling property or taking debts may end a family’s hope of ever escaping poverty.

These tragic outcomes can be avoided through health insurance, which decreases the risk of financial hardship if a major health shock occurs.

Our work on RSBY

Through our projects we are:

Throughout all our work on RSBY, our cadre of RSBY Mitras (Friends) are vitally important. They are providing handholding support to communities, especially those from socially excluded groups, helping them to understand and access RSBY, and responding to complaints where health services have not been provided.

Social exclusion and RSBY

The success of the RSBY health insurance programme depends on its benefits reaching the poor. However, in 2013/14 only 53.9% of BPL families were signed up to the scheme.

People from socially excluded groups are more likely to be registered as BPL due to the exclusion they face in accessing employment as a result of their identities. However, they are also more reluctant to approach healthcare institutions for fear of facing discrimination.

Due to their exclusion from mainstream society, socially excluded groups are less likely to know about the scheme and its associated benefits. This has a negative impact on the uptake of scheme and continues to remain a challenge for implementers.

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