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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
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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)
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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
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