Rashtriya Swasthya Bima Yogna

State Institute of Health & Family Welfare, Jaipur

 Why RSBY: Need

Ø Inadequate public health infrastructure

Ø Socioeconomic conditions
Ø Inability to deal with medical
emergencies due to financial crisis
Ø Heavy expenditure on medical care and
hospitalization
Ø 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

7%
Characteristics of
unorganized sector

ØPoor
ØSelf Employed
ØIlliterate
ØMigratory
ØLack of Skills

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 RSBY: Objective

 To provide protection & health

insurance to BPL households from
financial liabilities arising out of health
shocks that involve hospitalization.

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 Eligibility

•
Ø Unorganized sector workers
Ø
Ø BPL category and their family
members ( Max. five)

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 Benefits
Ø Rs 30,000 per BPL family
Ø Coverage of hospitalization
Ø Surgeries
Ø Cashless
Ø Provision of Smart Card
Ø Provision of pre and post
hospitalization expenses
Ø Transport allowance @ Rs.100 per
visit maximum of Rs 1000


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Unique Features of the Scheme
Ø Empowering the beneficiary
Ø Safe and foolproof
Ø Portability
Ø Cash less and Paperless transactions
Ø Robust Monitoring and Evaluation
Ø Business Model for all Stakeholders
Ø Insurers
Ø Hospitals
Ø Intermediaries
Ø Government

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9
 Approval and Monitoring Committee
i) Joint Secretary/Director General Convener
Labour Welfare,

Ministry of Labour & Employment

ii) Representatives of Ministry of Finance Member

iii) Representatives of Ministry of Health Member

and Family Welfare
iv) Representatives of Planning Member
Commission

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 Release of Funds
Ø GoI Contribution: 75% of the
estimated annual premium of Rs.750
Ø Smart card cost-Central Government
Ø State Contribution: 25% of the annual
premium
Ø Beneficiary Contribution: Rs. 30 per
annum as registration/renewal fee
Ø The administrative and other related
cost -State Governments
•

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Selection of Insurance Provider

Ø Registered with IRDA

Ø
Ø Should have full-fledged
establishment and experience
Ø
Ø Atleast one year experience in
catering Health Insurance of 50,000
families or more
•

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 Implementing Agency
 The State Government is determine the
implementing agency.
 It can be:-


ØAutonomous body
ØState Government Department
ØA Cooperative Society
ØAn NGO
•
• SIHFW: an ISO 9001: 2008 certified Institution
13
Formulation of the Projects

ØIdentification of Insurance agency

ØBPL data base
ØEnrollment of Beneficiaries and
Delivery of Smart Card to
commence
ØEmpanelment of Government and
private institutions
ØPayment of insurance premium to
the insurance service provider
ØDelivery of health service

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14
Setting up of Technical Cell

Ø To plan the insurance scheme

Ø Workout financial implication and
other details
Ø Assist in the preparation of pilot
projects
Ø Assist in the effective implementation
Ø Monitor and evaluate the
implementation of the project
•

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15
Operationalizing the Scheme
Ø Signing of MOU between the Central and the
State Govt.
Ø Contract between the State Govt. and the
Insurance Provider
Ø Delivery of Smart Card to commence
Ø Defining a process for system conformance
Ø Setting up of a Central KMS
Ø Development of a Uniform application
Ø Availability of a Robust Backend system for
data transmission & MIS
Ø Designate a Central Nodal officer

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 Smart Card

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Features of Smart Card

Ø Unique Identification
Ø Claims Processing
Ø Enable product innovation
Ø Stores
Ø Supports

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 Enrolment

KFO Confirmation
Photograph Thumb
of the Head Impression
of the of all
Family members

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Smart Card Registration Process

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 Key Management System

 KMS is the basic requirement for

implementing smart card security.


 It provides following:
ØAuthenticity of card
ØProtection against un-authorized
tampering of data


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 How to Use Card
• abc Ho
Go To
Hospital

Patien
t
Go To
Shows Docto
Card r
After Advise
Treatment Hospitalization
Again Thumb
Impression is
Taken and
updated in
System
RSBY COUNTER

Verifies Thumb
Impression Process Card
Check Limit and issue Slip

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Process Overview

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Monitoring and Evaluation

Ø The State Government placed a well

defined mechanism for monitoring
and evaluation at the time of project
implementation
Ø
Ø At the Central Government level, the
Cell constituted for this purpose
Ø

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 Progress so far

Scheme being implemented in 4



districts-
Ø Bikaner
Ø Barmer
Ø Jhalawar
Ø Rajsamand
•

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 Thank You

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