The document provides information on the Rashtriya Swasthya Bima Yojana (RSBY), a government-run health insurance program for low-income families in India. It discusses that RSBY aims to provide health insurance coverage and cashless hospitalization to below poverty line families. It offers a benefit of Rs. 30,000 for a family of five with coverage of pre-existing conditions and transportation costs. The premium is paid by both central and state governments, with beneficiaries paying a Rs. 30 registration fee. Over 36 million families had been enrolled as of 2014.

1. BUSINESS
ENVIRONMENT
RASHTRIYA SWASTIYA
BIMA YOJANA

2. INTRODUCTION

3. Rashtriya Swasthya Bima Yojana
Rashtriya Swasthya Bima Yojana (RSBY, literally "National
Health Insurance Programme" is a government-run health
insurance programme for the Indian poor. The scheme aims to
provide health insurance coverage to the unrecognised sector
workers belonging to the BPL category and their family members
shall be beneficiaries under this scheme. It provides for cashless
insurance for hospitalisation in public as well as private hospitals.
The scheme started enrolling on April 1, 2008 and has been
implemented in 25 states of India. A total of 36 million families
have been enrolled as of February 2014. In the starting RSBY is a
project under the Ministry of Labour and Employment. Now it is
transferred to Ministry of Health and family welfare from
April 1, 2015.

4. What is RSBY?
 Ministry of Labour and Employment,
Government of India has launched a
health insurance scheme for BPL families
which is called Rashtriya Swasthya Bima
Yojana (RSBY).

5. Who is eligible?
 The beneficiary is any Below Poverty
Line (BPL) family, whose information is
included in the district BPL list prepared
by the State government. The eligible
family needs to come to the enrolment
station, and the identity of the household
head needs to be confirmed by the
authorized official.

6. What is the insurance coverage
in RSBY?
 Rashtriya Swasthya Bima Yojana
provides cover for hospitalization
expenses upto Rs. 30,000/- for a family of
five on a floater basis. Transportation
charges are also covered upto a maximum
of Rs. 1,000/- with Rs. 100/- per visit.

7. What is the premium for RSBY?
 The premium for RSBY is different in
different set of districts. State
Governments select insurance companies
through open tendering process and
technically qualified lowest bid is selected

8. Who pays the premium for
RSBY?
 Government pays the premium for
RSBY. Central Government pays 75% of
the total premium (90% in case of Jammu
& Kashmir and North east States) while
State Government pays the remaining
premium.

9. Will beneficiaries have to pay
anything to get the policy?
Beneficiaries need to pay Rs. 30 per family
at the time of enrolment.

11. ABOUT RSBY
 Social Security and healthcare assurance for all has been the
motto of Government of India, and it has taken various steps
in this regard. One of the most important policy milestones is
the Unorganized Workers Social Security Act (2008) enacted
by the Central Government to provide for the social security
and welfare of the unorganized workers. This act
recommends that the Central Government provide social
security schemes to mitigate risks due to disability, health
shocks, maternity and old age which all unorganized workers
get exposed to and are likely to suffer from.
continued

12. In India more than two thirds of expenditure on health is
through Out of Pocket (OOP) which is the most inefficient
and least accountable way of spending on health. Supply
side financing on health alone has not been found to be
successful in reducing OOP expenditure on health
substantially and therefore, to test the demand side financing
approach, Government of India, decided to introduce
Rashtriya Swasthya Bima Yojana (RSBY) a Health
Insurance Scheme for the Below Poverty Line families with
the objectives to reduce OOP expenditure on health and
increase access to health care.

13.  RSBY was launched in early 2008 and was initially
designed to target only the Below Poverty Line (BPL)
households, but has been expanded to cover other defined
categories of unorganised workers, covering:
1. Building and other construction workers registered with the
Welfare Boards
2. Licensed Railway Porters
3. Street Vendors
4. MNREGA workers who have worked for more than 15
days during the preceding financial year
5. Beedi Workers
6. Domestic Workers

14. 7. Sanitation Workers
8. Mine Workers
9. Rickshaw pullers
10.Rag pickers
11.Auto/Taxi Driver
continued

15.  The premium cost for enrolled beneficiaries under the
scheme is shared by Government of India and the State
Governments. The program has the target to cover 70
million households by the end of the Twelfth Five Year
Plan (2012-17). Its main service delivery model remained
as demand financing, freedom of choice among accredited
government and private hospitals, and cashless service
reimbursable to provider on a pre-determined package rates
on family floater basis, could become a strong pillar for the
universal health care system laid down by Government of
India

16.  Since 1st April, 2015, the Scheme Rashtriya Swasthya
Bima Yojana (RSBY) has been transferred to Ministry of
Health & Family Welfare on “as is where is” basis.
Ministry of Health & Family Welfare is administering and
implementing the scheme through a decentralized
implementation structure at the State level.

17. OBJECTIVE OF RSBY
 To provide financial protection against catastrophic health
costs by reducing out.
 To improve access to quality health care for below poverty
line households of pocket expenditure for hospitalization and
other vulnerable groups in the unorganized sector.

18. DETAILS OF THE SCHEME
 The beneficiaries under RSBY are entitled to hospitalization
coverage up to Rs. 30,000/- per annum on family floater
basis, for most of the diseases that require hospitalization.
The benefit will be available under the defined diseases in the
package list. The government has framed indicative 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. The coverage extends to maximum five
members of the family which includes the head of household,
spouse and up to three dependents. Additionally, transport
expenses of Rs. 100/- per hospitalisation will also be paid to
the beneficiary subject to a maximum of Rs. 1000/- per year
per family. continued

19. The beneficiaries need to pay only Rs. 30/- as registration fee
for a year while Central and State Government pays the
premium as per their sharing ratio to the insurer selected by
the State Government on the basis of a competitive bidding. At
every state, the State Government sets up a State Nodal
Agency (SNA) that is responsible for implementing,
monitoring supervision and part-financing of the scheme by
coordinating with Insurance Company, Hospital, District
Authorities and other local stake holders.

20. FEATURES OF THE SCHEME
 The RSBY scheme is not the first attempt to provide health
insurance to low income workers by the Government in
India. The RSBY scheme, however, differs from these
schemes in several important ways.
 Empowering the beneficiary
 Business Model for all Stakeholders
 Information Technology (IT) Intensive
 Safe and fool proof
 Portability
Cash less and Paperless transactions
 Robust Monitoring and Evaluation

21. Who is the Beneficiary
 The beneficiary is any Below Poverty Line (BPL)
family, whose information is included in the district
BPL list prepared by the State government and the
family falling into any of the above defined (point
number 1) eleven categories are eligible. The eligible
family needs to come to the enrolment station, and the
identity of the household head needs to be confirmed
by the authorized Government official.

22. HOW RSBY WORKS
 RSBY involves a set of complex and inter-related
activities. The broad sets of activities are given as
follows:
 Insurance agencies selection
 Hospital empanelment
 Preparation of Beneficiary data
 Enrolment process
 How Services are availed by the Beneficiary

23.  Claim settlements
 Financing of the scheme
 Policy Extension

24. STATITICS OF RSBY

25. Enrolment of
Beneficiaries
Number of Districts In Districts with Enrollment
S.N
o.
State
Selected
Enrollment
Complete
Enrollment in
Progress
Total
BPL Families
BPL Families
Enrolled Till Date
1 Assam 23 23 - 2371950 1421104
2 Bihar 38 38 - 13921372 7028409
3 Chhattisgarh 27 27 - 4869167 4146227
4 Gujarat 26 26 - 4653237 2691497
5 Himachal
Pradesh
12 12 - 877763 480588
6 Karnataka 30 30 - 10031663 6206620
7 Kerala 14 14 - 2275554 2060802
8 Manipur 6 6 - 120237 70925
9 Meghalaya 11 11 - 479743 256138
10 Mizoram 8 8 - 243407 194886
11 Nagaland 11 - 11 518476 255314
12 Orissa 30 30 - 6158498 4462959
13 Tripura 8 8 - 768359 481331
14 Uttarakhand 13 13 - 728216 285229
15 West Bengal 21 21 - 11100347 6290446
Total 278 267 11 59117989 36332475
Rajasthan is only
implementing the
RSBY for
Categories other
than BPL,
therefore only
NREGA
enrolments
included in this
data.

26. Empanelment
of Health Care
Providers
Source :
www.rsby.
gov.in
District Hospital
S.No
.
State
Selected Private Hospitals Public Hospitals Total Hospitals
1. Assam 23 47 141 188
2. Bihar 38 1001 151 1152
3. Chhattisgarh 27 640 395 1035
4. Gujarat 26 1251 638 1889
5.
Himachal
Pradesh
12 21 155 176
6. Karnataka 30 541 653 1194
7. Kerala 14 271 278 549
8. Manipur 6 8 - 8
9. Meghalaya 11 15 170 185
10. Mizoram 8 21 80 101
11. Nagaland 11 9 11 20
12. Orissa 30 211 424 635
13. Tripura 8 2 100 102
14. Uttarakhand 13 66 94 160
15. West Bengal 21 822 481 1303
Total 278 4926 3771 8697

27. CONCLUSIONS & RECOMMENDATIONS
 State Governments feel that while the objective of
the scheme is excellent , the implementation
machinery is not up to the mark.
 Enrollment too slow – only 44% of eligible
beneficiaries enrolled in first two years of
implementation ( till April 2010 ).
 Enrollment being done by private agencies – no
transparency or grievance redressal mechanisms.
 37% of respondents had above five members in
their family – whom to leave out ?

28.  Only 25% aware of card validity period. At the time of
enrollment they should explain everything properly.
 No Extra Travel cost provided.
 Average days taken to receive the smart card is 29 Days , it
should be more fast and efficient in sending smart cards.
 More awareness should be done.
 Include more healthcare facilities.
 More counters and staff should be provided in Hospital.
 Extend the list of empaneled Hospitals.
 Improve and include more health facilities.

30. THANK YOU