Rastrya Swasthay Bima Yogna  


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).

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 enrollment station, and the identity of the household head needs to be confirmed by the authorized official.

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.

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.

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.

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

What is the time period for the enrollment and the policy period for the beneficiaries?
In case of new policy, the Scheme shall commence operation from the 1st of the succeeding month in which the smart card is issued. Thus, for example, if the initial smart cards are issued anytime during the month of April in a particular district the scheme will commence from 1st of May. The scheme will last for one year till 30th of April of next year. This would be the terminal date of the scheme in that particular district. However, in the same example, if the card is issued in the month of May, June and July then the insurance will immediately start from the next day itself for the beneficiaries and policy will be over on 30th April of next year. Thus, all cards issued in the district in May will also have the Policy start date as 1st of May (even if issued subsequent to the date) and terminal date as 30th April of the following year. The date of commencement of insurance for the cards issued during the intervening period will be as follows:
 

Smart card issued During Commencement of Insurance Policy period
April, 2009 1st May, 2009 30th April, 2010
May, 2009 May, 2009 30th April, 2010
June, 2009 June, 2009 30th April, 2010
July, 2009 July, 2009 30th April, 2010

What is the time period for enrollment and policy period in case of renewal of the policy?
In the case of renewal, the policy will start from first of the next month in which the earlier policy will expire. Therefore, for example, if the earlier policy is getting over on 30th April and card is renewed in the month of April then the new policy will start only from the 1st May and will finish on 30th April of next year. However, in the same example, if the card is issued in the month of May, June and July then the insurance will immediately start from the next day itself for the beneficiaries and policy will be over on 30th April of next year. The date of commencement of insurance for the cards issued during the intervening period will be as follows

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What happens in case of any dispute?
If any dispute arises between the parties during the subsistence of the policy period or thereafter, in connection with the validity, interpretation, implementation or alleged breach of any provision of the scheme, it will be settled in the following way:

  • Dispute between Beneficiary and Health Care Provider

    The parties shall refer such dispute to the redressal committee constituted at the District level under the chairmanship of concerned District magistrate and authorized representative of the insurance company as members. This committee will settle the dispute.

    If either of the parties is not satisfied with the decision, they can go to the State level committee which will be Chaired by the Principal Secretary………. with representative of the Insurance Company as a member.
     

  • Dispute between Health Care Provider and the Insurance Company

    The parties shall refer such dispute to the redressal committee constituted at the District level under the chairmanship of concerned District magistrate, authorized representative of the insurance company and a representative of the health care providers as members. This committee will settle the dispute.

    If either of the parties is not satisfied with the decision, they can go to the State level committee which will be chaired by the Principal Secretary …………. with representative of the Insurance Company as a member.

    Note: If State redressal committee is unable to resolve the dispute, mentioned in section a and section b above, within 60 days of it being referred to them, then it will be settled as per procedure given in section c below.
     

  • Dispute between Insurance Company and the State Government
    A dispute between the State Government/Nodal Agency and Insurance Company shall be referred to the respective Chairmen/CEO’s/CMD’s of the Insurer for resolution.

    In the event that the Chairmen/CEO’s /CMD’s are unable to resolve the dispute within {60 } days of it being referred to them, then either Party may refer the dispute for resolution to a sole arbitrator who shall be jointly appointed by both parties, or, in the event that the parties are unable to agree on the person to act as the sole arbitrator within {30 } days after any party has claimed for an arbitration in written form, by three arbitrators, one to be appointed by each party with power to the two arbitrators so appointed, to appoint a third arbitrator.

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How will the publicity for RSBY will be done and who will do it?
Insurance Company in consultation with State Nodal Agency will prepare and implement a communication strategy for launching/ implementing the RSBY. The objective of these interventions will be to inform the beneficiaries regarding enrolment and benefits of the scheme.

In addition to this State Government will also undertake communication activities, especially to improve the utilization of the scheme.

What is District Kiosk and what are its functions?
District Kiosk shall be set-up by the insurer in all the project districts. The main points regarding district kiosk are as follows:

Location: District Kiosk shall be located at the district headquarter. The State Government may provide a place at the district headquarter to the insurer to set up district kiosk. It can be at a prominent place which can be accessed easily by beneficiaries. Alternatively the insurer can set up district kiosk in their district office.

Specifications: District Kiosk shall have at least following hardware, according the specifications of Government of India, so that it can carry out its tasks in an efficient way:

A Computer A Smart Card Printer Two Smart Card readers One Fingerprint Scanner Web Camera A telephone line In addition to these a District Kiosk Card shall be available at the district kiosk which will be issued by Ministry of Labour and Employment, Government of India.

Role: District Kiosk will be the focal point of activity at the district level, especially post issuance of the smart card. The role of district kiosk will be including but limiting to as follows:

  • To modify the existing smart cards with respect to changing the details of the dependents in the card. However, all the changes in the smart card shall be from within the BPL list only and the total number of members on the smart card cannot be more than the members in the BPL list. In case of death of a member of the household a new name can be added from the existing BPL list. Presence of FKO is not necessary to perform this role.
     

  • To split the existing smart cards as per the need of the beneficiary household. However, the total amount of both the cards combined shall be 30,000 in case the card has not been used till now or it will be the balance amount in the smart card at the time of splitting. The splitting amounts will be decided by the beneficiary. Presence of FKO is not necessary to perform this role.
     

  • To issue new smart cards in place of missing/ damaged smart cards. The new smart card will have the exact details as were there on the original smart card. The original smart card which is lost/ damaged will be hotlisted by the person issuing the new card at the district kiosk to prevent misuse of the lost/ damaged card. Presence of FKO is not necessary to perform this role.
     

  • To issue new smart cards for beneficiaries who were left during the round of enrollment at the village. The beneficiary will need to come with all the family members whom he/ she want to be enrolled. Presence of FKO is necessary for this function.

    The Insurer needs to make an arrangement with the District authorities so that they have access to FKO on a periodic basis to carry out this function.

    Note: A small charge needs to be paid by the beneficiary for this. The amount for providing this service will be decided by the respective State Governments.

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What are the intermediaries and what is their role in RSBY?
The Insurer may enter into service agreement(s) with one or more intermediary institutions for the purposes of ensuring effective outreach to Beneficiaries and to facilitate usage by Beneficiaries of Benefits covered under this tender. The role of intermediaries will not only be to help in mobilizing people for enrolment but they will also provide IEC and BCC for service delivery. The Insurer will also compensate such intermediaries for their services at an appropriate rate.

The role of intermediaries would include among others the following:

What is meant by Project office and District office of RSBY and what are their functions?
Insurer shall establish a separate Project Office at convenient place for coordination with the Government/Nodal agency at the State Capital. The project office shall coordinate with State Government/ State Nodal Agency on a daily basis. Insurer will have appropriate people in their own/TPA, State and District offices to perform following functions:

The Insurer shall set-up a district office in each of the project districts of the State. The district office will coordinate activities at the district level. The district offices in the selected districts will perform the above functions at the district level

What is Call Center Service and what it does?
The Insurer shall provide telephone services for the guidance and benefit of the beneficiaries whereby the Insured Persons shall receive guidance about various issues by dialing a State Toll free number. This service provided by the Insurer as detailed in this clause-18 is collectively referred to as the “Call Centre Service”.

Call Centre Information: The Insurer shall operate a call centre for the benefit of all Insured Persons. The Call Centre shall function for 24 hours a day, 7 days a week and round the year. As a part of the Call Centre Service the Insurer shall provide the following :

Language: The Insurer undertakes to provide services to the Insured Persons in English and local languages.

Toll Free Number: The Insurer will operate a state toll free number with a facility of a minimum of 5 lines. The cost of operating of the number shall be borne solely by the Insurer. The toll free numbers will be restricted only to the incoming calls of the clients only. Outward facilities from those numbers will be barred to prevent misuse.

Insurer to inform Beneficiaries: The Insurer will intimate the state toll free number to all beneficiaries along with addresses and other telephone numbers of the Insurer’s Project Office. Insurer may provide the details of the call center service with the technical proposal.

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List of Empanelled Hospitals, Dehradun
 

S No Name Govt Hospital Name of Private Hospital
1 Doon Hospital HIHT Jolly Grant
2 Doon Women Hospital Dhanvaritari Hospital Vikasnagar
3 Coronation Hospital Bhandari Hospital Vikasnagar
4 SPS Hospital Rishikesh Lehman Hospital Herbertpur
5 Combined Hospital Premnagar Padmavati Nursing Home Haridwar Road
D Dun
6 CHC Raipur Chauhan Hospital Vikasnagar
7 CHC Doiwala Krishna Surgical Centre Vikasnagar
8 CHC Sahiya Life Line Hospital Haridwar Road D Dun
9 CHC Vikasnagar Asha Nursing Home Jogiwala D Dun
10 CHC Mussoorie Luxmi Dental Clinic Haridwar Road D Dun
11 CHC Sahaspur Negi Surgical Centre Araghar d Dun
12 CHC Chakarata Bora Hospital Haridwar Road D Dun
13 - Shed Hospital Doiwala
14 - Nirmal Ashram Eye Hospital Kherikalan
15 - City Hospital Chakarata Road D Dun
 
 
Year-wise RSBY Enrollment
 
Name of Block
 
No of Panchayats
 
No of Villages BPL Population BPL Enrolled
2010-11
BPL Enrolled
2011-12
Vikasnagar 43 51 13720 5899 6929
Sahaspur 54 86 9167 2506 3525
Doiwala 46 58 10139 3970 4430
Chakarata 77 205 6879 5215 3505
Kalsi 87 156 4332 2343 2367
Raipur 54 91 5953 2563 2279
Total 361 647 50190 22496 23035

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