RASHTRIYA SWASTHYA BIMA YOJANA
RASHTRIYA SWASTHYA BIMA YOJANA IN ODISHA
The “Rashtriya Swasthya Bima Yojana” or RSBY scheme announced by the Central Government attempts to address poor people through the provision of health insurance in the case of hospitalization for families Below the Poverty Line (BPL).
Objective
The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. Beneficiaries under RSBY are entitled for hospitalization coverage upto Rs. 30,000/- for most of the diseases that require hospitalization. Government has even fixed the 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 five members of the family, which includes the head of household, spouse and up to three dependents. Beneficiaries need to pay only Rs. 30/- as registration fee while Central and State Government pays the premium @ 75% and 25% respectively to the insurer, selected by the State Government on the basis of a competitive bidding.
The main features of the scheme are as follows.
i)Smart card based health insurance cover pf Rs. 30,000/- per family ( a unit of five) per annum on a family floater basis.
ii) All pre existing diseases to be covered.
iii) Hospitalization expenses, taking care of most of the illness, including maternity benefits.
iv) Transportation cost of Rs. 100/- per visit with an overall limit of Rs. 1, 000/- per annum.
v) The use of smart card, making the scheme truly cashless as also providing interoperability to facilitate use by migrant labour.
vi) Issue of smart card to the beneficiary on the spot in the village itself.
vii) Provision of issue of split cards enabling migrant workers to carry one card along with him/her work place.
viii)Use of Information Technology (IT) applications for delivering the insurance package.
ix) Use both public and private service providers for delivering the insurance package.
x) Seeking contribution by way of Registration fee, from the BPL beneficiary with a view to inculcating a sense of ownership in them.
xi) Allowing registration of BPL family member irrespective of their age.
Implementing Agency
The Labour and ESI, Department Government of Odishaa is implementing agency on behalf of the State Government.
Labour Commissioner, Odisha is the State Nodal Officer for implementation of Rashtriya Swasthya Bima Yojana in the state.
For implementation of the scheme in the state, State Labour Welfare Society, Orissa has been formed and registered under the Societies Registration Act.
Rashtriya Swasthya Bima Yojana (RSBY) was launched in Odisha in the year 2009. In the first round six districts namely Nayagarh, kalahandi, Jharsuguda, Deogarh, Nuapada and Puri were identified for implementation. New India Assurance Co. Ltd was selected as the service provider for implementation of the scheme. In the first round, the achievement on enrolment was 56.61%. 4,22,629 smart cards were issued. During the year 8189 numbers of claims were made amounting to Rs. 3,15,69,420.
In the year 2010 process for implementation of the scheme was initiated in four districts Jharsuguda, Deogarh Nuapada and Puri and enrolment started in the year 2011. The remaining districts were locked up in litigation.
The Government tried to fight the cases in the Hon’ble High Court which gave a favourable judgement in favour of the government appreciating the steps taken by the High Power committee headed by the Chief Secretary Odisha.
On dismissal of the Writ Petitions, the Government tried their best to implement the scheme in full swing.
In Odisha, the 1997 Rural BPL data and 2004 Urban BPL data were used for preparing the RSBY BPL database. The 1997 Rural BPL database had only the information of head of family and do not carry any information of family details. A series of exercise were undertaken by the state nodal agency to prepare the data in accordance to the BPL list and suitable to RSBY template. As a result the enrolment work could be completed in all 30 districts with not much difficulty as was experienced in the first round.
In the year 2011-12 the scheme has been extended to all 30 districts of the state. The initial six districts are now in second year (Round 2) and the remaining are in first year (Round 1) of implementation.
Odisha is one of the Pioneering States in implementation of Rashtriya Swasthya Bima Yojana. The State Government has been vigorously pursuing the implementation of the scheme in the State. As a part of its commitment, the State Government has already taken number of steps to accelerate in implementation of the scheme.
• The scheme is implemented in all the 30 districts of the State.
• 33. 91 Lakh BPL families during the year 2011-12 have been enrolled under the scheme in the state and the average percentage of enrolment is 64.94% The figure is almost 10% of the total active RSBY Smart Card Holders of the Country.
• 420 Government Hospitals including Medical College Hospitals and 75 Private Hospitals have been empanelled under the scheme to provide health facilities to the beneficiaries.
• As on 31.01.13 , 1,26,162 Smart Card holders of the state have availed the cash less health benefit of Rs.40,32,99,152/- (Details of number of BPL families identified, Insurance company implementing the secheme in the state,BPL families enrolled, Number of smart card holders availed the benefit involving the amount, number of Government and Private hospitals empanelled etc. is enclosed in annexure – A)
• Performance of Odisha in implementation of the scheme much higher than the national average . ( comparative statement is enclosed as Annexure – B)
Grievance Redrassal
• To redress the grievance of the beneficiaries, Service providers and others, State Level Grievance Redressal Committee in the State Level and State Toll Free Number – 155368 is in existence. Similarly in the districts District Level Grievance Redressal Committees have been formed.
IEC activities
For disseminating the benefits of the RSBY the SNA has taken up various activities in the state. Some of the notable activities under taken are ;
• Short films on RSBY has been prepared by the SNA which has been shown in the Workshops ,Enrolment camps, Health Camps and telecasted in Door Darshan .This film is one story which shows the contrast between conditions of card holders and non card holders facing health hazards.
• Video Spots of different scripts (30 Sec., 20Sec.10 Sec.) have been prepared and telecasted in the Prime Electronic Media Channels. It is powerful comedy giving powerful message.
• Labour Commissioner, Odisha has propagated message of the benefits of the scheme in different Electronic Media and in All India Radio in the form of Live Phone-in Programme & Panel Discussions.
• The Labour Commissioner has written different articles on RSBY published in the daily News papers – Samaja, Sambad, Samaya, Sambad Kalika and Doordarshi.
• RSBY messages also been disseminated through the Print Media in all most all News Papers, Magazines, Souvenirs etc.
• Smart Card holder beneficiaries have been provided with open heart surgery, uro-surgery in some of the empanelled hospitals .
Workshops
• State Level sensitisation workshops
• District Level Workshops under the chairman ship of the Collector
• VEDEO Conferancing through ORSAC and NIC- 24.07.12
• Health camps-
Review
• By the Hon’ble Minister Labour and ESI – 28.04.12 and 30.08.12
• High Power Committee headed by the Chief Secretary Odisha- 30.04.12, 12.12.12 30.01.13
• Commissioner –cum- Secretary Labour and ESI – 25th of every month
• Labour Commissioner, Odisha – 10th of every month
• Grievance Redressal Committee Meeting – Every third Tuesday
• Joint meetings with the Health and Family Welfare Departments- 04.04.12,
Out Patient Pilot Project in Puri
• Out Patient Pilot Project in the district of Puri is operational as a support scheme for RSBY IPD without causing any financial liability. 26 hospitals other than the hospitals empanelled under IPD have been empanelled and 78,116 beneficiaries have availed the benefit in the district.
Appreciation by Government of India
• In the review meeting on implementation of RSBY and workshop on OPD held in the month of Oct. 2012 organised by Ministry of labour and Employment, GOI and State Government , Odisha which was also attended by six other states, Odisha was awarded by Director General Labour Welfare Government of India for best enrolment, best OPD and for functioning of helpdesk.
Plan for the future
• Other categories of workers such as MGNREGA Workers, Building and Other Construction Workers, Beedi Workers, Railway Coolie and Vendors, Domestic Workers and Street Vendors, Aam Admi Bima Yojana/ Janshree Bima Yojana, Old Age pension holders will be included under the scheme shortly .
• Renewal/ tendering process of policy period under the RSBY Scheme in all 30 district so to provide uninterrupted benefit to the beneficiaries and to cover all eligible beneficiaries under the scheme.
• To disseminate the benefit of the scheme to the beneficiaries under the scheme extensive post enrolment IEC activities will be undertaken by the State Nodal Agency. The insurance companies will be impressed upon to conduct pre enrolment IEC activities.
• The insurance companies will be impressed upon to empanel maximum number of Private hospitals under the scheme
• Out Patient Pilot Project implemented in the district of Puri as a pilot project will be further extended for a period of one year and will be coterminous with the existing policy period of In-Patient RSBY scheme of Puri district. Tripartite agreement with ICICI Foundation, ICICI Lombard GIC Ltd and State Nodal Agency will be made in this regard.
• The State Server will be linked with the District servers through contracting the services of NIC in the office of the Labour Commissioner, Odisha.
• Increase the number KIOSKS – In all Medical College Hospitals
• Package rate of diseases to be increased and more number of hospitals will be empanelled
• Third Party Audit will be made by engaging a suitable agency. The SNA will select an agency after observing due formalities. The audit will focus on enrollment and distribution of smart cards to eligible beneficiaries apart from the rejected claims.
• PACS a voluntary Organisation with whom an MOU has been signed to undertake pre and post enrollment IEC activities without causing any financial liability on Government will be coordinated to undertake vigorous IEC activities.