Rashtriya Swasthya Bima Yojana - RSBY
Rashtriya Swasthya Bima Yojana: is a "National Health Insurance Program" designed by the Government of India for unorganized sector workers belonging to BPL category and their family members (a family unit of five). The salient features of the Yojna are:
- Cashless Hospitalization in public as well as private hospitals to all covered ailments.
- Hospitalization expenses, taking care of most common illnesses with as few exclusions as possible.
- All pre-existing diseases to be covered.
- Transportation costs (actual with maximum limit of Rs. 100 per visit) within an overall limit of Rs.1000.
The project works with Central and State government sharing 75% and 25% of the financial investment respectively. The insurance companies are chosen based on tendering systems and these insurance companies appoint the Third Party Administrator to outsource the job for claim management and enrolment.
The scheme started enrolling on April 1, 2008 and has been implemented in 25 states of India. A total of 23 million families have been enrolled as of February 2011. The scheme is based on cutting edge technology solutions i.e. smart card. Transactions are real time, hassle free and completely cashless. Ten thousand hospitals are now part of this scheme to empower the BPL people with Health benefits.
The key feature of RSBY is that a beneficiary who has been enrolled in a particular district will be able to use his/ her smart card in any RSBY empanelled hospital across India. This makes the scheme truly unique and beneficial to the poor families that migrate from one place to the other.
Vidal Health TPA Pvt. Ltd., has proved its social commitment by being a part of such National Health Scheme arranging identification of beneficiaries, issuance of smart cards, Empanelment of hospitals & claim settlement. It was actively associated with the implementation of the Scheme in Kerala. Now, Vidal Health TPA Pvt. Ltd., is involved in the implementation of a similar Scheme in Karnataka in 8 districts.
The “Chief Minister’s Comprehensive Health Insurance Scheme”
This is an Insurance Scheme launched by the Tamil Nadu State Government through the United India Insurance Company Ltd to provide free medical and surgical treatment in Government and Private hospitals to the members of any family whose annual family income is less than Rs.72,000/- (certified by the Village Administrative Officers) . Vidal Health TPA Pvt. Ltd. is proud to be associated with this mega public health scheme as the lead TPA.
The Scheme provides
- Cashless hospitalisation facility for a thousand and odd specified ailments/ procedures under the scheme up to Rs.1,00,000 per family per year.
- Limit increased to Rs.1,50,000 for some critical ailments/ procedures listed under the Scheme.
- Also pays for (i) Listed Follow-up Treatment & (ii) Listed Additional Diagnostic procedures.
Vidal Health TPA Pvt. Ltd., has set up an exclusive Project Office in Chennai to service the scheme. Smart Cards (Biometric) are used to prevent misuse of the scheme. To facilitate identification of the people who need hospitalization/ treatment several health camps have been organized all over the state. An exclusive Network of Hospitals has been created in Tamil Nadu as well as the adjoining states with special very low package rates for all the procedures listed in the Scheme. Liaison Officers have been specially recruited and posted in these hospitals to facilitate hassle-free cashless facility to the beneficiaries. ‘Online Claim Submission’ and ‘Claim Settlement’ have been successfully implemented to avoid processing delay. A dedicated ‘Toll Free Line’ is provided with 24 hour Customer Service Centre facility.