The Rashtriya Swasthya Bima Yojna (RSBY) has proved to be a big health cover for the economically weaker sections of the society as eligible families are getting free medical treatment facilities under the scheme. It is a cashless scheme being provided through Smart Cards and is striving to achieve its objective i.e. cut in out of pocket expenditure on catastrophic health expenditures. The beneficiaries are able to avail the cashless treatment in any of the empanelled hospital in India (empanelled by other States/UTs under RSBY).
Under this scheme, health coverage up to Rs. 30,000 has been fixed to each family for one year on family floater basis. Smart Card issued under the scheme in the name of the head of the family, could cover upto five members in all, for the benefits. The health cover is for more than 1000 diseases and the eligibility for the claim becomes on the admission in empanelled hospitals. However, on the new Smart Cards, the benefit of the scheme can be claimed without admission into the hospital. The patient is entitled to get free medicines upto Rs. 150 per month including medical test in the Hospital without getting admission in the hospital and can avail benefit up to Rs. 1500 in a year.
The unique feature of RSBY in Himachal Pradesh is provision of Rs. 1,75,000 per family for critical illness which is called as RSBY Plus. Three hospitals in the State have been empanelled to providing critical care viz. IGMC Shimla, PGIMER Chandigarh, and Dr. Rajender Prasad Government Medical College Tanda. Among critical diseases include treatment of Cardiac and Cardiothoracic Surgeries, Genito Urinary Surgery, Neuro Surgery, Radiation Oncology, Trauma, Transplant Surgeries, Spinal Surgeries, Surgical Gastroenterology, Hemophilia and Cancer. The treatment expenditure under critical care is directly reimbursed to empanelled hospitals by the State Nodal Agency.
For empowering the beneficiaries as many as 177 hospitals have been empanelled under the RSBY which includes 155 public and 22 private. Beneficiaries have been provided the freedom of choice between public and private hospitals.
The empanelled hospitals within and outside the State, have provided cashless benefit of more than Rs. 64.37 crore by treating more than 1.43 lakh Smart Card holders since inception of the scheme in the State out of which 2816 patients were given treatment under critical care and claimed Rs. 1296.87 lakh.
State Nodal Agency, HP has hired an Office at PGIMER, Chandigarh for providing cashless treatment to all the Smart Cart Holders of the State. The critical care is being managed directly by the department and 46 RSBY Smart Card holders have availed treatment amounting to Rs. 19.51 lakh at PGIMER, Chandigarh.
Initially, the scheme was covering only BPL beneficiaries which was extended from 1st January, 2013 to other categories viz: MGNREGA workers those who work for more than 15 days in preceding financial year, building and other construction workers, persons with more than 70 percent disabilities, domestic workers and street vendors. Now, other categories including sanitation workers, rag pickers, auto rickshaw and taxi drivers, weavers, artisans and contractual employees are also being covered under the ambit of the scheme. The disabled and contractual employees are State specific only and State is paying 100% premium. The current policy period for the beneficiaries already enrolled under the scheme has been extended upto 30th November, 2014 whereas new enrollment has already been started and more than three lakh new smart cards have already been issued.
Himachal Pradesh has achieved best in terms of enrollment as well as utilization of the scheme. The conversion ratio remained above 70% in all the years of enrollment. The State was awarded as “Best Utilization Rate State” in the country in April, 2013 during the National Workshop held at Thiruvananthapuram, Kerala.