Centre to expand health insurance benefits for poor

The Centre’s Rashtriya Swasthya Bima Yojana (RSBY) is being restructured to include 100 million below poverty line (BPL) people.

The Centre’s Rashtriya Swasthya Bima Yojana (RSBY) is being restructured to include 100 million below poverty line (BPL) people and increase cover for hospitalisation and health expenses from the Rs 30,000 to Rs 1 lakh.

The cashless hospitalisation scheme aimed at the poor would also be made more flexible to allow states to opt for top-up benefits for the people covered as well as include those above the poverty line.(HT Photo)

The cashless hospitalisation scheme aimed at the poor would also be made more flexible to allow states, which share the costs with the Union government, to opt for top-up benefits for the people covered as well as include those above the poverty line, a health ministry official said.

“While coverage will be free for BPL families, the new scheme will offer a low-premium option for the middle class and full premium for those who can pay,” said the official who did not wish to be named.

At present, the beneficiaries pay a token sum of Rs 30 to register and are issued a biometric smart card that entitles them to inpatient care of up to Rs 30,000 per family per year at empanelled hospitals.

The revamped RSBY will also subsume four central health plans that benefit 23 million families, which include 82 million people.

These schemes cover among other things outpatient and inpatient care, tertiary care and prescription drugs to employees, pensioners and their families.

These are the Central Government Health Scheme for civilian employees and pensioners, Retired Employees Liberalised Health Scheme of the railway health service, Ex-Servicemen Contributory Health Scheme for retired armed forces personnel and Employees’ State Insurance Scheme (ESI) for workers and their families in the organised sector with an annual income of Rs 1.8 lakh or less.

“MoUs (memoranda of understanding) will be entered with the state governments so that states that want to extend the services to people above poverty line and provide secondary and tertiary benefits can do so as a top-up of the scheme,” said Bhanu Pratap Sharma, secretary (health), ministry of health and family welfare, which has been made the nodal agency for the restructured RSBY.

Secondary healthcare involves patients being referred to specialists in better hospitals. Tertiary care is consultative care usually provided to a patient on reference from primary or secondary medical centres for special investigation and treatment.

“An important feature of the new scheme will be the strong IT platform beings set up for facilitating operations. A large database is being created that would include facilities at every hospital, disease profile and other details of each stakeholder,” Sharma said.

Free medical check-ups once every three years for middle aged and elderly at risk of heart diseases and diabetes will also be provided under the revamped RSBY.