Bhamashah Swasthya Bima Yojana: Boon for the underprivileged

3In its three years of commitment and performance, the present Government under the visionary and dynamic Chief Minister Vasundhara Raje has drawn out and formulated various extensive schemes and programmes to take care of the health of entire population across the State.

In an initiative to bring poor and downtrodden section of the society within the gamut of ensuring hightech and latest medical and health facilities, Government of Rajasthan has launched the Bhamashah Swasthya Bima Yojana, a unique and unprecedented medical insurance scheme.

In accordance to the Budget Announcement for the year 2014-15, the Bhamashah Swasthya Bima Yojana was launched on December 13, 2015 in Rajasthan. The ambitious Health Insurance Scheme is visualised to provide “hassle free cashless treatment, improved quality of care with efficiency” to the beneficiaries. The underprivileged, who otherwise have no access to hightech and expensive medical treatment, are being provided with an opportunity to get health services in private health institutions with super specialty medical facilities. The scheme is applicable for the residents of Rajasthan alone. This scheme is envisaged to bring a revolution in healthcare in rural area – by providing stimulus to private sector to open hospitals in rural areas and reduce the increasing burden on Government facilities in order to provide quality healthcare to over one crore families identified under National Food Security Scheme (NFSS) and National Health Insurance Scheme.

The health insurance scheme Bhamashah Swasthya Bima Yojana (BSBY) is likely to lessen workload on Government Health Institutions, ensure financial strengthening of Medicare Relief Societies of Government Health Institutions. Under the scheme, wide health database is generated which is further used for making policy decisions. This is the most comprehensive health insurance scheme of the country, under which maximum packages are being made available through government and private hospitals.

Basic aim of scheme is improvement in health indicators. However, Bhamashah Swasthya Bima Yojana also reduces ‘out of pocket’ expenses and provides financial security to the poor against illnesses. It successfully rolls out Government’s vision of maximum Governance and minimum Government, It hedges the financial risk of excess expenditure on healthcare by using Insurance as a tool.

Beneficiaries:- The scheme envisages benefits to the NFSS (National Food Security Scheme) beneficiaries and RSBY (Rashtriya Swasthya Bima Yojana) beneficiaries.  Implementation of the scheme is to be done through Bhamashah Cards, but till the time Bhamashah cards are issued, identity related to NFSS and RSBY is also be honoured.

Cover: Under the scheme, health insurance cover of Rs 30,000 is being provided for general illnesses and Rs 3 lakh for critical illnesses is being provided to a family on floater basis in one year for IPD procedures. All the illnesses of the members of ensured family are covered under Bhamashah Swasthya Bima Yojana.  This health cover is being provided by the New India Assurance Company.

Provisions of Bhamashah Swasthya Bima Yojana include 7 days of pre-hospitalisation and 15 days post hospitalisation facility to the beneficiaries. It also provides transport allowance of Rs 100 to Rs 500 for cardiac and poly-trauma cases. The health insurance scheme includes several packages. Packages are available for 1148 general illnesses, 500 critical illnesses and 67 are reserved for government hospitals. There are prescribed packages for secondary and for tertiary illnesses/treatment.

The package includes bed expenditure in the general ward, admission & nursing charges, surgery, consultation fee of the doctor, anesthesia, blood, oxygen expenditure, surgery equipment and medicine expenditure, plantation equipment, x-ray and tests etc.

Service Delivery:- These benefits are cashless for the beneficiaries and services are being made available through community health centers, government medical institutions, government and private hospitals, authorised under national health insurance scheme. There are 494 government health institutions and 631 empanelled private health institutions. Several multispecialty hospitals are providing services under the BSBY. RSBY hospitals stand empanelled if they agree for the required parameters for implementation of BSBY. New hospitals are empanelled if they fulfill the minimum requirements and provisions laid down in the RFP.

All the empanelled private hospitals have to abide by the rules and regulations issued by the government from time to time during the course of the implementation of the BSBY.

Adequate measures have been taken at the state and district level to ensure wide publicity of the ambitious public welfare scheme of  Bhamashah Swasthya Bima Yojana  in order to ensure that the maximum number of eligible persons take the optimum benefits of the scheme. Hoardings, flex, banners, pamphlets, posters and  leaflets are being distributed and put at public place to inform the masses about the advantages and benefits of the scheme.

At village level, Asha Sahyoginis are playing an important role between the medical department and the community by informing the rural masses about the facility of cashless medical facilities under the Bhamashah Swasthya Bima Yojana. The scheme is being regularly monitored. The progress of the scheme is being reviewed by the higher authorities of medical and health department. Toll-free call centres have been set up separately at the Directorate of Medical and Health to answer the queries of the common man in regard to the Bhamashah Swasthya Bima Yojana and also to sort out the problems pertaining to the scheme.

Apart from this, feedback is also being gathered from the people who have already availed the benefits of the Scheme. Latest information, directions, guidelines  issued by the State Government in regard to the scheme from time to time are being made available on the website  separately designed for this purpose.

Bhamashah Swasthya Bima Yojana has registered a constant increase in the number of beneficiaries. Since the inception of the scheme till November this year, more than 6 lakh claims have been forwarded by hospitals to the insurance company. Against the sanctioned claims to the hospitals, the Insurance company has made available over Rs 234 crore for the claims.
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