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Bhamashah Swasthya Bima Yojana – Taking Healthcare to All in Rajasthan

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Understanding the fervent publice desire to have a genuinely useful healthcare system, especially for the have-nots of the society, the Government of Rajasthan is reaching out to all with its flagship healthcare scheme — Bhamashah Swasthya Bima Yojana (BSBY), observes Shashank Nautiyal of Elets News Network (ENN).

BSBYBSBY, the cashless scheme meant to provide financial security to poor families in Rajasthan, is being implemented at 1899 empanelled hospitals which cover about 21 different specialties. Of these, at total of 519 are government hospitals, from the medical college to Community Health Centre (CHC).

It aims to provide quality healthcare to all beneficiary families of National Food Security Scheme.

Chief Minister of Rajasthan Vasundhara Raje first mentioned about the scheme in the budget 2014- 2015.

It was primarily launched in 2015-end to benefit people in the marginalised sections of the society with quality healthcare, with an aim to cover about 1 crore eligible families of Rajasthan. The first phase ended successfully on 12 December, 2017 and the second phase started on 13 December, 2017 for 2018 and 2019.

Eligibility

  • Citizens covered under the National Food Security Act (NFSA) and Rashtriya Swasthya Bima Yojana (RSBY) are eligible to avail its benefits.
  • No age bar to enroll for the scheme. Families of members are also eligible for enollment.

Features of Bhamashah Swasthya Bima Yojana

  • A complete cashless treatment scheme that pays for all health expenses incurred by the enrolled patients
  • The insurer gets Rs 30,000 for general illness and Rs 3 lakh for critical illness
  • Empanelled government and private hospitals provides patient care to the enrolled ones
  • The scheme provides a stimulus package to all empanelled private hospitals, if they show interest in opening their branches in rural areas
  • Rates are pre-decided for secondary and tertiary illness
  • The scheme also covers existing illnesses
  • Pre-hospitalisation medical expenses are covered up to seven days before admission in a hospital
  • Post-hospitalisation medical expenses are covered for up to 15 days after discharge from the hospital

Initially, the scheme was for in-patient expenses, but later, extended to OPD medical expenses as well

  • Call centres are there to get relevant information on this scheme. A mobile application is also there to track the status of the policy.

Benefits Package:

  • Out of 1,401 total packages under the scheme; 738 are secondary packages; 663 are tertiary packages
  • Cashless IPD (In-patient department) treatment is provided at all empanelled hospitals for all 1,401 packages
  • 67 disease packages are reserved for government institutions.

Empanelled hospitals and specialties: In the current phase of BSBY, the scheme is being implemented at 1,899 empanelled hospitals which cover about 21 different specialties. Out of these, 519 are government hospitals, right from the medical college to CHC (Community health centre).

 Budget: New India Assurance Agency (NIAC) is providing insurance coverage to beneficiary families. Rajasthan State Health Insurance (RSHAA) is responsible for paying the insurance premium on behalf of the eligible persons to the successful bidder. So far, packages worth more than Rs 1,800 crores have already been booked. Presently, a premium of Rs 1263 per family per year is paid to NIAC.

Progress: So far, more than 23.01 lakh patients benefitted under the scheme covering 1,401 different diseases which cover 21 different specialties.

Major Stakeholders

The scheme is owned by the Department of Medical, Health & Family Welfare and Department of Information Technology (DoIT) and the New India Assurance Co. Ltd. are key partners.

Swasthya Margdarshak (Health Guide): They are responsible to facilitate the complete process of BSBY scheme. Deputed to every hospital, their duty is to ensure eligibility of the visiting patients and to help them at every stage of treatment.

Role of ASHA: ASHA Sahyogini serve as the link between community and department. There about 46,000 ASHA Sahyogini are working in the State to aware eligible families about the scheme.

To make ASHA workers fully understand about the scheme and how they can reach out to the community, a video conference was also conducted under the chairmanship of the State Health Minister.

Three rounds of ‘ASHA Samwad’ were done through the conference. They were also provided with BSBY kit including dummy of Ration Card, Bhamashah Card, pamphlets of private hospitals, frequently asked questions etc.

Grievance Redressal: Given the big size of the scheme, the Government established purpose committees for Grievance Redressal at State and district level under the Chairmanship of CEO of State Health Assurance Agency and District Collectors respectively. These committees have been successfully addressing the complaints of people at empanelled hospitals.

Toll-Free Call Centre: A dedicated call centre has been established at Swasthaya Bhawan, the State’s headquarter to attend the queries of the beneficiaries and service provider. The centre also welcomes various feedbacks from the beneficiaries for the further improvement in actions. Results of the recent feedback of beneficiaries revealed that majority of the respondents were satisfied with the scheme. Most of the beneficiaries have said if there was no such scheme, they had to opt for a loan or to mortgage their lands.

Many citizens are also using this helpline to seek information on BSBY like empanelled hospitals, packages covered, no of illness covered under this scheme, and their eligibility for the scheme. People are also enquiring their remaining wallet balance of Bhamashah card through the toll free number.

“We have our in-house calling centre, which calls more than 50 percent of the beneficiaries to check their satisfaction level. As this is a total cashless scheme, we also confirm that not a single beneficiary is paying on the Bhamashah centres through calls, “said Ashish Modi, Joint CEO, Rajasthan State Health Assurance Agency (RSHAA).

 IEC/BCC: A dedicated website is created to inform beneficiaries about latest orders, guidelines and notices. Separate social media platforms are also created to share information and success stories of BSBY to engage more people. A widespread use of LED board can also be seen at BSBY empanelled hospitals to make beneficiaries aware about the scheme.

Under the scheme various tertiary care treatment are provided to BSBY beneficiaries at multi-specialty private and government hospital at free of cost as envisaged by the Government at the time of launch of the scheme.

To benefit newborns and pregnant women, there are separate packages related to the gynecological procedures for pregnant women and neonatal care for the newborn children in the scheme. The most important package for pregnant women is comprehensive ANC (Ante Natal Checkup) package, which comprises four ANCs at the time of delivery.

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