Is to provide the insurance cover to below poverty line [BPL] House holds from major & minor health shocks that involves hospitalization.
AREA OF FOCUS :
The scheme will cover Rs. 1,00,000/- BPL households / families giving them free access to health services of Kadapa & Chittoor District of Andhra Pradesh.
STRATEGY TO BE ADOPTED:
Initiating the scheme in two districts would mean covering the largest number of beneficiaries i.e., covering 100,000 BPL households.
The scheme will provide health insurance cover of 30,000 INR per year per BPL family (of five members) working in the unorganized sector. BPL families entitled to more than 700 in patient medical procedure and pre medical conditions are covered and there is no Age limit coverage extends to the head of house hold. Spouse and up to three dependents will be covered.
The Central Government and the trust in the ratio of 75: 25 will pay the annual premium for each beneficiary under the scheme.
AREAS OF OPERATION:
- More than 700 in patient medical procedures
- Free OPD consultations
- Specified surgical procedures in General ward
- Transportation cost of Rs. 100/- per visit.
Coverage under the scheme is being provided for BPL workers and their families (up to limit of five). A family would compromise the house hold head, spouse and up to three dependents.
The scheme will provide health insurance cover of Rs. 30,000/- per annual per BPL family working in the unorganized sector. The families are entitled to more than 700 in patient medical procedures and pre – existing medical conditions are covered and there is no age limit.
The majority of financing, about 75 percent, is provided by the Government of India under RSBY (Rashtriya Swasthya Bima Yojana) scheme, while the remainder is paid by the Trust. The organization engage in competitive bidding process and select a public or private insurance company licensed to provide health Insurance. The Insurer must agree to cover the benefit package prescribed by GOI trough a cashless facility that in-turn requires the use of smart cards which must be issued to all members.
The financial bid is essentially and annual premium enrolled house hold. The use of smart card will make the scheme truly cashless and also be provided inter operability to facilitate use by migrant labour.
An electronic list of eligible BPL households is provided to the insures according to a pre-specified format the list is posted in each village prior to the enrollment and the date and location is publicized in advance mobile stations are set up at local centers. These stations are equipped with the hard ware required to collect biometric information (finger prints) of the members of the house hold covered, and to print smart cards with the photo.
The smart card will be issued by the Insurance Company through the instrumentality of the smart card service providers. The smart card entitled its bearers to list of pre–specified in patient services in the second month following enrolment.
The insurance companies are mandated to set up help line in each district and shall be their responsibility to maintain it.
Total cost of the budget for 3 years about: 9, 81, 00,000 Indian Rupees.
NEED OF THE PROJECT:
The workers of unorganized sector constitute about 93% of total work force in the country. Majority of the workers are still without any social security coverage.
One of the major insecurities for workers in the UN-organized sector is the frequent incidences of illness and need for medical care and hospitalization of such workers and their family members. Despite the expansion in the health facilities, illness remains one of the most prevalent causes of human deprivation in India. It has been clearly recognized that health insurance is one way of providing protection to poor house holds against the risk of health spending leading to poverty. The poor are unable or unwilling to take up health insurance because as its cost or lack of perceived benefits. Organizing and administering health insurance, especially in rural areas, is also difficult.
To fulfill the barriers and to implement rural health plans with a broad collaboration out to obtain as critical access, the BPL family are definitely in need of health insurance scheme giving the opportunity to free access to health services.
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