Rashtriya Swasthya Bima Yojna: 2010 Guidebook - Health Systems ...

More documents

Recommendations

Info

• Maternity and NewbornChildren covered, subjectto conditions. See box.• Transportation costs arecovered with a maximumof Rs. 100 per visit andan annual limit ofRs.1,000.• Family size: up to fivemembers of a householdcan be covered. If thereare more than threechildren, the head of thehousehold must decidewhich three to beinsured. Extended familycannot be included in thefamily even if thebeneficiary familyconsists of less than fivepersons. Enrollment ofthe head of thehousehold and thespouse is compulsory.Maternity & Child Coverage under RSBY• All expenses related to the delivery ofthe baby (normal or cesarean) in thehospital/nursing home are covered• Coverage up to Rs 2,500 for normaldelivery• Coverage up to Rs 4,500 for caesareansection or complicated delivery• Involuntary termination of pregnancy orother medical emergency• Newborn coverage from day one up tothe end of the policy, even if thenewborn is the sixth member of theenrolled family. (Upon renewal, thehead of household must decide whichdependents are to be enrolled; only 5family members are covered)• Normal hospitalisation period for bothmother and child should not be lessthan 48 hours post delivery• Benefit is on a familyfloater basis, whichmeans that the totalbenefit amount (Rs.30,000) can be used byone person or jointly withother members of thefamily.• Age Limit: There is nolower or upper age limitfor coverage.• Maximum benefit for maternity coverageis Rs. 4.500/- including transportationcharge of Rs. 100/- per hospitalisationExclusions under Maternity Benefit• Abortion: Voluntary termination ofpregnancy, except for medicalemergency to save the life of themother• Hospitalisation Period: If less than 48hours from the time ofdelivery/operation• Payment by beneficiaries: Beneficiaries are required to pay Rs. 30 perfamily as registration charge, at the time of enrollment and upon renewal.Page 6
EXPENSES NOT COVERED UNDER RSBY• Conditions that do not require hospitalisation• Outpatient Diagnostic, Medical and Surgicalprocedures or treatments• Expenses for evaluation/diagnostic purposes• Expenses on vitamins and tonics etc.• Dental treatment or surgery unless arising from disease or injury andwhich requires hospitalisation• Congenital external diseases• Drug and Alcohol Induced illness• Sterilization and Fertility related procedures• Vaccination• Plastic surgery• Circumcision• Suicide• Traditional medicine,including Unani, Siddha, andAyurveda<strong>2010</strong> RSBY <strong>Guidebook</strong> Page 7
Page 1 and 2: Rashtriya SwasthyaBima Yojna2010 Gu
Page 3 and 4: Table of ContentsThe Concept of Hea
Page 5 and 6: The Concept of Health InsuranceHeal
Page 7 and 8: Rashtriya Swasthya Bima YojnaHouseh
Page 9: RSBY COVERAGEWho is eligible?• BP
Page 13 and 14: RSBY ProcessesENROLLMENTEnrollment
Page 15 and 16: USE OF SMART CARD• The smart card
Page 17 and 18: ROLE OF TPA’S DISTRICT KIOSKSDist
Page 19 and 20: UTILISATION OF BENEFITSHospitalisat
Page 21 and 22: WHO TO CALL WHEN THERE IS A QUESTIO
Page 23 and 24: Glossary of Terms• Beneficiary/In
Page 25 and 26: • Out-patient Diagnostic - labora
Page 27 and 28: Annex I: Indicative List of Package
Page 29 and 30: Annex II: Indicative List of Day Ca
Page 31 and 32: Annex III: List of Empanelled Hospi
Page 33 and 34: 89Sai Nursing Home &Charitable Disp
Page 35 and 36: 9 Sant HospitalMain Burari Road, Sa
Page 37 and 38: List of Empanelled Hospitals - Sout
Page 39 and 40: List of Empanelled Hospitals - West
Page 41 and 42: 16Rao Raghubir Hospital &Maternity
Page 43 and 44: Annex IV: Important Contact Informa
Page 45 and 46: Annex V: List & Contact information
Page 47 and 48: Annex VI: References1. Fundamentals
Page 49: Annex VII: Photo Credits1. Page 1 -

Rashtriya Swasthya Bima Yojna: 2010 Guidebook - Health Systems ...

Create successful ePaper yourself

Delete template?

Save as template?