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

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medicines that lead to hospitalisation. Expenses incurred one day beforeadmission at the hospital are covered under RSBY• Post-hospitalisation expenses are costs of care incurred after dischargefrom the hospital. Expenses incurred up to five days after discharge arecovered under RSBY.• Reimbursement of pre and post hospitalisation expense is subject toproduction of proof.Package Rates/Charges• RSBY has negotiated a packagerate/charge for all expenses (e.g.medicine, tests, bed charges,other materials, food etc.) relatedto the treatment of coveredservices. An empanelled hospitalshould not charge anything fromthe patient for treating somethingwhich is part of the list ofdiseases under package rates.• Under RSBY, a list of 725package rates has beendeveloped. An indicative list ofpackage rates under RSBY is provided in Annex I of this Guidebook.Process of Payment of Transportation Charges• Rs.100 will be paid to the beneficiary per hospitalisation (up to amaximum of Rs.1,000/- per year) at the time of discharge by the hospitalwhere he/she had been hospitalized. There is no proof (tickets/receiptsetc.) required to claim transportation charges.Coverage of Food Expenses of Family Members• Food only for the person who is hospitalized is covered in the package rate.Family members accompanying the patient have to pay for their food andrelated expenses.Coverage of OPD Expenses• Out-Patient Department (OPD) expenses e.g., medicines or tests, orexpenses in hospitals which do not lead to hospitalisation are not coveredunder RSBY and are therefore the responsibility of the individual.Page 162010 RSBY Guidebook
WHO TO CALL WHEN THERE IS A QUESTION• The TPA Call centre provides, through a State Toll free telephone number,telephonic guidance to the beneficiaries on various issues of coverage,utilisation of benefits or grievances, if any.• The Call Centre is functional for 24 hours a day, 7 days a week andthroughout the year.Call Center InformationBeneficiaries can receive information on the following areas from the TPA CallCentre:• Benefit details under the policy andthe balance available with thebeneficiaries• Information on Insurer’s office,procedures etc.• General guidance on the Services• Information about the process ofcashless treatment• Information on Empanelled Providers and contact numbers• Claim status information• Data of calls received and response on the system.• Any other relevant information/related service to the beneficiaries• Any of the required information available at the call centre to theGovernment/Nodal Agency• Any related service to the Government/Nodal Agency.2010 RSBY Guidebook Page 17
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 and 10: RSBY COVERAGEWho is eligible?• BP
Page 11 and 12: EXPENSES NOT COVERED UNDER RSBY•
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: UTILISATION OF BENEFITSHospitalisat
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 -

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