With a view to provide easy access to curative geriatric health care services by way of additional insurance cover, the state government has implemented the Senior Citizen Health Insurance Scheme (SCHIS) in the state.
The scheme will provide top up coverage of Rs. 30,000 per senior citizen to all existing Rashtriya Swasthya Bima Yojna smart card holders in addition to basic coverage of Rs.30,000 in Trust/Society mode. The coverage will be provided through State Nodal Agency HP Swasthya Bima Yojna Society till the start of National Health Protection Scheme and through Insurance Company after starting of National Health Protection Scheme.
A Spokesperson of the state government said that the targeted beneficiaries of this scheme, notified recently, are RSBY enrolled persons aged 60 years and above. The senior citizens of those families that are eligible for RSBY but not currently rolled in this scheme will not get benefit of SCHIS.
He said the scheme will provide an additional coverage of Rs.30,000 per senior citizen per year in the eligible RSBY beneficiary family. This package will be over and above the annual package of Rs.30,000 per family provided under RSBY. Exclusively senior citizen of the family enrolled in RSBY will be able to take additional benefit. If in any RSBY rolled family, there are more than senior citizen, then additional cover will be multiples of Rs.30,000 per senior citizen and will be provided on a floater basis among the senior citizens of the RSBY enrolled family. Therefore, if in a family there are two senior citizens, then an additional cover of Rs.60,000 would be available on a floater basis to both the senior citizens.
The Spokesperson said various packages have been offered under SCHIS. A separate list of surgical packages that cost more than Rs.30,000 have been prepared by the Ministry of Health & Family Welfare through a technical committee, including representatives from the Ministry, State governments and technical experts by covering Cardiology, Cardiothoracic Surgery, Cardiovascular Surgery, Neurosurgery, Poly-Trauma and repair, Burns, Surgical Oncology and Medical Oncology. Since the Government of India has included the tertiary care packages under SCHIS, treatment can be provided up to Rs.30,000 where only one senior citizen is in a family and up to Rs.60,000 where two senior citizens are in a family on family floater basis, hence additional over and above of Rs.30,000 or Rs. 60,000 as the case may be, will be compensated from existing top up of RSBY critical care up to Rs.1.75 lakh (for cancer it is up to Rs. 2.25 lakh).
Financing of the scheme will be done through insurance and trust models under Insurance Model. The estimated annual add-on premium for the implementation of SCHIS is up to Rs.500 per family. The Central and State government will share the insurance premium in the ratio of 90:10.
Under the Trust Model, the Central government will provide up to Rs.450 (90 per cent per family (families in which senior citizens are included). The State government will contribute 10 per cent. All such funds will be routed through a corpus-pooled bank account. Any amount remain unspent out of the funds released by the Central government earlier shall be refunded at closing of the financial year.
Any beneficiary who is currently enrolled in RSBY or will be enrolled in RSBY, and if is of age 60 years or above, is eligible for these additional benefits. There will be no separate enrolment process to provide benefits under SCHIS. The same smart card issued for RSBY will also be used for identification and verification to get benefit under SCHIS.
All the providers already empanelled under RSBY will be automatically empanelled for providing benefits under the SCHIS. The hospital will need to install necessary hardware and software confirming to the guidelines issued by the Central government for providing benefits under this scheme.
The trust/society will receive claims directly from the hospitals and will settle them based on the defined package rates. The central share would be paid in the same ratio as mentioned above with respect to total actual expenditure for claims payments. Expenses for IEC and other administrative expenses will be borne by the state government out of the RSBY administrative funds.
He said a beneficiary under SCHIS would be able to get cashless treatment in any of the RSBY empanelled hospitals as per the fixed norms and guidelines.