Table 1 Key Parameters under Health Insurance Programs in India
Parameter | Rashtriya Swasthiya Bima Yojana (RSBY) | State health insurance programs for the poor (Andhra Pradesh, Tamil Nadu and Karnataka) | |
|---|---|---|---|
Description | Additional Caveats | Description | |
Benefits covered | Cost of hospitalization for 725+ procedures at empaneled hospitals up to INR 30,000 per annum per household; INR 100 per visit up to INR 1000 per year for transport cost | Pre-existing conditions are covered; minimal exclusions; day surgeries covered; outpatient expenditure is not covered | Andhra Pradesh - Families are provided coverage for INR 200,000 per family per year, and there are no restrictions on the number of family members enrolled Karnataka - INR150,000 per year for 5 persons in a family Tamil Nadu –INR100,000 per family per year |
Eligibility criteria | Must be on the official state BPL list; Limited to five members of the household including household head, spouse, and three dependents | All enrolled members must be present to be enrolled; | Must be on the official BPL list of the specific state. No restrictions on the number of family members enrolled in Andhra Pradesh, and Tamil Nadu. Covers five members of family in Karnataka. |
Premium and fees | INR 30 registration fee per household per annum paid by household. | Â | No specific enrolment fee in the three states of Andhra Pradesh, Karnataka, and Tamil Nadu |
Financing | 75%/ 25% Government of India/ State Government | The ratio is 90% /10% in Northeast states and Jammu & Kashmir | Completely funded by the respective states |
Insurer | Both public and private insurance companies can bid to work in a district or more than a district recommended by state governments | In one district only one insurance company is finally selected | Both public and private insurance companies can bid to work at the state level |
Service provider | Both public and private sector service providers can apply to join the network of providers empaneled under the scheme | Minimum eligibility criteria on quality of services to be provided have been laid down by the MoL & E | Both public and private sector service providers in the specific state can join the network of providers empaneled in the program. Minimum eligibility criteria laid down by the respective State Health Ministries |