Senior Citizen health insurance scheme himachal pradesh

Himachal implements Senior Citizen Health Insurance Scheme, will provide Rs. 30,000 additional cover

If there are two senior citizens in a family, then a cover of Rs.60, 000 would be available on a floater basis to both the senior citizens.

Shimla: The Himachal Pradesh Government has implemented the Senior Citizen Health Insurance Scheme (SCHIS) in the state with an aim to provide access to curative geriatric health care services by way of additional insurance cover.

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, informed a government spokesperson.

Any beneficiary who is 60-years-old or above and is currently enrolled in RSBY or will be enrolled in RSBY is eligible for these additional benefits.

If in any RSBY rolled family, there is more than one senior citizen, then the additional cover will be multiples of Rs.30, 000 per senior citizen that will be provided on a floater basis among the senior citizens of the RSBY enrolled family.

Therefore, if there are two senior citizens in a family, then a cover of Rs.60, 000 would be available on a floater basis to both the senior citizens.

Exclusively senior citizen of the family enrolled in RSBY will be able to take additional benefit.

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.

The senior citizens of the families that are eligible for RSBY but not rolled in this scheme will not receive the benefit of SCHIS.

This package will be over and above the annual package of Rs.30, 000 per family provided under RSBY.

The spokesperson said various packages have been offered under SCHIS. Ministry of Health & Family Welfare has prepared a separate list of surgical packages that cost more than Rs.30, 000.

It was done through a technical committee that included 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.

These two additional covers 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).

These two additional covers 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. Under the Trust Model, Central and State government will share the insurance premium in the ratio of 90:10.

All such funds will be routed through a corpus-pooled bank account.

The unspent amounts will be refunded at the closing of the financial year.

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, said the spokesperson.

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 conforming 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.

Expenses for IEC and other administrative expenses will be borne by the state government out of the RSBY administrative funds.

The state government will bear the expenses for IEC and other administrative works 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.

Photo: Iran-Daily

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