Biju Swasthya Kalyan Yojana: Registration, Eligibility and Benefits

Posted on: May 23, 2024 | 3 mins | Written by: HDFC ERGO Team

Biju Swasthya Kalyan Yojana: Registration, Eligibility and Benefits

As per the 2019 records, Odisha has been ranked second in the Catastrophic Healthcare Expenditure list. When the average healthcare costs rise above 40% of the average income of an expenditure, it is termed Catastrophic Healthcare Expenditure. To manage such circumstances, it is essential to have easy accessibility to individual health insurance and family health insurance as well.

Biju Swasthya Kalyan Yojana is an initiative of the Odisha government launched in 2018, a state government medical insurance scheme, especially targeted towards the economically weaker sections of the society.

What is Biju Swasthya Kalyan Yojana?

Under this special health insurance scheme, the beneficiaries have access to healthcare services at impaneled hospitals for curing several medical conditions like surgery, hospitalization, pre and post-hospitalization expenses, investigation costs, medicine costs, etc.

It has been specifically designed to support especially the economically weaker and underprivileged sections in society.

Eligibility criteria of Biju Swasthya Kalyan Yojana

All the Odisha inhabitants can access the BSKY facility across all the state-government-owned and operated healthcare facilities spread across the state. The eligibility criteria to access BSKY facilities include:

1. The beneficiary must be a resident of Odisha.

2. The facilities are available for both BPL and APL families.

3. There are no specific age limits for this. It is equally available for newborns to senior citizens.

Benefits of Biju Swasthya Kalyan Yojana

Some of the most highlighting benefits of Biju Swasthya Kalyan Yojana include:

1. Wide coverage:

BSKY card offers comprehensive health insurance coverage for up to INR 5 lakhs per family and INR 10 lakhs for women, for treatment costs incurred in Odisha. Over 250 surgeries and 4000+ medical treatments are covered under this scheme.

2. Affordable:

BSKY coverage is available at INR 30 per year for premiums. It is aimed to offer affordable but standard healthcare services to the families in Odisha.

3. Cashless facility:

Considering the status of the BSKY health card, you can even access cashless treatment facilities at network hospitals across the state. This further enhances the usability of the scheme, making it user-friendly. The scheme has tie-ups with nearly 200 hospitals which is expected to grow even further.

4. PED coverage:

BSKY even allows PED coverage. Moreover, there is no pressure of any specific waiting period to ensure this coverage. This means that even if you have asthma, hypertension, diabetes, etc. during policy commencement, you can still undergo treatments for these ailments under this policy scope without any exclusion or restriction. You must note that you need not undergo any medical screening before purchasing the plan.

5. Uncapped room rent:

BSKY does not impose any room rent capping.

Treatments covered under BSKY

BSKY allows medical treatment coverage for the following health issues:

1. In-patient coverage:

BSKY allows medical treatment coverage incurred due to in-patient hospitalization, pre- and post-hospitalization costs up to a specific tenure, room rent, nursing charges, etc.

2. OPD coverage:

BSKY allows OPD treatment coverage incurred during visits to hospitals or any government healthcare centre, including expenses incurred for investigations, medicines, consultation charges, etc.

3. Maternity expenses:

BSKY allows maternity expenses, including delivery costs and post-delivery care costs. It even includes postpartum care costs of the mother for a specified tenure immediately after discharge. This ensures complete medical care for both the mother and the child without financial worries.

4. AYUSH coverage:

BSKY allows Ayurveda, Unani and homoeopathy treatment cost coverage apart from the conventional allopathy treatment cost. It includes medication, investigations, Panchami therapies, and other approved procedures.

5. Organ transplant:

BSKY includes organ transplant costs offering critical illness insurance coverage too. It includes donor screening costs, organ harvesting costs, engraftment hospitalization charges, medicine costs, post-transplant recovery charges, etc.

Biju Swasthya Kalyan Yojana card and registration process

There is still no online method for BSKY registration. Every family in Odisha with SFSS and NFSA coverage can register under BSKY and receive a BSKY card. The government issues the BSKY health card for every eligible family. The BSKY database is updated in real-time and always in sync with the SFSS and NFSA databases.

Documents required for Biju Swasthya Bima Yojana

To enroll under the BSKY scheme, you need to provide the following documents:

1. Identity proof like an Aadhaar card, PAN card, voter’s ID

2. Address proof like an Aadhaar card, voter’s ID, utility bills

3. Income proof like income certificate, BPL card

4. Recent passport-size photograph

Claims settlement process of BSKY

The papers essential for claim settlement need to be uploaded on the BSKY app within 7 days of discharge of the concerned beneficiary. In case of any delay, the claim might get rejected.

Once a claim is raised, the money is transferred electronically through PFMS within 1 month.

If the concerned beneficiary undergoes multiple surgeries during one OT session, the one with the maximum rate the primary package and receives 100% reimbursement according to the concerned package rate; the second one receives 50% coverage; the third and other subsequent procedures receive 25% coverage under the BSKY scheme.

If there are any missing papers to be uploaded, the hospital is asked to complete the paperwork within 7 days. If the entire paperwork is completed within 7 days, then the claims are automatically accepted.

Documents required for making a claim against Biju Swasthya Bima Yojana

To ensure a smooth claim settlement under Biju Swasthya Bima Yojana you need the following documents:

1. Claim form

2. A valid Biju Swasthya Bima Yojana health card

3. Genuine identity proof

4. Medical documents

5. Receipts and bills of medical expenses incurred during the treatment course

Conclusion

BSKY has been introduced as a very crucial and critical initiative by the Odisha government for essentially mitigating the hefty financial load of medical healthcare costs on the residents of the state, especially those who belong to the comparatively weaker section of the society. The primary target for the introduction of this scheme is to ensure easy accessibility of standard medical care and protection for all irrespective of economic status and financial constraints and worries.

FAQs

1. Is the BSKY available to both rural and urban Odisha?

Yes, BSKY coverage facility is available throughout the state, be it urban or rural.

2. Is the BSKY facility available throughout the country?

No, the BSKY facility has been exclusively designed for the people of Odisha. You cannot avail of its coverage benefits outside the state.

3. Is there any specific age limit for enrolment in the BSKY scheme?

No, there are no age criteria to get enrolled under the BSKY scheme. It is open to people of all ages starting from newborns to senior citizens.

4. What is the procedure to add a new family member to the BSKY scheme?

You can add new family members to the existing BSKY scheme by properly updating the family information. You must obtain new health cards for the newly added members utilizing the synchronization procedure of the government.

5. Does BSKY cover all medical expenses?

No, BSKY does not offer complete medical coverage. There are certain exclusions. You must read the policy documents well beforehand to know the finer details.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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