the heinz journal carnegie mellon university us

7/29/2019 The Heinz Journal Carnegie Mellon University US

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Rashtriya Swasthaya Bima Yojana:A Public-Private Partnership Micro Health

Insurance Model for Achieving Goal No. 1 ofUN Milennium Development Goals

By: Harish Sihare, Dr. Pawan Kumar, Mayank SihareVolume 8, Issue 2

Policy. Research. Practice.

The Heinz JournalThe H. John Heinz III College

Carnegie Mellon University

4800 Forbes AvenuePittsburgh, PA 15213


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Rashtriya Swasthaya Bima Yojana:A Public-Private Partnership Micro Health

Insurance Model for Achieving Goal No. 1 ofUN Milennium Development Goals

Harish Sihare, Dr. Pawan Kumar, Mayank Sihare, Carnegie Mellon University

Abstract

The UN Millennium Development Goal to eradicate extreme poverty and hunger is the mostbroadly supported specific development goal that the world has ever agreed upon. Health risksprobably pose the greatest threat to the lives and livelihoods of poor households (Jutting, 2004),

and a short-term health crisis can greatly contribute to long-term poverty. In this paper we triedto evaluate Rashtriya Swasthaya Bima Yojana (RSBY), an innovative public-private partnershipmodel of micro health insurance launched by the Government of India to eradicate thehealthcare problems and poverty of its population living below poverty line (BPL) in rural andurban India. The results of the study show that the program is not only providing free healthcare to poor households, but it is also giving them a chance to improve their standard of livingby providing access to quality healthcare through empanelled private players.

Keywords: Poverty, Below Poverty Line, RSBY, Micro Health Insurance, Health care, PublicHealth,


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Introduction

The United Nations Millennium Development Goal to eradicate extreme poverty and hunger isthe most broadly supported, comprehensive, and specific development goal that the world hasever agreed upon (www.undp.org). According to World Bank Revised Global and RegionalPoverty Estimates (2008), in 2005 95.3 percent of the extremely poor people (approximately903 million) in developing member countries (DMCs) resided in 25 countries located in theAsian Development Bank (ADB) region. In addition, about 900 million people in the ADBregion are moderately poor, meaning that 1.8 billion people, more than half of the regionspopulation, are extremely poor or vulnerable to poverty.

Poverty is a complex and multi-dimensional phenomenon that can result in inadequateresources required for a minimum livelihood and lack of access to skill development, education,healthcare and other amenities. Typically, when a member of a poor household experiences ahealth crisis their medical expenses and routine household expenditures rise, and theircontributions to their household income declines. (Wagstaff and Doorslaer, 2003; Gertler,Levine & Moretti, 2009; Gertler and Gruber, 2002). Approximately 150 million people aroundthe world experience a financial catastrophe, meaning they spend more than 40 percent of their

available income, after meeting their basic needs, on health care (WHO Factsheet N320, 2007).Low (nil) income coupled with high medical expenses can result in extremely high debt, the saleof assets, and the removal of children from school; potentially turning a short-term health crisisinto long-term poverty (Van Damme et al, 2004; Annear et al, 2006). Due to poverty and lowincome, these households generally forego high-value care, opting instead for low quality healthcare (Das, Hammer and Leonard, 2008),17 which contributes further to poor health outcomesand poverty. Subsequently, health security has become an integral part of any povertyeradication plan (Jutting, 2004).

Health insurance for poor people in the form of community/micro health insurancei (MHI) hasaddressed some of these problems in developing and industrialized countries (Escobar andPanopolou 2003; Knaul and Frenk 2005; Obermann et al. 2006; Liu and Rao 2006; Wagstaff et

al. 2007). By covering the cost of care after a health crisis, health insurance helps to smoothexpenditures, reduce the need to sell assets or take on new debt, increase the quantity andquality of care sought, and improve health outcomes (Levine, 2008). Various governments andvolunteer organizations have initiated and tried various models of micro health insurance inmany countries, including Brazil, India, Philippines, Ghana, Burkina Faso, Nigeria, Tanzaniaand the USA. Unfortunately many of these efforts have failed due to the use of a top-downapproach that is not tailored to the specific needs of the society, does not involve keystakeholders, lacks sufficient coverage, and does not built trust amongst the members. (Fieldand Thornton, 2009 ; Hamid et al, 2010)

The effectiveness of health insurance programs for the poor depends on their accessibility,affordability, and reach (Field and Thornton, 2009; Rosyara et al, 2006; Preker et al,

2002).Therefore,, there exists a need globally to create a cost-effective micro health insuranceprogram that addresses these issues and ensures the expansion and utilization of public andprivate healthcare systems effectively.

Poverty in India is a crucial issue, similar to other developing countries. According to anestimate of the World Bank (2005), 42 percent of the population in India falls below theinternational poverty line of USD 1.25 a day (purchasing power parities PPP), in nominalterms INR 21.6 a day in urban areas and INR 14.3 in rural areas. To aid this population theGovernment of India has started Rashtriya Swasthaya Bima Yojna (RSBY), an innovative and


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cost-effective new MHI program for families living below the poverty line (BPL) in rural andurban India (www.rsby.in). The programs main objective is to provide insurance coverage toBPL households experiencing a major health crisis that involves hospitalization. Within just twoyears of its initiation, RSBYs enrollment process has been initiated in 26 of Indias 29 states,resulting in the registration of 15,718,261 households by May 31, 2010 (www.rsby.in).

In this paper we have tried to explain how the Government of India utilized a public-privatepartnership to alleviate poverty and provide economic development for the most vulnerablesection of society. The program was analyzed under the lenses of affordability, accessibility,reach, and utilization of formal healthcare facilities by the poor. Data for this purpose is mainlytaken from statistics published by the Ministry of Labour and Employment, and theGovernment of India via the RSBY website. Based on the programs successful experience inIndia, we suggest replicating this model in the other 24 DMCs of the ADB region. Successfulimplementation and application of this model may provide a pathway to Goal No. 1 of UnitedNations Millennium Development Goals (MDGs).

The paper is organized as follows:

Section II includes a brief description of poverty scenario in India Section III provides a brief description of RSBY program and its modus operandi Section IV presents RSBYs success story Section V contains the studys conclusions and recommendations

Poverty Scenario in India

Pursuant to the Millennium Summit in September 2000, the worlds leaders adopted the UnitedNations Millennium Declaration (UNMD). The UNMD commits its member nations to a newglobal partnership to reduce extreme poverty and sets out a series of targets with a deadline of2015 (UN Nations, 2010). As stated previously, 42 percent of Indias total population is livingbelow poverty line, as defined by the new international poverty line of USD 1.25 (PPPii) per day.If the standard of USD 2.00 (PPP) per day level is used, then about 75.6 percent of thepopulation of India falls below the poverty line. At the same time, data also suggests that theproportion of the poor based on the poverty line of $1.25 (PPP) per day in India has beendecreased from 60 percent in 1981 to 42 percent in 2005.

Contrary to the above, poverty estimations of National Sample Survey Organization (NSSO) ofthe Ministry of Statistics suggest that the proportion of poor in 1990 was about 36 percent,which has declined to 27.5 percent in 2004-05 (Government of India, 2008). Different PPPbaseline and yeariii can account for the difference between these estimations. According to NSSOestimations (Government of India, 2008), the national poverty line at 2004-05 prices was INR356.30 per capita per month (i.e. INR 21,378 per household per annum) in the rural areas andINR 538.60 per capita per month (i.e. INR 32,316 per household per annum) in the urban areas.Put simply, out of total 300 million BPL in the country, 73 percent BPLiv live in rural areas. The

population living below the poverty line (BPL) in the rural areas is still unacceptably high at over220 million.

To achieve the Millennium Development Goal of reducing the proportion of poor by half (from36 percent in 1990 to 18 percent by 2015) the Government of India initiated several programs toaddress poverty in terms of adequate resources to make a minimum living/livelihood, andaccess to skill development, education, and healthcare (Government of India, 2008). Theseprograms are broadly categorized as:


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i. Wage employment program, which includes initiatives like the Mahatma GandhiNational Rural Employment Guarantee Act, (NREGA) 2005v that guarantees 100days of wage employment to every rural household.

ii. Self employment and skill development programs, like Swarnjayanti GramSwarozgar Yojana (SGSY)vi and the National Skill Development Mission (NSDM)

iii. Health care programs like the National Rural Health Mission (NRHM)vii andNational Urban Health Mission (NUHM)viii, which aim to improve the quality of lifeto rural and urban citizens and carry out the necessary architectural correction inthe basic health care delivery system.

iv. Social security and safety nets, which include programs like the Indira GandhiNational Old Age Pension Scheme (IGNOAPS) ix launched in 2007 to provide apension of IND 200 per month to every person above 65 years in a BPL householdand to offer a health security to the BPL households in the form of coverage of out-of-pocket expenditurex caused by health crises. Another prime example is theRashtriya Swasthya Bima Yojna (RSBY) program discussed in this paper.

Rashtriya Swasthya Bima Yojnaxi Scheme

RSBY was launched by the Government of Indias Ministry of Labour and Employment toprovide health insurance coverage to 60 million people living BPL. RSBY has brought togethernot only the central (federal) government, state government, public hospitals and publicinsurers, but also private hospitals and insurance companies (Figure 1). Beneficiaries underRSBY are entitled to hospitalization coverage up to approximately USDxii 667 (INR 30,000) formost diseases that require hospitalization. The government has also fixed the package rates forthe hospitals for a large number of interventions. Pre-existing conditions are covered from dayone and there is no age limit. Coverage extends to five members of the family, which includesthe head of household, spouse and up to three dependents. Beneficiaries need to pay less thanUSD 1.00 (INR 30) as a registration fee, while 75 percent of the premium is paid by the CentralGovernment and the remaining premium is paid by the respective State Government.


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Figure 1: A Public Private Partnership Model of RSBY (Swarup, 2008)

The selection of the insurer for a district or cluster of districts is done by the respective stateGovernment through competitive bidding. The insurer can be a public or private insurancecompany licensed to provide health insurance by the Insurance Regulatory DevelopmentAuthorityxiii (IRDA). The insurer is then expected to cover the benefit package prescribed by theGovernment of India through a cashless facility using smart cards that are issued to allmembers. Insurance companies usually subcontract with a qualified smart cardxiv provider toprovide this service. The insurers are required to engage intermediaries with local presence,such as NGOs, in order to provide grassroots outreach and assist members in utilizing theservices after enrollment.

The insurer is also required to provide a list of empanelled hospitals (either public or private)

that will participate in the cashless arrangement. These hospitals are expected to meet certainbasic minimum requirements (e.g., size and registration) and must agree to set up a specialRSBY desk with smart card readers and trained staff. The financial bid is essentially an annualpremium per enrolled household. The insurer is compensated on the basis of the number ofsmart cards issued, representing the number of households covered. Each contract is specifiedon the basis of an individual district in a state and the insurer agrees to set up an office in eachdistrict where it operates. While more than one insurer can operate in a particular state, onlyone insurer can operate in a single district at any given point in time.


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The program provides participating BPL households with the freedom of choice between publicand private hospitals. Its business model has been designed like a social sector program, withincentives built in for each stakeholder that will help expand and sustain the program in thelong run.

Insurers: Since the insurer is paid a premium for each household enrolled for

RSBY, there is motivation to enroll as many households as possible from the BPLlist, resulting in better coverage of targeted beneficiaries.

Hospitals: Hospitals are also paid per beneficiary treated, and so are alsoincented to provide treatment to a large number of beneficiaries. Even publichospitals have the incentive to treat beneficiaries under RSBY, as the money fromthe insurer is flowing directly to the concerned public hospital and can be usedfor their own purposes. Insurers, in contrast, monitor participating hospitals inorder to prevent unnecessary procedures or fraud resulting in excessive claims.

Intermediaries: The intermediaries, such as NGOs and MFIs, have a greaterstake in assisting BPL households and get paid for the services they render in

reaching out to the beneficiaries.

Overall by paying only a maximum sum up to 17 USD (INR 750) per family per year, thegovernment is able to provide access to quality health care to the BPL population with healthycompetition between public and private providers.

Outpatient department (OPD) facilities are not covered under this program but OPDconsultation is free. Any expenditure beyond consultation incurred in the OPD that does notlead to hospitalization will be the responsibilities of the beneficiaries. The program also includestransportation cost of approximately USD 2 (INR 100) per visit, with an overall limit ofapproximately USD 22 (INR 1,000) per annum.

The program does not cover the following situations/cases and diseases: conditions that do notrequire hospitalization, congenital external diseases, drug and alcohol induced illness,sterilization and fertility related procedures, vaccinations, war/nuclear invasion, suicide andnaturopathy, Unani, Siddha, and Ayurveda. However, the aforementioned are only indicativein nature and it has been specified in the guidelines that there should be minimum exclusions,that the list of exclusions would be negotiated between State and the insurers, and that it wouldbe subject to assessment by the Approval and Monitoring Committee to ensure that it is notoverly wide.

Contribution of RSBY Scheme for Poverty Eradication

The contribution of the RSBY program can be demonstrated as follows:

Reach of RSBY Scheme

To date 26 state governments, including 1 union territory, (Arunachal Pradesh, Delhi,Rajasthan, Gujarat, Haryana, Bihar, Uttrakhand, Kerala, Punjab, Chhattisgarh, Karnataka,Maharashtra, Manipur, Sikkim, Tamilnadu, Uttar Pradesh, West Bengal, Jharkhand, HimachalPradesh, Nagaland, Goa, Assam, Orissa, Tripura, Chandigarh and Meghalaya) have utilized theRSBY program. Of these 26 states, the enrollment process and empanelment of hospitals has


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begun in 22 states. Of the 631 districts in India, BPL families residing in 399 districts have beenselected for RSBY coverage (Table 1), with the programs enrollment process complete in nearly50 percent of these districts. In states where the enrollment process has been completed, thetotal BPL families enrolled out of the selected BPL population are about 57 percent. The successof the program has been clear within two years of its initiation - out of nearly 52 million IndianBPL families 29.5 percent have been covered by RSBY.

Table 1Penetration of RSBY Scheme Among Below Poverty Line Households in India

S.No.

State/UT

Number of Districts BPL Families

Total#

Selected*

E

nrollment

C

omplete*

En

rollmentin

Progress

inA

llDistricts^*

InSel

ecteddistricts*

E

nrolled*

%ageofBPLfamilies

Cov

eredinstate

%ageo

fTargetedBPL

fam

iliescovered

1

Andhra

Pradesh 23 0 0 0 2864400 0 0 0.00% -

2

Arunachal

Pradesh 16 0 0 0 40700 0 0 0.00% -

3 Assam 27 4 1 3 1050300 371346 127064 12.10% 34.22%

4 Bihar 37 37 10 9 5578450 5578450 2577171 46.20% 46.20%

5 Chhattisgarh 18 16 13 3 2220717 2220717 974701 43.89% 43.89%

6 Delhi 10 10 1 0 539471 539471 218055 40.42% 40.42%7 Goa 2 2 2 0 6953 6953 3505 50.41% 50.41%

8 Gujrat 27 27 10 0 1130034 1130034 682354 60.38% 60.38%

9 Haryana 20 20 19 1 1146942 1146942 691197 60.26% 60.26%

10

Himachal

Pradesh 12 12 2 9 286924 286924 218202 76.05% 76.05%

11

Jammu and

Kashmir 15 0 0 0 92100 0 0 0.00% -

12 Jharkhand 24 8 5 3 2124000 1630491 553260 26.05% 33.93%

13 Karnataka 28 6 0 5 2787700 338931 78103 2.80% 23.04%

14 Kerala 14 14 14 0 1767205 1767205 1173388 66.40% 66.40%

15

Madhya

Pradesh 50 0 0 0 4646800 0 0 0.00% -

16 Maharashtra 35 29 27 2 6558000 3461175 1515561 23.11% 43.79%

17 Manipur 9 0 0 0 69600 0 0 0.00% -


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S.No.

Sta

te/UT

Number of Districts BPL Families

Total#

Select

ed*

Enrollm

ent

Compl

ete*

Enrollm

entin

Progr

ess

inAllDistricts^*

InSelected

districts*

Enrolled*

%ageofBPL

families

Coveredi

nstate

%ageofTarg

etedBPL

familiesc

overed

18 Meghalaya 7 5 1 0 83100 50997 27330 32.89% 53.59%

19 Mizoram 8 0 0 0 23800 0 0 0.00% -

20 Nagaland 11 4 3 0 66800 49970 39301 58.83% 78.65%

21 Orissa 30 12 2 4 3813500 704717 418929 10.99% 59.45%

22 Punjab 21 21 19 2 451935 451935 170191 37.66% 37.66%

23 Rajasthan 33 33 4 0 2295700 0 0 0.00% -

24 Sikkim 4 0 0 0 24600 0 0 0.00% -

25 Tamilnadu 31 31 2 0 454736 454736 149520 32.88% 32.88%

26 Tripura 4 4 1 3 303335 303335 211238 69.64% 69.64%

27 Uttar Pradesh 70 70 58 11 9717452 9717452 4651461 47.87% 47.87%

28 Uttarakhand 14 14 2 0 117940 117940 53940 45.74% 45.74%

29 West Bengal 19 19 4 2 1913767 1913767 879002 45.93% 45.93%

30

Andaman and

Nicobar (UT) 3 0 0 0 21200 0 0 0.00% -

31

Chandigarh

(UT) 1 1 1 0 8000 8000 5407 67.59% 67.59%

32

Dadra and

Nagar Haveli

(UT) 1 0 0 0 18800 0 0 0.00% -

33

Daman and

Diu (UT) 2 0 0 0 5300 0 0 0.00% -

34

Lakshadweep

(UT) 1 0 0 0 1900 0 0 0.00% -

35

Puducherry

(UT) 4 0 0 0 55700 0 0 0.00% -

India 631 399 201 57 52287861 32251488 15418880 29.49% 47.81%

Source: #www.districts.nic.in/dstats.aspx, ^ State-wise Estimated Number of below Poverty Line(BPL) Households in India, (As on 01.10.2006), available athttp://www.indiastat.com/economy/8/incidenceofpoverty/221/stats.aspx, * RSBY website as on May 31,2010,http://rsby.in/Overview.aspx


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Availability of Health Care Facilities Under RSBY to BPL Beneficiaries

With the help of the public private partnership model for empanelment of hospitals in rural andurban areas more than 4,000 hospitals have been empanelled to provide cashless facilities to

BPL families. Private hospitals have shown a big interest in the program, motivated by potentialearnings from serving more patients. Out of the total empanelled hospitals, around 75 percentare private (Table 2).

The availability of specialized healthcare facilities for BPL families has increased significantly.For example, certain hospitals have started mobile healthcare services in the remote areas inorder to capitalize on the programs opportunities. In the state of Punjab a hospital is availablefor every 369 BPL families, whereas the average hospital availability for all India is one for every3517 BPL families (Table 2). Though Table 2 shows that this ratio is not as good in the states ofAssam, Bihar, Tripura and Uttar Pradesh, this may be due to empanelment processes that arenot yet completed in these states.

Table 2Access and Utilization of Healthcare Facilities under RSBY Scheme

State

Availability of Healthcare Facility Utilization of Healthcare Facilities

No. of

Private

Hospitals

Empanelled

No. of

Public

Hospitals

Empanelled

Enrolled

BPL

Families

Per

Hospital*

No. of

Hospitalization

Hospitalization

Value

Claim/Loss

Ratio#

Assam 1 5 21177 0 -

Bihar 204 14 11822 40,093 163,153,924 26.26%

Chandigarh 8 3 492 17 147,000 4.84%

Chhattisgarh 84 174 3778 4,952 20,111,640 49.34%

Delhi 77 - 2832 14,268 49,235,221 40.87%

Goa 2 - 1753 7 24,500 1.00%

Gujarat 259 94 1933 81,615 280,211,705 88.37%

Haryana 403 21 1630 51,703 251,418,106 64.61%

Himachal

Pradesh 23 122 1505 2,053 9,590,700 4.64%

Jharkhand 86 32 4689 16,630 82,092,448 25.26%

Karnataka 23 43 1183 4 1,000 0.01%


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Kerala 157 133 4046 157,887 489,662,387 80.31%

Maharashtra 654 8 2289 36,504 198,080,831 40.69%

Meghalaya 5 15 1367 31 145,195 2.37%

Nagaland 5 - 7860 1,765 13,472,653 52.79%

Orissa 47 17 6546 160 866,000 0.64%

Punjab 316 145 369 3,649 24,278,716 44.04%

Tamilnadu 32 - 4673 4,842 11,049,377 14.09%

Tripura - 15 14083 4,174 9,846,590 25.99%

Uttar

Pradesh 767 227 4680 112,418 659,676,400 48.35%

Uttarakhand 20 37 946 1,117 6,178,019 17.50%

West

Bengal 106 - 8292 13,326 71,526,200 19.31%

India 3279 1105 3517 547,215 2,340,768,612 29.60%

Utilization of Healthcare Facilities under RSBY Scheme

The use of public health care facilities is free of costin India, but limited availability means thatpoor people with lower means do not get access to the same. Hence, poor families prefer the

services of informal healthcare service providers like local vaidya, ozha, untrained mid-women,and hakkims etc. As a result, the disease burden related to infectious and chronic degenerativediseases (De Costa and Diwan, 2007), for which informal healthcare providers do not have therequired expertise and resources, is increasing among poor populations. As previouslydiscussed, continuous expenditure on these diseases leads to increased debt, the sale of assets,and ultimately chronic poverty.

Utilization of a formal healthcare system is the key to managing this multifaceted problem. MHIin the form of the RSBY program, at its core, has mitigated this financial risk and healthproblems of poor households. As of May 31, 2010, as many as 547,215 beneficiaries of the RSBYprogram have received free treatment in empanelled hospitals for various health ailments (Table2). An unofficial survey stated that around 2/3 of these claims are related to chronic and

infectious deceases. The total medical expenditure under RSBY for various medical treatments isaround 2,340 million in the last year. This reduced financial burden on BPL households is notonly improving health outcomes, but it is also helping them escape the clutches of poverty. Thisfact is further supported by high claim/loss ratioxv in states like Gujarat, Haryana, and Kerala inwhich the first phase of the program has been completed.


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Conclusion and Recommendation

Health insurance cover cannot change the probability of an adverse health event, but it canmitigate the financial consequences of a health crisis, especially for a poor households (Stone,2002). Access to health care in the form of micro health insurance is a boon for the people livingin chronic poverty, where a short-term health crisis can contribute to a never-ending viciouscycle of poverty. The success of an effective micro health insurance program for the poordepends on its ability to reach the target population and its successful utilization. The RSBYmodel in India is not only facilitating the overall social-economic development of poorhouseholds, but it is also giving huge business opportunities to all key stakeholders. Under theRSBY program around IND 70 million/year is pumped into each district by state and centralgovernments in the form of premiums paid for health insurance (Swarup, 2008). Within justtwo years of initiation, the realized outcomes of the RSBY program in terms of subscription rate,utilization of health services, and mitigation of economic burden for medical expenditure arebeyond expectation. These outcomes are not only helping to improve health outcomes, but arealso assisting the primary goal of MDGs by reducing the health expenditure burden of the poor.The model is able to achieve all this due to its unique mix of both public and privateparticipants, a transparent system, and the usage of information technology. Therefore, we can

safely conclude that the RSBY model can be a much needed, innovative and cost-effective publicprivate partnership model that can also be replicated in the other 24 DMCs of the ADB region.


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Endnotes

i Micro Health Insurance is a risk transfer device which refers to health insurancecharacterized by low premium and low caps or low coverage limits, sold as part of atypical risk-pooling and marketing arrangements, and designed to service low-income people and businessesnot served by typical social or commercial insurance schemes.ii Purchasing power parityiii World bank Base Year is 1993, whereas NSSO base year is 1981 and calculated for $1 valueivi.e. About 22 crore or approximately 4.5 crore BPL households

vThe further details about Mahatma Gandhi National Rural Employment Guarantee Act, 2005can be obtained from http://nrega.nic.in/netnrega/home.aspx

vi The further details about Swarnjayanti Gram Swarozgar Yojana can be obtained fromhttp://angul.nic.in/sgsy.htm

vii The detailed information about National Rural Health Mission (NRHM) can be obtained fromhttp://mohfw.nic.in/NRHM.htm

viii The detailed information obtained National Urban Health Mission (NUHM) can be obtainedfrom http://www.uhrc.in/module-ContentExpress-display-ceid-95.html

ixThe detailed information Indira Gandhi National Old Age Pension Scheme can be obtained fromhttp://nsap.nic.in/guidelines.htmlx Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in manydeveloping countries.8 The Out of pocket payments and indebtedness in Rural India according ofNSSO 60th round, 2004 has been given in the appendix 1xi The details of RSBY scheme given here is taken from official website of RSBY i.e.http://rsby.in/Index.aspx xii The exchange rate assumed for purpose of the study is 1 USD = INR 45xiii Established by Parliament of India to protect the interests of the policyholders, to regulate,promote, and ensure orderly growth of the insurance industry in India. For more details logon to

www.irdaindia.orgxivSmart Card is central to RSBY, as it would enable cashless transaction as well as inter-operatibility in network hospitals throughout the country. It would also enable foolproof

biometric identification of the beneficiary. The smart cards will be issued by the smart cardservice provider on behalf of the Insurance Company to the beneficiary.xvthe loss ratio in insurance sector is the ratio of total losses paid out in claims plus adjustmentexpenses divided by the total earned premiums

the heinz journal carnegie mellon university us

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