Biju Swasthya Kalyan Yojana: Your Guide to BSKY Card Benefits

The Biju Swasthya Kalyan Yojana is a pioneering initiative launched by the Chief Minister of Odisha. It aims at providing universal health coverage, particularly focusing on economically vulnerable families in the state. The state government covers the full cost of healthcare services at all government facilities, from sub-centers to district hospitals and medical colleges, regardless of income or residence status.

Under the cashless healthcare in empanelled private hospitals aspect, the State Government will cover healthcare expenses at designated private hospitals for economically disadvantaged families in the state. This coverage extends to Rs. 5 lakh per family annually, with an extra Rs. 5 lakh allocated for female members after the primary limit is reached. The BSKY has ushered in a new phase of Universal Health Coverage since its establishment, facilitating over 45 lakh instances of cashless treatment monthly. By using the BSKY card, beneficiaries can easily access quality healthcare services without worrying about out-of-pocket expenses, ensuring comprehensive coverage and financial protection for their medical needs.

Biju Swasthya Kalyan Yojana (BSKY): Overview

What is Biju Swasthya Kalyan Yojana?

The Biju Swasthya Kalyan Yojana (BSKY) is an Indian health insurance initiative initiated by the Odisha Government in 2018. It strives to offer cost-effective and easily accessible healthcare services to Odisha's populace, prioritising those facing economic hardship or societal vulnerability. Through BSKY, qualified recipients gain access to cashless medical care at partnered hospitals for a range of health needs, encompassing hospital stays, surgical procedures, and both pre- and post-hospitalisation costs. Additionally, the scheme encompasses expenses for diagnostic tests, medications, and ancillary medical provisions. BSKY card also plays a significant role in claiming benefits under this scheme.

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Components of Biju Swasthya Kalyan Yojana (BSKY)

Given below are the two components of BSKY:

• Component-1 (Cashless health care in state government hospitals)
  The state government will cover the entire expense of healthcare services provided to all patients, regardless of their income, status, or place of residence, in all state-run healthcare facilities, ranging from sub-centers to district headquarters and government medical college hospitals.
• Component-2 (Cashless health care in empanelled private hospitals)
  The state government will cover healthcare expenses at empaneled private hospitals for identified economically vulnerable families in the state. This includes an annual health coverage of Rs. 5 lakh per family, with an additional Rs. 5 lakh allocated for female family members once the initial limit is reached.

Documents required for Biju Swasthya Kalyan Yojana (BSKY)

At the enrollment stage, individuals may be required to submit the subsequent documents:

• Verification of identity (such as Aadhaar card, voter ID, PAN card, etc.).
• Verification of residency (including Aadhaar card, voter ID, utility bills like electricity, etc.).
• Proof of income (like income certificate, BPL card, etc.).
• Passport-sized photograph.

Eligibility criteria for Biju Swasthya Kalyan Yojana (BSKY)

Given below is the eligibility criteria for Biju Swasthya Kalyan Yojana (BSKY):
All citizens of Odisha are eligible for cashless health care services at all State Government

• All citizens of Odisha are eligible for cashless health care services at all State Government healthcare institutions from Sub Centre level to District Head Quarters Hospital and Government Medical College Hospital, for which the State Government will bear the full cost.
• All BSKY Smart Health Card/ National Food Security Act (NFSA)/State Food Security Scheme (SFSS) card holders.
• There are no age restrictions for BSKY. The policy is available to people of all ages, from newborns to senior citizens.

What is a BSKY card?

The BSKY Smart Health Card is a 64 KB chip-based SCOSTA card that features the card number and the name of the head of the household. Within the chip are stored the family's particulars, including the names, ages, genders, demographic details, Aadhaar numbers of each beneficiary, unique smart card numbers, and their relationship with the head of the household. To ensure you have sufficient coverage, you can perform a BSKY card balance check to verify the available benefits and usage details on your card.

Read more: Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY)

Benefits of BSKY (Biju Swasthya Kalyan Yojana)

Here are the key benefits of Biju Swasthya Kalyan Yojana:

• Families possessing the BSKY Smart Health Card, NFSA, or SFSS card are eligible for cashless inpatient (IPD) and day care treatments for procedures covered by the empaneled hospitals under BSKY, both within and outside the state, up to the annual coverage limit.
• BSKY offers health insurance coverage for medical expenses incurred during treatment at hospitals and health centers throughout Odisha, with coverage up to Rs. 5 lakh for families and up to Rs. 10 lakh for women.
• BSKY strives to offer cost-effective health insurance to families within the state, starting with premiums as low as Rs. 30 annually.
• BSKY includes coverage for pre-existing conditions, allowing individuals to receive treatment for ailments they had before obtaining the policy. Unlike many health plans, BSKY does not enforce any waiting period for pre-existing illnesses to be covered under its policy.
• There is no limit on room rent, allowing the insured individual to select their preferred room type during hospitalisation without concerns about additional expenses.

Coverage under Biju Swasthya Kalyan Yojana

Expenses for the following are covered under BSKY:

Inpatient treatment

The Biju Swasthya Kalyan Yojana (BSKY) covers expenses for medical care incurred during hospitalization. This includes the costs associated with room charges, nursing services, and all necessary medical treatments while the patient is admitted.

Outpatient treatment

BSKY provides financial coverage for medical expenses related to outpatient visits at hospitals or health centers. This includes consultation fees, diagnostic tests, and medications prescribed by healthcare providers during these visits.

Maternity expenses

Under BSKY, maternity expenses are covered, including the costs of delivery and post-delivery care. This also includes postpartum care for the mother in the weeks following discharge, aiding financially constrained families in accessing comprehensive healthcare for new mothers without financial strain.

Ayurvedic and homeopathic treatment

BSKY extends its coverage to include Ayurvedic and homeopathic treatments alongside conventional allopathic care. The scheme acknowledges the value of traditional medicine and provides coverage for inpatient Ayurveda, Homeopathy, and Unani treatments, including diagnostic tests, medications, and approved procedures.

How to apply for BSKY?

There isn't a direct enrollment process for the Biju Swasthya Kalyan Yojana. All families covered by the National Food Security Act (NFSA) or State Food Security Scheme (SFSS) within Odisha qualify as beneficiaries and receive the BSKY Smart Health Card from the government. Beneficiaries can obtain their BSKY Smart Health Card at designated Mo Seva Kendras by presenting their valid NFSA/SFSS Card. For additional information or to check the status of their card, beneficiaries can also visit the BSKY portal.

Read more: Government Health Insurance Schemes in India

Documents required for claiming benefits under Biju Swasthya Kalyan Yojana

To process your claim, ensure you have the following documents:

• Claim form
• Valid BSKY card
• Proof of identity
• Medical records
• Receipts for incurred medical expenses

Also, read: Benefits of ABHA Health card

Claim settlement for Biju Swasthya Kalyan Yojana

The required documentation for claim settlement, outlined in the package master, must be uploaded on the BSKY (Biju Swasthya Kalyan Yojana) app within seven days of the patient's discharge. Failure to upload within this timeframe may result in claim rejection.

Upon submission of claims in the BSKY application, payments are electronically processed via the Public Financial Management System (PFMS) within four weeks.

In cases where a beneficiary undergoes multiple surgical procedures during a single operating theater (OT) session, the procedure with the highest rate is considered the primary package and reimbursed at 100%. The second procedure is reimbursed at 50%, while subsequent procedures are eligible for reimbursement at 25% of the package rate.

Hospitals are required to upload any missing documentation if the minimum necessary documents for claim settlement are not provided at the time of claim submission in the BSKY application. If these documents are uploaded within seven days, the BSKY application will automatically accept the claims.

The Biju Swasthya Kalyan Yojana (BSKY) stands out as a vital initiative by the Government of Odisha aimed at alleviating the substantial financial strains of healthcare for its residents, especially those facing economic vulnerability. With a vision to guarantee medical treatment accessibility to all citizens regardless of financial limitations, BSKY offers an extensive array of benefits, including cashless treatment, coverage for pre-existing conditions, maternity expenses, Ayurvedic and homoeopathic treatments, and organ transplant procedures.