Biju Swasthya Kalyan Yojana (BSKY Odisha): Features, Coverage & How to Apply

According to the National Sample Survey Office, 2019, Odisha ranks second-highest on the Catastrophic Healthcare Expenditure list in the country. Healthcare expenses are termed catastrophic when the average healthcare cost is more than 40% of a person's income. Thus, in Odisha, there is a dire need to provide health insurance to the residents. The state government introduced the Biju Swasthya Kalyan Yojana (BSKY) to address the issue. In this article, you will learn about the benefits, coverages, eligibility and other details of BSKY.

Contents

• Biju Swasthya Kalyan Yojana (BSKY) Overview
• What is Biju Swasthya Kalyan Yojana? 
• Benefits of Biju Swasthya Kalyan Yojana (BSKY)
  • 1. Wide coverage
  • 2. Affordability
  • 3. Cashless treatment
  • 4. Pre-existing conditions
  • 5. No cap on room rent  
• Treatments covered under BSKY 
  • 1. Inpatient treatment 
  • 2. Outpatient treatment
  • 3. Maternity expenses
  • 4. Ayurvedic and homoeopathic treatment
  • 5. Organ transplant
• Biju Swasthya Kalyan Yojana (BSKY) card & registration process
• Eligibility criteria of Biju Swasthya Kalyan Yojana (BSKY) 
  • Documents required for Biju Swasthya Kalyan Yojana (BSKY)
• Claims settlement process of BSKY 
• Documents required for making a claim against BSKY
• BSKY Contact Address
  • Contact Details for The Office of SHAS HQ
  • Contact Details for The Office of SHAS DISTRICT
• Benefits of Biju Swasthya Kalyan Yojana (BSKY)
  • 1. Wide coverage
  • 2. Affordability
  • 3. Cashless treatment
  • 4. Pre-existing conditions
  • 5. No cap on room rent
• Treatments covered under BSKY
  • 1. Inpatient treatment
  • 2. Outpatient treatment
  • 3. Maternity expenses
  • 4. Ayurvedic and homoeopathic treatment
  • 5. Organ transplant
• Biju Swasthya Kalyan Yojana (BSKY) card & registration process
• Eligibility criteria of Biju Swasthya Kalyan Yojana (BSKY)
  • Documents required for Biju Swasthya Kalyan Yojana (BSKY)
• Claims settlement process of BSKY
• Documents required for making a claim against BSKY
• Contact Details for Swasthya Mitras at empanelled private Hospitals
• The Bottom Line
• Frequently asked questions

Biju Swasthya Kalyan Yojana (BSKY) Overview

What is Biju Swasthya Kalyan Yojana? 

Biju Swasthya Kalyan Yojana (BSKY) is a health insurance scheme that the Government of Odisha launched in India in 2018. The scheme aims to provide affordable and accessible healthcare to the people of Odisha, especially to those who are economically disadvantaged or belong to vulnerable sections of society. Under the BSKY scheme, eligible beneficiaries can avail of cashless treatment at empanelled hospitals for various medical conditions, including hospitalisation, surgery, and pre and post-hospitalisation expenses. The scheme also covers the cost of diagnostic tests, medicines, and other medical supplies.

Benefits of Biju Swasthya Kalyan Yojana (BSKY)

BSKY aims to provide comprehensive and affordable health insurance to families in Odisha, helping to ensure that they have access to quality healthcare when needed. Here are the benefits of this scheme.

1. Wide coverage

Biju Swastya Kalyan Yojana government health card provides health insurance coverage for medical expenses (up to Rs. 5 lakhs for families and up to Rs. 10 lakhs for women) incurred for treatment in hospitals and health centres across the state of Odisha. Around 4,036 medical treatments and 255 surgical procedures are covered under this scheme.

2. Affordability

BSKY government yojana aims to provide affordable health insurance to families in the state, with premiums starting at just INR 30 per year.

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3. Cashless treatment

Depending on the health card status, BSKY allows for cashless treatment at network hospitals, which means that the insured person does not have to pay the entire medical expenses upfront. The cashless network under BSKY is continuously expanding, covering more hospitals across Odisha for the convenience of policyholders. Currently, over 200 designated hospitals participate in the cashless treatment facility. This number is expected to grow further for increased access. Insured individuals simply need to visit the enlisted network hospitals and present their BSKY health card online to avail of cashless treatment.

4. Pre-existing conditions

BSKY covers pre-existing conditions, which means that the insured person can get treatment for conditions which they already had before taking out the policy. Unlike most health plans, Biju Swastya Kalyan Yojana does not impose any waiting period to cover pre-existing illnesses under its policy scope. So once insured, individuals having diabetes, hypertension, asthma, etc., can undergo hospitalisation related to such conditions without exclusion. Also, there is no requirement for medical checkups at the time of enrollment. Pre-existing disease coverage further enhances the inclusivity aspect of the state-funded scheme.

5. No cap on room rent  

BSKY does not have a cap on room rent, meaning that the insured person can choose the type of room they prefer while hospitalised without worrying about additional costs.

Treatments covered under BSKY 

The following types of treatments are covered under the BSKY.

1. Inpatient treatment 

Biju Swastya Kalyan Yojana covers medical expenses incurred during hospitalisation, including the cost of the room, nursing, and all necessary medical treatment.

2. Outpatient treatment

BSKY provides coverage for medical expenses incurred during outpatient visits to a hospital or health centre, including the cost of consultations, diagnostic tests, and medications.

3. Maternity expenses

BSKY covers maternity expenses, including the cost of delivery and post-delivery care. Postpartum care for the mother immediately after discharge up to a few weeks is also included. This aids financially constrained families in providing adequate healthcare for new mothers without financial worries.

4. Ayurvedic and homoeopathic treatment

BSKY provides coverage for Ayurvedic and homoeopathic treatment in addition to allopathic (modern) treatment. The scheme recognises the significance of alternative traditional medicinal forms. It incorporates reasonable cost coverage for qualified in-patient Ayurveda, Homeopathy and Unani treatments spanning diagnostic tests, medication, Panchkarma therapies and approved procedures.

5. Organ transplant

Coverage for organ transplant procedures, including the cost of the transplant surgery and post-surgery care. BSKY covers expenses incurred towards donor screening, organ harvesting, hospitalisation for engraftment surgeries and immuno-suppressive medication needed for long-term post-transplant recovery under set limits. By affording high-cost procedures, the policy provides renewed living hopes despite chronic organ failures.

Biju Swasthya Kalyan Yojana (BSKY) card & registration process

The Biju Swasthya Kalyan Yojana does not have an online application process for direct health card use. Every family in Odisha with National Food Security Act (NFSA) or State Food Security Scheme (SFSS) coverage is eligible to receive a BSKY Smart Health Card under this programme. Each family gets a BSKY Smart Health Card from the government. In real-time, the BSKY database is updated and synchronised with the NFSA/SFSS databases.

Eligibility criteria of Biju Swasthya Kalyan Yojana (BSKY) 

All inhabitants of Odisha are entitled to cashless healthcare services at all State Government healthcare facilities. Following are the basic eligibility criteria for BSKY health card registration.

A resident of Odisha: To be eligible for BSKY, you must be a resident of Odisha.

Below Poverty Line (BPL) or Above Poverty Line (APL) family: BSKY is available to both BPL and APL families in Odisha.

Age: There are no age restrictions for BSKY. The policy is available to people of all ages, from newborns to senior citizens.

Documents required for Biju Swasthya Kalyan Yojana (BSKY)

Applicants may need to provide the following documents at the time of enrollment:

Proof of identity (Aadhaar card, voter ID, PAN card, etc.)

Proof of residence (Aadhaar card, voter ID, electricity bill, etc.)

Proof of income (income certificate, BPL card, etc.)

Passport size photograph

Note that the list of documents given above is indicative and may vary from the actual documents required.

Claims settlement process of BSKY 

The minimum papers required for claim settlement, as indicated in the package master, must be uploaded in the BSKY ( Biju Swasthya Kalyan Yojana ) app within seven days of the patient's discharge. If uploaded more than seven days after discharge, the claim can be rejected.

After the e-swasthya claims are raised in the BSKY application, payment is made electronically through the Public Financial Management System (PFMS) within four weeks.

If a beneficiary needs to have several surgical procedures during a single OT session, the procedure with the highest rate will be treated as the primary package and will be reimbursed at 100% of the package rate; the second surgical procedure will be reimbursed at 50% of the package rate; and the third and subsequent surgical procedures will be entitled to claim at 25% of the package rate.

The hospital is asked to upload the missing papers if the minimum number of documents needed for claim settlement is not provided at the time the claim is raised on the BSKY application. If this documentation is shared within seven days, the BSKY application will automatically accept the claims.

Documents required for making a claim against BSKY

You may need the following documents to claim. 

Claim form

A valid BSKY card

Proof of identity

Medical documents

Receipts for medical expenses

BSKY Contact Address

You can get in touch with the relevant BSKY authorities by visiting the “Contact Us” page on the official BSK website.

Contact Details for The Office of SHAS HQ

Contact Details for The Office of SHAS DISTRICT

Benefits of Biju Swasthya Kalyan Yojana (BSKY)

BSKY aims to provide comprehensive and affordable health insurance to families in Odisha, helping to ensure that they have access to quality healthcare when needed. Here are the benefits of this scheme.

1. Wide coverage

BSKY provides health insurance coverage for medical expenses (up to Rs. 5 lakhs for families and up to Rs. 10 lakhs for women) incurred for treatment in hospitals and health centres across the state of Odisha. Around 4,036 medical treatments and 255 surgical procedures are covered under this scheme.

2. Affordability

BSKY aims to provide affordable health insurance to families in the state, with premiums starting at just INR 30 per year.

3. Cashless treatment

BSKY allows for cashless treatment at network hospitals, which means that the insured person does not have to pay the entire medical expenses upfront.

4. Pre-existing conditions

BSKY covers pre-existing conditions, which means that the insured person can get treatment for conditions which they already had before taking out the policy.

5. No cap on room rent

BSKY does not have a cap on room rent, meaning that the insured person can choose the type of room they prefer while hospitalised without worrying about additional costs.

Treatments covered under BSKY

The following types of treatments are covered under the BSKY.

1. Inpatient treatment

BSKY covers medical expenses incurred during hospitalisation, including the cost of the room, nursing, and all necessary medical treatment.

2. Outpatient treatment

BSKY provides coverage for medical expenses incurred during outpatient visits to a hospital or health centre, including the cost of consultations, diagnostic tests, and medications.

3. Maternity expenses

BSKY covers maternity expenses, including the cost of delivery and post-delivery care.

4. Ayurvedic and homoeopathic treatment

BSKY provides coverage for Ayurvedic and homoeopathic treatment in addition to allopathic (modern) treatment.

5. Organ transplant

Coverage for organ transplant procedures, including the cost of the transplant surgery and post-surgery care.

Biju Swasthya Kalyan Yojana (BSKY) card & registration process

The Biju Swasthya Kalyan Yojana does not have a direct enrollment mechanism. Every family in Odisha with National Food Security Act (NFSA) or State Food Security Scheme (SFSS) coverage is eligible to receive a BSKY Smart Health Card under this programme. Each family gets a BSKY Smart Health Card from the government. In real-time, the BSKY database is updated and synchronised with the NFSA/SFSS databases.

Eligibility criteria of Biju Swasthya Kalyan Yojana (BSKY)

All inhabitants of Odisha are entitled to cashless healthcare services at all State Government healthcare facilities. Following are the basic eligibility criteria for BSKY.

A resident of Odisha: To be eligible for BSKY, you must be a resident of Odisha.

Below Poverty Line (BPL) or Above Poverty Line (APL) family: BSKY is available to both BPL and APL families in Odisha.

Age: There are no age restrictions for BSKY. The policy is available to people of all ages, from newborns to senior citizens.

Documents required for Biju Swasthya Kalyan Yojana (BSKY)

Applicants may need to provide the following documents at the time of enrollment.

Proof of identity (Aadhaar card, voter ID, PAN card, etc.)

Proof of residence (Aadhaar card, voter ID, electricity bill, etc.)

Proof of income (income certificate, BPL card, etc.)

Passport size photograph

Note that the list of documents given above is indicative and may vary from the actual documents required.

Claims settlement process of BSKY

The minimum papers required for claim settlement, as indicated in the package master, must be uploaded in the BSKY ( Biju Swasthya Kalyan Yojana ) app within seven days of the patient's discharge. If uploaded more than seven days after discharge, the claim can be rejected.

After the claims are raised in the BSKY application, payment is made electronically through the Public Financial Management System (PFMS) within four weeks.

If a beneficiary needs to have several surgical procedures during a single OT session, the procedure with the highest rate will be treated as the primary package and will be reimbursed at 100% of the package rate; the second surgical procedure will be reimbursed at 50% of the package rate; and the third and subsequent surgical procedures will be entitled to claim at 25% of the package rate.

The hospital is asked to upload the missing papers if the minimum number of documents needed for claim settlement is not provided at the time the claim is raised on the BSKY application. If this documentation is shared within seven days, the BSKY application will automatically accept the claims.

Documents required for making a claim against BSKY

You may need the following documents to claim. 

Claim form

A valid BSKY card

Proof of identity

Medical documents

Receipts for medical expenses

Contact Details for Swasthya Mitras at empanelled private Hospitals

The Bottom Line

The Biju Swasthya Kalyan Yojana (BSKY) emerged as a critical initiative by the Government of Odisha to mitigate the heavy financial burdens of healthcare on its residents. Particularly those who are economically vulnerable. Launched with the vision to ensure that no citizen of Odisha is deprived of medical treatment due to financial constraints, BSKY encompasses a wide range of benefits from cashless treatment facilities, coverage for pre-existing conditions, maternity expenses, Ayurvedic and homoeopathic treatments, and organ transplant procedures.

Frequently asked questions

Here are some common questions and answers about the Biju Swasthya Kalyan Yojana.

Is the BSKY scheme available only to residents of rural areas, or can urban residents also benefit from it?

BSKY is available to both rural and urban residents of Odisha, provided they meet the eligibility criteria.

Can I avail of treatment under BSKY at any hospital in India, or is it restricted to hospitals in Odisha only?

BSKY provides coverage for treatment at hospitals and health centers within the state of Odisha. It does not cover treatment outside the state.

Is there an age limit for enrolling in BSKY for individuals or families?

There are no age restrictions for enrollment in BSKY. It is available to people of all ages, from infants to senior citizens.

What is the process for adding new family members to an existing BSKY policy?

New family members can be added to an existing BSKY policy by updating the family's information and obtaining BSKY Smart Health Cards for the new members through the government's database synchronisation process.

Can I avail of cashless treatment for Ayurvedic or homeopathy treatment under BSKY, or is it limited to allopathic treatments?

BSKY provides coverage for Ayurvedic and homeopathic treatments in addition to allopathic treatments, allowing beneficiaries to avail of cashless treatment for these alternative therapies.

What is the maximum insurance cover under Biju Swasthya Kalyan Yojana (BSKY)?

The maximum insurance coverage under the Biju Swasthya Kalyan Yojana (BSKY) depends on the type of treatment and the beneficiary category. The scheme provides financial assistance for treating various illnesses, including severe conditions such as cancer and heart disease. The sum insured of this scheme is up to Rs. 5 lakhs for families and up to Rs. 10 lakhs for women.

How does Biju Swasthya Kalyan Yojana (BSKY) work?

Here is how the BSKY works. The beneficiary must show the BSKY card at a network hospital to raise a cashless claim. Alternatively, they can avail treatment in a non-network hospital, submit the necessary documents, and then raise a claim through the BSKY application. Once the documents are uploaded the application will process the claim.

Are all medical expenses covered under BSKY?

The BSKY scheme has certain exclusions and conditions, and not all medical expenses may be covered under the scheme. It is advisable to check the terms and conditions of the scheme before seeking treatment.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet, and is subject to changes.

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