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Providing outpatient insurance to complement Rashtriya Swastya Bima Yojana (RSBY) -- ICICI Lombard

About the Project

Project Name: Providing outpatient insurance to complement Rashtriya Swastya Bima Yojana (RSBY) -- ICICI Lombard
Type of Facility Project: Microinsurance innovation grantee
Country of Operation: India
Region: Asia and the Pacific
Sub Topics: Business viability, Client interface, Policy and regulation, Subsidies, Impact, Improving value, Health

Organizational Overview

ICICI Lombard General Insurance Company Ltd. is the largest private sector general insurance company in India with a gross written premium of around USD 1 billion for the financial year ended 31 March 2011. It offers a wide range of products and services for business and individual customers across all population segments ranging from all risk insurance policies for large projects to home insurance for households.  One focus of ICICI Lombard is to provide health coverage to a large number of low income households across the country via various government health insurance schemes.  Health microinsurance initiatives began in 2005, and as of 31 March 2011 ICICI Lombard served approximately 7 million families across India.


Project Description

Rashtriya Swasthya Bima Yojana (RSBY) is India’s national health insurance programme for below the poverty line (BPL) families, most of whom are informal workers. It was launched in 2008 by the Ministry of Labour and Employment (MoLE). As of early 2013, RSBY has expanded to more than 487 of India’s 671 districts, now reaching more than 34 million families.[1] (You can find out more about the RSBY scheme in this video.) RSBY was launched with an inpatient (IP) benefit package, a common app...READ MORE


The project targeted low income households who qualify for enrolment in the RSBY health insurance scheme sponsored by the government of India.  Nationwide, this group comprises at least 300 million people, mostly employed in the informal economy and earning approximately Rs 55-60 ($1.25) per day. The project targeted households in Puri (district of Orissa) and Mehsana (district in Gujarat) and was expected to impact 270,000 lives across both locations.


Learning Agenda

  • Will this product support the economic viability of RSBY in the long term?
  • By offering outpatient insurance as a complement to RSBY, does that improve RSBY’s client value?
  • As drugs are the key component of outpatient care, what are the factors that affect prescription patterns and patient utilisation?
  • What is the impact of offering a comprehensive outpatient and inpatient product on health seeking behavior, health outcomes, out of pocket expenditure, financial risks of households and access to healthcare?

Project Status

Key Performance Indicators

All key indicators as of December 2013

Pilots began on 1st July 2011 in Puri and on 1st November 2011 in Mehsana




Total enrolment (no. of families)



Total enrolment (no. of lives)



Total number of claims to date (OP)



Total number of claims to date (IP)



OP Incidence (%)



IP Incidence (%)



Number of OP claims over time - Puri

Number of OP claims over time – Mehsana

Project Updates
Empanelling providers It is the job of the insurer in each district to empanel health-care providers. They have to identify and contract potential providers, secure, install the RSBY hardware and software at the provider, and train the provider. Each healthcare provider signs a memorandum of understanding (MoU) with the insurer stating their agreement to fulfil the scheme’s requirements which include providing OP care and dispensing medicines directly through nearby pharmacies at fixed r...READ MORE

Project Lessons

On empanelment of health-care providers Empanelment of health-care providers is critical, and may require a mix of public and private health-care providers. The initial plan was to empanel only public health-care providers. It was subsequently realized that the geographic distribution of public health-care providers was not uniform, especially in Puri. Most of the public facilities were not accessible from remote areas.  Public facilities also often lac...READ MORE
On training health-care providers It is necessary to train providers on site to ensure that they receive training. Providers felt that they did not have time or sufficient notice to attend training. Time and money was therefore wasted on trainings that were not attended. As a result, training was instead carried out at the clinics, with an invitation for further training in a more central location. ...READ MORE
On claims Prompt claims payment and good communication around claims is important to maintain health-care provider engagement. Sometimes claim payments took longer than the 21 day turnaround service standard due to problems with the claims data or health-care providers’ bank account details. These delays demotivated the health-care provider. Measures taken to address these problems include rigorous checking of health-care providers’ bank details and bett...READ MORE
On technology Plan for hardware security before installation. Since many hospitals do not have locker/storage facilities, security of the hardware becomes an issue.  It would have been better to anticipate this need in advance to avoid last-minute solutions or loss of equipment. It is important to make administrative processes efficient for clients and health-care providers. Initially, the finger print matching to validate the cardholder’s identity...READ MORE
On enrolling clients Start with clean enrolment data. ICICI Lombard found that the quality of the data for BPL households was often poor. The data, taken from the 1997 and 2001 censuses, contained errors including duplications, missing records, and outdated information on deaths, births, marriages, and migration. There were discrepancies in about 10 to 15 per cent of the data which sometimes led to resentment in villages, followed by lower enrolment. The pre...READ MORE
On client awareness Awareness building must be on-going to promote long-term understanding of RSBY benefits. Initial awareness campaigns were successful in creating a buzz about RSBY OP benefits, but they were too complex, and did not result in sufficient understanding of the benefit package among the health-care providers or clients. In particular, many clients misunderstood the fact that the OP benefits included a range of common drugs prescribed during an...READ MORE
On OP claim patterns Most claims were for infectious diseases. The most common symptoms reported in OP claims were fever, pain, and inflammation. The most commonly prescribed medicines were anti-inflammatories, painkillers, anti-pyretics, and antibiotics. The high incidence of infectious diseases is likely to be a result of poor living conditions and hygiene. These diseases should be highly preventable with increased availability of safe drinking water and b...READ MORE
On client value Time can be as important to clients as money. If the processes are too slow, a product will not provide sufficient value to clients. Clients often did not find a value in using their RSBY cards to access OP care if health-care providers asked them to wait due to technology challenges with RSBY systems (such as a lack of internet connectivity, inability to use the technology platform when the operator is absent, non-matching finger prints, lac...READ MORE
Project page contributor/s:  Nitin Shrivastava (ICICI Lombard) and Jeanna Holtz and Alice Merry (The Facility)
Date of last update:  April 2014