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RSBY -DKMA Training


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RSBY -DKMA Training

  1. 1. Rashtriya Swasthya Bima Yojna –Capacity Building of District Key 06.03.12 Seite 1
  2. 2. Current Status of RSBY Implementation in India  Cards issued – App. 27.6 Million  People enrolled – App. 100 million  Number of People benefitted till now – App. 3.2 million  Number of Hospitals Empanelled – App. 8600  States where Service delivery has started – Twenty Five  Number of Insurance Companies Involved – 06.03.12 Seite 2 2 Page
  3. 3. What is RSBY Benefits  Cover for Hospitalisation Expenses of Rs. 30,000/- (EUR 500 ) per family per annum on a family floater basis (Upto five family members)  1020 pre-defined surgical packages including Maternity & Newborn Care  Cover for Day Care Surgeries  All Pre-existing Diseases to be covered  1 day pre and 5 day post hospitalisation Expenses  Transportation costs (Rs. 100 per visit) with overall limit of Rs.1000 Sources of funding for program  Rs. 30 (EUR 0.5) per family per year from Beneficiaries  75% of Premium from Central Government  25% of Premium from State Government Both Public and Private providers can be empanelled Beneficiary can get cashless treatment in empanelled 06.03.12 Seite 3 3 Page
  4. 4. Smart Card  Smart Card with embedded chip which stores details:  Fingerprint and photos (up to five members)  Other details like Name, Age, Gender, Relationship etc. of up to five family members  Unique identification number  Insured Amount (Rs. 30,000/- in the beginning) 06.03.12 Seite 4 4 Page
  5. 5. eb site ad on w n 3. Uplo rificatio 4. Selection through tendering r ve Government af t e State Nodal 9. Submission of data and bill Insurance of India Agency Company 2 10. Payment to Insurer v e . Se e in rif nd re par at ica f Beneficiary 1. P n f or m tio or e n Data giv s Proces rie s 12 . Claim ent a nelm ia 5. Em p e fic n p f Be FKO H ah elt g-up -u o ettin tt ing e nt Cr ae 5. S Se n ol lm atio rd 8. Download of FKO rific a Data at DKM server Poidr rv es District Call r Kiosk Centre En Ve art C 7. m 7. of S 6. Issuance of BPL FKO Card Awareness Beneficiaries Health 11. Camps U ti lisa t i on of S er v DKM ice 06.03.12 Seite 5 5 Page
  6. 6. Enrollment 06.03.12 Seite 6 6 Page
  7. 7. Key transfer Verification by FKO by fingerprint and smart card FKORSBY CardCard Data of Beneficiary 06.03.12 Seite 7 7 Page
  8. 8. Role of State Government 1. Set up/ Identify State Nodal Agency for RSBY  Develop a full time team for State Nodal Agency with some experts in IEC, Data Analysis, IT etc.  District Coordinators for RSBY  Get Financial Accounts audited 2. Provide certified & validated BPL data as per Planning Commission guidelines and in prescribed format. 3. Designate DKMA and FKOs for each selected district a. Help Insurance company prepare enrollment schedule and prepare Awareness campaign for beneficiaries b. Help identify locations to hold enrollment camps and facilitate such 06.03.12 Seite 8 8 Page
  9. 9. Other Key Roles of State Government Pre-Enrollment Incentive for FKOs (if necessary) 06.03.12 Seite 9 9 Page
  10. 10. Other Key Roles of State Government Post 06.03.12 Seite 10 10 Page
  11. 11. Role of State Government 1. Premium Payment  State Nodal Agency to Pay state share to the Insurer within 15 days of receiving bills in the prescribed format  State Nodal Agency to pay Central Share to the Insurer within 7 days of receiving from Central Government  Payment to the Insurer shall be on a Monthly basis and not after completion of enrollment period 2. Organise weekly review meetings at State and District level 3. Organise awareness activities post-enrollment 4. Enable Government hospitals to compete with private Hospitals by providing incentives 5. A State server shall store all the data of last year and coming year for all the operational 06.03.12 Seite 11 11 Page
  12. 12. Role of State Government 1. This data shall be analysed based on: – Conversion ratio – Hospitalisation ratio - Average and Genderwise – Average Family size – Disease pattern – Burnout Ratio 2. Monthly reports based on data analysis can be prepared and shared with different stakeholders 3. Concurrent evaluation of the scheme shall be 06.03.12 Seite 12 12 Page
  13. 13. What is Key Management System Central Key Generating Authority Hospital Code issued Issues personalised DKM Cards, FKO Cards, HAC Cards, District Kiosk cards Issue District Kiosk District Key Manager Card District Kiosk Personalise and issue FKO Cards Post issuance Issues personalised HAC Card issues Authentication of smart card at the time Field Key Officer of enrollment Hospital Beneficiaries Hospitalisation Insurance Company Issues personalised Beneficiary Smart 06.03.12 Seite 13 13 Page
  14. 14. Role of District Key Manager 1. Receive DKMA card and issue following cards: a. Field Key Officer Cards according to the specified schedule b. Hospital Authority Cards c. District Kiosk Cards 3. Set up DKM Server at District level 5. Monitor the participation of FKOs in enrollment 7. Get enrollment data downloaded from FKO cards to DKM 06.03.12 Seite 14 14 Page
  15. 15. Role of District Administration  Provide support to Insurance Company in Implementation of the scheme  Ensuring participation of FKOs in enrollment process  Helping in empanelment of good private hospitals  Help in organising the District workshops  Help in linking with BDOs, Panchayats  Provide space for District kiosk at a Government location  Organise Periodic review meetings  Provide them list of Good NGOs who can be hired for 06.03.12 Seite 15 15 Page
  16. 16. Role of Health Department  Install necessary hardware and software in the public hospitals  Provide help desk in the hospital alongwith person  Training of Hospital Personnel  Provide cashless treatment on package rates  Get the Reimbursement from the Insurer  Organise Health Camps  Enable RKS to receive money from Insurer and use it in a flexible way  Tie up with Pharmacies and Diagnostic Centres  Provide for cash incentives for 06.03.12 Seite 16 16 Page
  17. 17. Signage Outside Empanelled 06.03.12 Seite 17 17 Page
  18. 18. 06.03.12 Seite 18 18 Page
  19. 19. Potential for Government Hospitals  The claim payment from Insurance Company will come directly to the hospitals  Hospitals can use all the money through RKS for development of the hospitals and improving infrastructure  Government hospitals in many States are able to earn a lot through RSBY  In Kerala out of 50 crores which was paid by Insurance Company as claim payment, Government hospitals have earned more than 27 crores  Government of Kerala has also given 25% of this as cash incentive to the staff working in these Government hospitals  Rest 75% have been used 06.03.12 Seite 19 19 Page
  20. 20. BEFORE 06.03.12 Seite 20 20 Page
  21. 21. Administrative Wing (before) (after) 06.03.12 Seite 21 21 Page
  22. 22. Role of Insurance Company1. Finalise the TPA/ Smart Card Pre-Enrollment service provider2. Set up team at State and District level for the implementation3. Organise District-level workshops with all stakeholders4. Organise separate District workshop with health care providers before the empanelment Print these three details in the Enrollment 06.03.12 Seite 22 22 Page
  23. 23. Role of Insurance Company 1. Enrollment of the beneficiaries Post Enrollment 1. Prepare villagewise plan 2. Communicating this plan to the Send villages consolidated data the Government 3. Identify locations in each village for enrollment 4. Coordinate with State Government for the FKOs Send Back end 5. Visit villages according to the plan data to Central with enrollment team Govt.. 6. Personalise the smart card and print and give on the spot and take Rs. 30 from the beneficiaries 7. Arrange for contingencies like electricity failure 06.03.12 Seite 23 23 Page
  24. 24. Few Important Documents  Tender Document  Contract Document between Nodal Agency and Insurance Company  About RSBY and FAQs on RSBY  District Kiosk and Server Specifications  Roles and Responsibilities of State Government  Roles and Responsibilities of the Insurer  Guidelines for DKM and FKOs  Format of Review Meetings  Guidelines for Business Continuity 06.03.12 Seite 24 24 Page
  25. 25. Thank You 06.03.12 Seite 25