The document discusses a health insurance enrollment process and management information system (MIS) development for Waseela-e-Sehet, a health insurance scheme run by BISP. It outlines the objectives of the health insurance, its features and dynamics. It then describes the key enrollment processes, proposed enrollment MIS including software modules, data workflow, and the benefits of using smart cards. Finally, it highlights some points regarding NADRA's proposal for the enrollment MIS project.

1. Health Insurance Scheme
Enrolment Process
&
Enrolment MIS Development
Waseela-e-Sehet
BISP
Syed Anwar Hussain
MIS Expert (WS)

2. Agenda
• Presentation Objectives
• Waseela-e-Sehet Objectives
• HI Salient Features
• HI Dynamics
• HI Overall Scheme
• HI Main Processes
• Workflow at Enrolment Site
• Enrolment MIS (Initiation Doc & RFP)
• Why Smartcard ?
• NADRA Proposal Highlights
Waseela-e-Sehet (HI) 2

3. Presentation Objectives
• To present Overall Health Insurance (HI)
Scheme
• To explain Enrolment MIS Project
• To highlight NADRA’s Proposal

4. WASEELA-e-SEHET OBJECTIVE
• Improving access to health services and
reducing income loss from catastrophic
health shocks.
"Be Healthy – Be Productive”

5. HI SALIENT FEATURE
• The insured would be covered for hospitalization resulting
from illness or injury with an annual maximum of Rs.
25,000 per family (total of six members);
• Benefits package would cover normal deliveries and
hospitalizations due to complicated deliveries and C-
Sections;
• Diagnostic tests/procedures conducted during
hospitalization will be covered;
• Surgical procedures provided on a day care basis will be
covered;
• The scheme will cover all ages;
• Health insurance would not exclude pre-existing conditions;

6. HI SALIENT FEATURE …. cont.
• The scheme would provide opportunity to the
insured to get services from any enlisted hospital;
• The premium as determined by the insurance
company and agreed with BISP for the insured
family would be paid annually in advance by BISP;
• The insured will be provided transportation costs
for bringing the patients to the hospital with a
maximum of Rs.1000
• The payments would be made to the hospitals
and this would be a cashless/paperless
mechanism for the patients.

7. HI SCHEME DYNAMICS
• Partner-Agent Model (SLIC & BISP)
• Behavior Change & Communication (BCC)
• MIS & M&E System Development
• Enrolment of BISP Beneficiaries
• Selection and Empanelment of hospitals
• Transaction System Implementation
• Claims Settlements
• Establishment of Field Offices
• Quality Assurance
• Redress and Complain Mechanism
• Third Party Evaluation

8. HI OVERALL SCHEME
BISP HQ
SLIC HQ
Hospitals
Civil Societies,
NGOs, VBOs
Facilitate
BISP Beneficiary
Claims
Premium
Claims
Partner-
Agent
Model
E
nrolm
entD
ata
E
xchange
EnrolmentofBeneficiary
&
IssuanceofSmartcard
Feedback
Mechanism
Visit
Treatment
Select
Select
Initial Phase: NADRA
Rollout Phase:
SLIC Zonal Offices

9. HI MAIN PROCESS
BCC Campaign Preparation
Signing of MoU between BISP and SLIC
Pilot Test of in 4 Selected Districts
Tehsil-wise Enrolment Plan & Process
BBC Campaign to
educate Beneficiaries
about Waseela e
Sehet and its usages
MIS & M&E Systems Development
(Enrolment, Transaction)
Meetings to discuss
the scheme &
Implementation
Methodology
Initial Phase:
NADRA to assist in
Enrollment Process
Rollout Phase:
SLIC Zonal Offices will
take-up Enrolment
Procurement of
Resources &
Technology
Trainings of MIS
staff at all levels
2
3
11
7
8
Issuance of Smart Card
with Brochure having
details on usage &
protection of Smart Card
Approval of WS Operations Manual
Advance BCC Campaign Launch
Kickoff Meetings with SLIC & other Stakeholders
6
Empanelment of Hospitals
1
4
5
9

10. HI MAIN PROCESS … cont.
Discharge of Beneficiary & debiting of
The final amount from the smart card
12
13
Settlement of all Claims between
Hospitals and SLIC
Redress and Complain
Mechanism
15
14
Data
Transmission
to BISP &
SLIC Servers
Updating of all
Data and M&E
Reports
10
11
Beneficiary Authentication
Using Smart Card system
Beneficiary Visit Hospital
Doctor checkup beneficiary,
and If required, Admission
&Treatment will be carryout
Blocking of the anticipated
insurance amount using
smart card system
Medical
bills claim
by hospital
from the
SLIC

11. Enrolment Process
Verification Configuration
Verification of Beneficiary
Family Head using CNIC
Configuration of Household
Data into family Unit
Reception
BISP Desk
Community Rep
Acquisition
Family Photos, Fingerprints
Personalization
· Smart Card Activation &
Handing Over
· BISP/SLIC Info Leaflets
Awareness
BISP Desk
Initial Verification of
BISP Beneficiary
NADRA
NADRA
Program Details & Service
Utilization
NADRA

12. Enrolment MIS Development
Management Information Systems involve three
primary resources:
• People (BISP Beneficiary)
• Information Technology (hardware, software)
• Information:
– data that would be printed and stored in the
Smartcard.
– M&E Reports

13. Enrolment Software
1. Beneficiary Data Management Module: This application will extract the data
from existing BISP household data on the format decided among SLIC and BISP
Waseela-e-Sehet teams.
2. Download / Upload Module: This application will download household data
from BISP server to local server and will upload Beneficiary family data from local
server to BISP server in case BISP server is available online. In case BISP server is
offline then the local server should have the utility to send data in batch file as
well as generate backup on removable media.
3. Family Configuration Module: This application will convert household data into
family units. This application will have a full editing and search utilities.
4. Photo & Biometric Module: This application will take photographs & fingerprints
of beneficiary and her family. And make the enrolled data available to the Smart
Card Activation module.
Waseela-e-Sehet (HI) 13

14. Enrolment Software cont…
5. Smart Card Activation and Printing Module: This application will
write on the smart card the family data along with fingerprint of
up to 6 individuals of the beneficiary family (maximum 2
fingerprints per individual) and photograph of the individuals. And
also print the smart card.
6. Security Management System (SMS) Module: This application will
provide the complete security features against illegal tempering or
duplication.
7. Backend Data Management Module: This application will provide
a robust mechanism of data exchange between the BISP Head
office, Tehsil offices, the Insurance Companies and selected
company.
Waseela-e-Sehet (HI) 14

15. Beneficiary Personal Data:
· Tagging of Basic Household Data
· for linking children with parents
· Grouping Data into Family Unit
· Photograph
· Fingerprints
BISP
Server
Insurance
Company
Server
Beneficiary received
activated card after
Verification
Beneficiary Data
imported to
Enrolment Site
Authentication Required
to Login to
BISP/NADRA
Server to Import Data
Enrolled Data and Smart
Card specific data
transferred BISP/NADRA
& Insurance Co Servers.
And Final Card delivered
To beneficiary
NADRA
Server
CNIC Verification
Verification of
Fingerprint
WORKFLOW PROCESS AT THE ENROLMENT SITE

16. Enrolment MIS Project
• Project Initiation Doc
• Request For Proposal (RFP)

17. WHY SMART CARD?
S.NO Characteristics PVC Card Smart Card
1.
Internet Connectivity in hospital for
Beneficiary verification
24 hrs
Connectivity
Required
Connectivity
not required all
the time
2.
Data security on card Low High
3.
Biometrics feature Not available Available
4.
Authentication on card No Authenticity
or Identification
available
Authenticity &
Match on Card
is available
5.
Can communicate with computer devices No Yes
6.
Printing Requirement on Card for
Identification
Printing
Required;
cumber sum
Process
No printing
Required, as
all data stored
on chip
7.
Capable of performing encryption Not available Available
8.
Unique serial number Available Available
9.
Personalization/updating Not available Available
10.
Capable of processing data from card Not available Available
11.
Information and applications on a card can
be updated without having to issue new
cards
No Yes
12.
Cost-effective Less More

18. SMART CARD BENEFITS
• Cashless/paperless transactions even in the
remote areas despite of load-shedding.
• Authentication of beneficiary in empanel hospitals
due to Transaction Station self power system.
• The amount of Rs 25000 must be stored on the
card itself for maintaining transparency and quick
service.
• Tamper-resistant security device.
• In case of damage/lost, card can be issued from
local Tehsil office without delay.

19. NADRA Proposal Highlights
Waseela-e-Sehet (HI) 19
Technical:
• Complete SRS doc of Enrolment Application not
included so as to freeze the requirements for signoff.
• The detailed methodology given in the proposal is too
brief; hence it is not possible to assess how NADRA
would deliver against the work plan (not given).
• System Architecture does not conform to prescribe
standards as well as to Product Perspective given in
RFP.
• The Roles & Responsibilities mentioned under “Scope”
need to be revisited for clarity.

20. NADRA Proposal Highlights … cont.
• The original design of Enrolment process has been
changed by NADRA. The major deviation is in the
distribution of smart card to the beneficiaries.
• In original design, the complete enrolment process i.e.
from verification, identification of family, biometric,
photographs and handing over the smart card to
beneficiary would happen in one go that is during
enrolment in the field.
• Whereas, NADRA would first capture the data while
going in the field, the enrolled data will be exported back
to NADRA HQ for processing and personalization of smart
card. The smart card will then be sent back to the
enrolment sites again for distribution to the
beneficiaries.

21. NADRA Presentation
• Complete demo of Enrolment Software with all
its functionalities;
• Detailed methodology with Timelines of
Enrolment Process;
• Technical aspect of Enrolment Procedures;
• Integration scope with Transaction System;
• Dedicated Team (members & roles) for the
Enrolment Project;
• Effect/update on BISP core IT system;
• Transition and Transfer of Technology Strategy.