RASHTR!

YA SWASTHYA
B!NA YO]ANA
!ND!A
.composition of workforce
In Millions
28,
7
369,
93
ORGANIZED UNORGANIZED
HARATERST!S OF
UNORCAN!ZED SETOR
WORKFORE
Poor
SelfEmployed
Employers not identifiable
!lliterate
Nigratory
Lack of skills (Unskilled)
RASHTR!YA SWASTHYA B!NA
YO]ANA
enefits
'otal sum insured of Rs 30,000 per PL
family on a family floater basis
Preexisting diseases to be covered
Coverage of health services related to
hospitalization and services of surgical
nature which can be provided on a day
care basis
RASHTR!YA SWASTHYA B!NA
YO]ANA
enefits
Cashless coverage of all eligible health
services.
Provision of Smart Card.
Provision of pre and post hospitalization
expenses.
'ransport allowance @ Rs.100 per visit
FUND!NC
Contribution by CO! : 7S of the estimated annual
premium of Rs 7S0, subject to a maximum of Rs. S6S
per family.
Contribution by the State Covernments: 2S of the
annual premium and any additional premium beyond
Rs 7S0.
eneficiary to pay Rs. 30 per annum as Registration
Fee/ Renewal Fee
Administrative cost to be borne by the State
Covernment.
Cost of Smart Card to be borne by the Central
Covernment. An additional amount of Rs.60 per
beneficiary would be available for this purpose.
FUTURE OURSE OF AT!ON
.understanding the process
hat have the State Covernments to
do?
hat is the role of !nsurance
Companies?
Role of Health Service Providers?
Role of Smart Card Service Providers?
Role of Social
Aggregators/NCOs/NF!s/!ntermediaries
WHAT HAvE THE STATE
COvERNNENTS TO DO?
!dentify/Setup a State Nodal Agency which is a separate
legal entity under the control of the State Covernment
Select 20 Districts at the earliest.
All the Districts have to be covered in the next five years.
Chosen Districts should have adequate network of health
facilities/hospitals which meet minimum standards.
Prepare data relating to PL families and health related
infrastructure.
Communicate the yearly schedule of coverage along with the
names of the districts to the Central Covernment as well as the
!nsurance Companies.
Finalize the tender document.
'ake a view on the package rates.
Advertise.
#OST ADvERT!SENENT #HASE
'ASKS FOR S'A'E COvERNNEN'S
Organise Statelevel workshop for
sensitizing the officials, Hospital staff and
the NCOs. ('he cost will be borne by the
Central Covernment)
Prebid Conference with the !nsurance
Companies.
#rocure list of B# families, including
soft copies, from the concerned
Districts and hand over these soft
copies, for test run, to the entral
Covernment Technical Team.
#OST ADvERT!SENENT #HASE
'ASKS FOR S'A'E COvERNNEN'S
Plan for delivery of cards
ork out a tentative villagewise visit plan on the basis of
PL List.
!dentify locations where cards could be issued.
!dentify occasions (market days etc.) when the scheme
and the delivery programme could be publicized.
!dentify the staff which would provide authentication at
the time of issue of cards. (A preidentified official will
accompany the team)
Prepare for training of Covernment officials for
issue of Smart Cards.
Understand and operate the Key Nanagement
System
#OST ADvERT!SENENT #HASE
'ASKS FOR S'A'E COvERNNEN'S
Cet the Contract Document legally vetted.
!ntimate Central Covernment in case
assistance is required for technical
evaluation.
Prepare template of proposal to be sent to
Central Covernment.
Finalize a date for signing of NOU with
Central Covernment and Contract with
!nsurance company.
Put in place an institution for smooth fund
flow to !nsurance Companies.
WHAT HAvE THE STATE
COvERNNENTS TO DO?
PROPOSAL 'O 'HE CEN'RAL COvERNNEN'
'ender Document issued by the State
Covernment.
Ninutes of the Committee approving
the proposal at the State level
ROE OF !NSURANE
SERv!E #ROv!DER
Study the profile of the Districts.
Empanel the hospitals, both public and private, on the basis of
the guidelines (also take a view on the package rates) and
subsequently enter into an arrangement with them.
Procure hardware, like smart card reading machines, as per the
specifications and provide them to the network hospitals. (Cost
of these equipments and maintenance thereof shall be borne by
the concerned hospitals)
Enter into an arrangement with the Smart Card Service
Providers and NCOs/intermediaries.
Organize Districtlevel training workshops for network hospital
personnel and for NCOs/intermediaries after selection.
!N#ENENTAT!ON OF THE
SHENE
Signing of NOU between the Central
and the State Covernment.
Contract between the State
Covernment and the !nsurance
Provider.
Delivery of Smart Card to commence
SNART ARD
hat is Smart Card?
How will it operate?
ho would bear the cost?
SNART ARD
The #rocess
Smart cards to be provided by the selected
!nsurance Company. 'he !nsurance Company
can outsource this task. ('he guidelines are
being worked out and will be sent within ten
days)
PL family details will be provided in a
predefined electronic format by the respective
State Covernments to the !nsurance
Company for the Districts selected for health
insurance coverage.
SNART ARD
The process
A detailed villagewise schedule will be
worked out by the State Covernment in
consultation with the selected !nsurance
Provider.
Representatives of the respective State
Covernments and the !nsurance Provider to
visit each village jointly in the selected
District(s).
Advance publicity of these visits by the State
Covernments
SNART ARD
The #rocess
Photograph of the head of the family and
thumb impressions of all the family members
to be taken during the visit to the village.
Collection of Rs.30 from the beneficiary as
registration fee by the !nsurance Service
Provider ('his would be adjusted against the
amount of premium to be paid to the
!nsurance Company.)
SNART ARD
'he Process
Handing over the smart card and
insurance related pamphlet, in local
language, by the !nsurance Provider to
the beneficiary.
'he smart card would entitle the
beneficiary at the time of the delivery of
the card.
#ER!OD OF !NSURANE
. in one District
'he Scheme shall commence operation from
the first of the month after the next month
from the date of issue of smart card. 'hus, if
the initial smart cards are issued anytime
during the month of February in a particular
district, the scheme will commence from 1st
of April. 'he scheme will last for one year till
31st Narch of next year. 'his would be the
terminal date of the scheme in that particular
district. 'hus, cards issued during the
intervening period will also have the terminal
date as 31st Narch of the following year.
#ER!OD OF !NSURANE
..an illustration
Sl.
No.
Smart card
issued upto
!nsurance will
start
#olicy period #remium
1. February, 2008 1
st
April, 2008 1
st
April to 31
st
Narch Full
2. Narch, 2008 1
st
Nay, 2008 Upto 31
st
Narch,
2003
Full
3. April, 2008 1
st
]une, 2008 Upto 31
st
Narch,
2003
Full
4. Nay, 2008 1
st
]uly, 2008 Upto 31
st
Narch,
2003
3/12
S. ]une, 2008 1
st
August, 2008 Upto 31
st
Narch,
2003
8/12
6. ]uly, 2008 1
st
September, 2008 Upto 31
st
Narch,
2003
7/12
7. August, 2008 1
st
October, 2008 Upto 31
st
Narch,
2003
6/12
Enrolment will freeze from September, 2008 for above policy period.
#ER!OD OF !NSURANE
.. in another District
!n case the initial cards themselves are issued
in another district in subsequent months, e.g.
Nay, the scheme itself will commence from
1st of ]uly and will have a terminal date of
30th of ]une of the next year. 'he cards
issued subsequently will also have 30th ]une
as the terminal date. However, the
commencement of insurance for cards issued
subsequently in that district will be
determined by the logic mentioned earlier.
#ROESS FOW
The State Government selects the Districts and
identiIies the State Nodal Agency.
The Nodal Agency advertises to seek quotes
Irom the Insurance Companies.
Submission oI quotes / bids by Insurance
Companies.
#ROESS FOW
Arrangement by the
Insurance Service
Provider with:
a Health Service
Providers
b Smart Card Service
Providers
c Intermediaries/
NGOs/ MFIs
Examination and evaluation oI quotation and
selection oI the Insurance Service Provider.
Preparation and submission oI proposal to the
Central Government.
Evaluation and Approval oI the proposal by the
Central Government.
#ROESS FOW
Signing oI MoU between the Central and the
State Government / Nodal Agency.
Signing oI MoU between the Nodal Agency and
the Insurance Service Provider.
Handing over the BPL Data by the State
Government to the Insurance Service Provider.
#ROESS FOW
Preparation oI village-wise plan by the Nodal
Agency/State Government Ior delivery oI smart cards
in consultation with the Insurance Company.
Village-wise delivery oI smart cards, along with
a brochure. Collection oI Rs.30 as registration
Iee to be adjusted against the premium.
Preparation oI a
brochure by the
Insurance Co.
listing out the
beneIits and the
contact numbers
as well as the
hospitals.
Premium claim by
the Insurance
Company Irom
the State Nodal
Agency.
Claim oI 75
oI the premium
Irom the
Central
Government.
Visit to the Hospital by I.P.
#ROESS FOW
VeriIication oI the Thumb impression.
Admission oI the patient, blocking oI the anticipated
amount (on the basis oI the amount indicated in the
medical procedures) on the card and payment oI
transportation charges.
Treatment oI the patient and taking care oI the expenses
thereon.
#ROESS FOW
Lodging oI claims by the Health Service Providers Irom
the Insurance Company.
Settlement oI claims.
Discharge oI the patient and debiting oI the Iinal
amount Irom the smart card.
SONE !NTEREST!NC
FEATURES OF THE SHENE
For the first time !' tools being used for
the poorest of the poorby them,
for them
!t is a 'business model' with business
opportunity for all.
.....let us make it work