RSBY -DKMA Training

13.04.23 Seite 1www.rsby.gov.in

Rashtriya Swasthya Bima Yojna – Capacity Building of District Key Manager


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 – Thirteen


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 hospital


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)


Insurance Company

State Nodal Agency

Health

Care Provider

s7.

Enr

ollm

ent o

f Ben

efici

aries

FKO

7. Verification

of Smart Card

BPLBeneficiaries

Government of India

Beneficiary Data

www.rsby.gov.in

5. Empanelment

District Kiosk

DKM

Call Centre

5. Setting-up

Setting-up

1. Prepare in

given format

2. Send for

verification

3. Upload on website

after verification 4. Selection through tendering

6. I

ssua

nce

of

FK

O C

ard

8. D

ownl

oad

of

FK

O

Dat

a a

t D

KM

ser

ver

9. Submission of data and bill

10. Payment to Insurer

11. Utilisation of Services

12. Claim Process

AwarenessHealth Camps


Enrollment Station


Key transferVerification by FKO by

fingerprint and smart card

Data of Beneficiary family

FKO CardRSBY

Card


Role of State Government1. 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 districta. Help Insurance company prepare enrollment schedule and

prepare Awareness campaign for beneficiariesb. Help identify locations to hold enrollment camps and facilitate

such camps


Pre-Enrollment

Other Key Roles of State Government

Incentive for FKOs

(if necessary)


Post Enrollment

Other Key Roles of State Government


Role of State Government6. 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

7. Organise weekly review meetings at State and District level

8. Organise awareness activities post-enrollment

9. Enable Government hospitals to compete with private Hospitals by providing incentives

10.A State server shall store all the data of last year and coming year for all the operational districts


Role of State Government13.This data shall be analysed based on:

– Conversion ratio– Hospitalisation ratio - Average and Genderwise– Average Family size– Disease pattern– Burnout Ratio

14.Monthly reports based on data analysis can be prepared and shared with different stakeholders

15.Concurrent evaluation of the scheme shall be done


What is Key Management System

Central Key Generating Authority

Hospital

District KioskDistrict Key Manager

Field Key OfficerBeneficiaries

Authentication of smart card at the time of enrollment

Personalise and issue FKO Cards

Issues personalised DKM Cards, FKO Cards, HAC Cards, District Kiosk cards

Issues personalised Beneficiary Smart Card

Issues personalised HAC Card

Insurance Company

Issue District Kiosk Card

Post issuance issues

Hospitalisation

Hospital Code issued


Role of District Key Manager1. Receive DKMA card and issue following cards:

a. Field Key Officer Cards according to the specified scheduleb. Hospital Authority Cardsc. District Kiosk Cards

2. Set up DKM Server at District level

3. Monitor the participation of FKOs in enrollment

4. Get enrollment data downloaded from FKO cards to DKM Sever


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 sensitisation


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 staff


Signage Outside Empanelled Hospitals


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 to


BEFORE AFTER


Administrative Wing (before) (after)


Role of Insurance Company1. Finalise the TPA/ Smart Card

service provider

2. Set up team at State and District level for the implementation

3. Organise District-level workshops with all stakeholders

4. Organise separate District workshop with health care providers before the empanelment

Pre-Enrollment

Print these three details in the Enrollment Brochure


Role of Insurance Company

Post Enrollment

Send consolidated data the Government

Send Back end data to Central

Govt..

1. Enrollment of the beneficiaries 1. Prepare villagewise plan

2. Communicating this plan to the villages

3. Identify locations in each village for enrollment

4. Coordinate with State Government for the FKOs

5. Visit villages according to the plan with enrollment team

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 etc.


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 Plan


Thank You

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RSBY -DKMA Training

Health & Medicine

Transcript of RSBY -DKMA Training