RASHTRIYA SWASTHAY BIMA YOJANA (RSBY) In Gujarat, Department of Health and Family Welfare is implementing the RSBY scheme since 2008. Initially it is piloted in five district of state and then extended to entire state.

OBJECTIVES OF THE SCHEME To provide health insurance coverage to Unorganized Workers. In Gujarat BPL-Rural & urban, NREGA workers, Railway porters, and BoC workers are covered Beneficiaries are entitled to get hospitalization coverage up to Rs. 30,000/‐. Package rates for a large number of interventions (1090 Procedures) are fixed. Pre‐existing conditions are covered. Five members of the family are covered. Newborn are covered as sixth member. Beneficiary pay Rs. 30/‐ as registration fee while Central (75%) & State (25%) Government pays the premium. Insurance Companies are selected through competitive bidding (e-tender).

Cont… Every enrolled family is issued a smart card containing family details along with members fingerprints and photographs. Claim transaction occurs at hospital through a hospital transaction software developed by MoLE. The beneficiaries gets cashless treatment at any of the empanelled hospital. He/she only need to carry his/ her smart card and provide verification through his/ her fingerprint. Health Service Providers send online claims to the insurer and get paid electronically.

GRIEVANCE REDRESSAL MECHANISM Chair – Deputy Director DGLW Convener – Under secretary RSBY Member – IC NaNO (National Nodal officer) NGRC Chair – Principal Secretary H&FW. Convener – State nodal officer-MD NHM Member – IC representative SGRC Chair – Dist Magistrate-Collector Convener – District Key Manager-CDHO DGRC 9/17/2018

Key Management System FKO DKM BPL families Issuance of MIC card DKMA(District Key Management Authority): Managed by DKM. Runs on a software used to issue FKO cards. FKO/MIC (Field Key Officer/Master Issuance card): Cards issued by DKM, used during enrollment by Govt. Representative to verify identity of beneficiary. MHC (Master Hospital Card): Issued by GoI and activated by DKM, used in Hospitals to validate Transaction Authenticity of Transaction Process. DKC (District Kiosk Card): Issued by GoI and activated by DKM, used at Dist. KIOSK for validation process. Issuance of MIC card FKO DKM Smart card verification BPL families Provide back MIC card to DKM After enrollment

RSBY POLICY YEAR 2016 BENEFICIARY BPL (RURAL & URBAN), MNREGA, Western Railway Porter, Building and Construction Workers PERIOD OF INSURANCE ONE YEAR HOSPITALIZATION EXPENSES Rs. 30,000 MEMBERS COVERED MAX. FIVE (SELF + SPOUSE + 3 DEP.) (Maternity and new born care is included) PROCEDURES 1090 PREMIUM 60% will be paid by Central Govt. and 40% by the State Govt. PRE-EXISTING DISEASE COVERED YES (SUBJECT TO MINIMAL EXCLUSIONS) DAY CARE SERVICES IF RELATES TO SURGICAL NATURE TRANSPORT ALLOWANCE ACTUAL WITH LIMIT OF RS 100/VISIT (ANNUAL CEILING OF RS 1000) PRE HOSPITALIZATION ONE DAY PRIOR POST HOSPITALIZATION FIVE DAYS (From Date Of Discharge)

Key Management System FKO DKM BPL families Issuance of MIC card DKMA(District Key Management Authority): Managed by DKM. Runs on a software used to issue FKO cards. FKO/MIC (Field Key Officer/Master Issuance card): Cards issued by DKM, used during enrollment by Govt. Representative to verify identity of beneficiary. MHC (Master Hospital Card): Issued by GoI and activated by DKM, used in Hospitals to validate Transaction Authenticity of Transaction Process. DKC (District Kiosk Card): Issued by GoI and activated by DKM, used at Dist. KIOSK for validation process. Issuance of MIC card FKO DKM Smart card verification BPL families Provide back MIC card to DKM After enrollment

Introduction to Hardware PC FKO Card Reader DKMA Card Reader MSO

Enrollment Process for DKMA

Login window appears. Fill login ID and Password and select continue button  

Card Request>>New Request

A request entry form

Personalization

Personalization of RSBY Authority Cards One or more FKO cards can be personalized using this module. Insert DKMA card in one of the readers, Select reader name from the list and press. Connect DKMA button

Enter the PIN for DKMA card and press OK.

Enter DKMA Reference No On pressing the OK button a message is displayed as “Insert a MIC Card in the available Reader, Select Reader Name and Press 'Personalize Card' Button.” Press ‘OK’ to proceed.

Select a Reader

Recharging

Select a Reader

Card Surrender

FKO Card Surrender Select a Reader

PIN Change/Unblock

DKMA Pin Change PIN Change/Unblock  DKMA  Pin Change

Enter New Pin

District Codes

District Codes Master

Reports Personalization Report, Card Stock Balance

Report

Personalization Reports

Enrolment Role of District Key Manager Get FKO training organised at Block level Provide support to the IC/ TPA in making the route chart for enrolment through block officials Get DKM Computer operator trained in using New DKM Software Receive FKO cards from SNA and Issue them to FKOs Provide FKO Undertaking to FKOs and collect it when they return Visit Enrolment Stations on a random basis and use checklist Receive back FKO card from FKOs, download the data on computer and issue card to new FKO if needed

Enrolment Insurance Company/ TPA SCSP Prepare a IEC materials to be given at the time of enrolment with following details: List of hospitals empanelled Details of the scheme Details of the district kiosk and call centre. SCSP Organise number of Enrolment kits as per the Tender conditions Awareness exercise in the villages as per the route plan before the enrolment date Visit the villages as per the route plan with the enrolment kit Enroll the beneficiaries as per the guidelines and provide smart card on the spot alongwith the brochure Evaluations have revealed that in a lot of cases Brochure was not provided to beneficiaries so this needs to be ensured.

Enrolment FKO (Field Key Officer) Receive the FKO card along with Undertaking Be present at the enrolment station as per the route plan intimated Identify the beneficiaries and verify them on the spot through its fingerprint and smart card After the enrolment process is over give back the FKO card to the DKM along with the filled undertaking Without Presence of FKOs , the Smart Cards Cannot be Printed now. FKOs shall fill the undertaking and provide back to district authorities after the Enrolment.

Pre – Enrollment Activities District Insurance company Prepare route plan Sharing enrollment dates to all District authorities for making ground level awareness (E.g. Police for safety, electricity board for continuous supply of electricity) Conduct enrollment workshop (block level) Ensuring sufficient FKOs Sharing ASHA Incentive guidelines Prepare IEC material Dissemination plan Identification slips to be distributed to identified families IEC dissemination report from Sarpanch/ASHA/FKO/THO Follow Route plan Enrollment Kit Installation District KIOSK Set-Up Publicity through Mike announcement at Temples, Mosques, Church and Gurudwaras,etc. Handbills Distribution, Posters Banners and Hoardings Payment to ASHA worker Video shows using projectors

RSBY Enrollment Station

DKMA & FKO’s Role Pre Enrollment During Enrollment Post Enrollment

Role of DKM – Pre enrolment Receive DKMA card from State Nodal agency Issue three authority cards: (a) Field Key Officer - FKO (Master Issuance Card - MIC), (b) Hospital Authority (Master Hospital Card - MHC) and (c) District Kiosk (Master Kiosk Card - MKC) cards. Ensure safe upkeep of Cards, maintain record of receipt, issuance, missing etc. Keep PIN in safe custody. Set up DKM Computer with necessary hardware and software in own office Understand the additional features & requirements for 64KB Card migration for all – DKM, FKO, Hospital Ensure Training of FKOs, IT, other support staff at the district Issue Field Key Officer (FKO) Cards to FKOs according to the specified schedule. Issue MHC Card and MKC Card to the Insurance Company or its representatives. Ensure Insurance company organize District Workshop at least 7 days before commencement of enrolment Facilitate the Route Plan with the insurance company/its intermediaries for effective coverage of beneficiaries in the district

Role of DKM – Pre enrolment Verify insurance enrolment manpower and machines/kits status as per tender document Ensure effective IEC by the insurance company and lend all possible support Ensure empanelment of optimum number of eligible hospitals – public and private Ensure that hospitals are functional before enrolment Ensure hospital training workshop is conducted by the insurance company and be present during that Allocate space for setting up of district kiosk by insurance company free of cost or at. Ensure that district kiosk is functional before the enrolment starts.

Role of DKM – During Enrolment Monitor the participation, timely attendance, presence and role fulfillment of FKOs in the enrollment process Keep few extra FKOs as stand by Provide support to the Insurance Company Field visit to the enrollment stations and record observations in the prescribed format Review the performance of Insurance Company as regards the enrolment status, review meeting format attached

Role of DKM – Post Enrolment Get the enrollment data downloaded from FKO cards to the DKMA computer Reissue FKO cards to new FKOs after personalizing again Collect FKOs Undertaking document and wasted cards Ensure submission/download of enrolment data from insurance/intermediary team (automatic through software) Monitor & compare the enrollment data at DKMA computer (as downloaded from FKO cards with that provided by insurer to determine the premium payable Coordinate with district administration to organize health camps for building awareness about RSBY Visit empanelled hospitals to check beneficiary facilitation and record observations as per standard format

Role of DKM – Post Enrolment Hold grievance committee meetings on pre-scheduled days every month, ensure that necessary entries are made on the website regarding all the complaints/grievances received 24 Hour helpline – check the functioning of Helpline on regular basis Communicate with SNA in case of any problem related to DKMA software, authority cards Prepare detailed report on enrolment, empanelment, utilization and beneficiary feedback

Data of Beneficiary family Verification by FKO Key transfer Verification by FKO by fingerprint and smart card FKO Card RSBY Card Data of Beneficiary family

Role of FKO – Pre Enrolment A .Pre-Enrollment Receive personalized Master Issuance Card from the DKM after providing own fingerprint Make sure to remember the Pin number of the FKO card as it would be needed at the enrolment camp and wrong Pin number will block the card which will stop the whole enrolment process Receive information about the name of the village (s) and the location of the enrollment Station(s) inside the village for which FKO role has to be performed Receive the contact details of the Insurance Company or their field agency representative forming part of enrollment team Receive information about the date and time on which enrolment is to take place Provide own contact details to the DKM and the Insurance Company field representatives

Role of FKO –Pre Enrolment Check the display of the beneficiary list in the village Make sure that the FKO card is personalized with his/her own details and fingerprints and is not handed over to anyone else at any time. Should ensure that at least 1 FKO card for every 450 beneficiaries, expected at the enrollment camp, is issued to him/her i.e., in case the beneficiary list for a location is more than 450, they should get more than 1 FKO card personalized with their details & fingerprint and carry with them for the enrollment.

Role of FKO – Enrolment Reach the enrollment station punctually at the given time and date without fail and Inform the Insurance Company/DKM a day in advance in case unable to come Ensure that the beneficiary list is displayed at the enrollment station Identify the Beneficiary at the enrollment station either by face or with the help of specified identification document, can also make use of the Gram Pradhan to correctly identify the beneficiary Make sure that the enrollment team corrects the name and relationshipof dependents in the field in case of any mismatch Make sure that the enrollment team enters the gender and age data of all members in the field Make sure that the enrollment team is not deliberately excluding any member (upto maximum of 5) of the identified and verified beneficiary households for RSBY enrollment Ensure that the card is printed only after he/she has authenticated the card by inserting his/ her FKO card and provided fingerprint

Role of FKO – Enrolment Ensure that the card is printed only after he/she has authenticated the card by inserting his/ her FKO card and provided fingerprint After the smart card is printed, make sure the enrollment team validates the fingerprint of atleast one enrolled member of the beneficiary family against the smart card being issued to them. In case this validation fails, then a new smart card has to be issued to the family following the same process again without charging any extra money. The wasted card should be retained by the FKO and deposited to the DKM. Make sure that the enrollment team is issuing the smart card on the spot to the beneficiary Ensure that the details of all eligible (within RSBY limits of Head of family + spouse + 3 dependents) family members as per beneficiary list and available at the enrollment station are entered on the card, and their fingerprint & photograph taken Ensure that the enrollment team is provides a brochure(including hospital list) to each beneficiary family along with the smart card

Role of FKO – Enrolment Ensure that the Scheme benefits are explained to beneficiaries while they are waiting for enrolment/card (could be done through running audio media at the camp) Make sure that the smart card is given inside a plastic cover and beneficiaries are told not to laminate it If a beneficiary complains that his/her name is missing from the Beneficiary list, then collect the information in the specified format and share with the DKM If all the eligible dependents of a beneficiary family are not present at the camp, the family should be informed that the other members can be added to the card at the District kiosk.

Role of FKO –Post Enrolment Return the FKO card to the DKM after the enrollment is over at the location (s) for which the FKO is responsible At the time of returning the card, ensure that the data is downloaded from the card and that the number of records downloaded is the same as the number he verified at the camp. In case of any discrepancy, make a note of the difference and ask the DKM to send the card and the note back to CKGA Submit the FKO undertaking in the prescribed format to the DKM Submit the waste cards collected at the enrolment camps to the DKM Hand over the list of left out people, collected at the enrollment camp to the DKMA. Prepare the Zero enrollment village list.

Awareness Activities Handbills

Hospital banner Information Slip

POSTER

RSBY Film-Night Show Sagbara, Narmada

Target Families as per 33 Districts Sr.No District Name Total Data Enrolled Families as per DKMA 1 Ahmedabad 392670 99719 2 Amreli 111279 34754 3 Anand 200616 67856 4 Aravalli 79881 40186 5 Banaskantha 312236 103793 6 Bharuch 139532 58562 7 Bhavnagar 122859 54111 8 Botad 37355 15669 9 Chhotaudepur 136550 64391 10 Dahod 275470 78988 11 Dangs 69241 28575 12 Devbhoomi Dwarka 39038 16001 13 Gandhinagar 66713 32121 14 Gir Somnath 84192 37154 15 Jamnagar 93431 25792 16 Junagadh 107010 52869 Sr.No District Name Total Data Enrolled Families as per DKMA 17 Kheda 176355 76742 18 Kutch 126971 42609 19 Mahisagar 110874 61964 20 Mehsana 143604 76929 21 Morbi 62925 26792 22 Narmada 95684 54696 23 Navsari 86581 49806 24 Panchmahal 176248 68314 25 Patan 164598 62985 26 Porbandar 23329 12171 27 Rajkot 195531 69930 28 Sabarkantha 131956 46974 29 Surat 177169 78169 30 Surendranagar 161527 60258 31 Tapi 93588 64889 32 Vadodara 202418 84443 33 Valsad 148985 76035   4546416 1824247

Thank you www.rsbygujarat.org newrsbygujarat@gmail.com RSBY-Toll free no. 1800 233 1021