Rashtriya Swasthya Bima Yojna in the State of Chhattisgarh
28th June 2011 RSBY RRM Ranchi 1
Main features
• Business Model for all Stakeholders• Empowering the beneficiary • Insurers • Hospitals• Government• IT based
IMPLEMENTATION OF THE SCHEME– Setting up of Nodal agency– Identification of Insurance agency– Appointment of DKM and FKOs– BPL data base– Enrollment of Beneficiaries and Delivery of
Smart Card to commence– Empanelment of Government and private
institutions– Payment of insurance premium to the
insurance service provider.– Delivery of health services
State Nodal Agency-Chhattisgarh
Department of Health and Family Welfare – Nodal Department A Separate Nodal Agency under State Health Society has been
constituted.
Nodal Agency comprise of Director Health Services as Ex- officio CEO Additional CEO -functional or Executive CEO Consultant- Hospital, Enrollment, M&E and Computer programmer Accounts Manager and other support Staff. District RSBY Consultant ( in position 17/18 districts) Chief Medical and Health Officers are DKM and a separate Nodal
officer has been nominated for each district. The Hospital Administrator at District Hospital and Block programme
Manager under NRHM will coordinate Hospital activities Health Workers ( male and Female ) have been designated as FKO in
Rural areas whereas AWW work as FKO in Urban areas
17th November 2011 RSBY for consultants 4
Insurance Company
State Nodal Agency
Health Care Providers
7. E
nroll
men
t of B
enef
iciar
ies
FKO
7. Verification
of Smart Card
BPLBeneficiaries
Government of India
BPL Data
www.rsby.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
13. Submission of Data to State and Central Govt.
Status of scheme • No of districts covered:- 18• Total BPL families enrolled till date:- 15,48,696• Total population enrolled:- 52,11,797• Avg. Family size:- 3.4• No of beneficiaries till date:- 1,43,849• Claim amount generated till date:- Rs.6328.22• Claim ratio:- 71.6• Burnout ratio:- 105.2• Hospitalization ratio:- Rs.4449.5
17th November 2011 For RSBY consultants 6
Moral hazards/ issues
• At the time of enrollment
• At the time of empanelment
• For utilization of services
Going Beyond BPL
• RSBY is being extended to other categories of Unorganized sector workers who are non-BPL
• NREGA beneficiaries• Building and Construction Workers• Postman• ASHA Workers/ Mitanin• Anganwadi Workers• Non-Government sectors
• In many of these categories people have agreed to pay part or full premium by themselves
• Some other ministries are also contemplating to extend it to their targeted beneficiaries