Smart Healthcare conclave 2016, Vinita singh PPT

1. Bhamashah Swasthaya Bima Yojana
Rajasthan

2. Bhamasha Swasthaya Bima Yojana
Launched on 13th
December, 2015 for
around 1 crore eligible families of
Rajasthan in compliance of Budget
Declaration of Hon’ble Chief Minister,
Rajasthan.

3. Organogram-State Level

4. Organogram-District Level

5. Bhamasha Swasthaya Bima Yojana
• Beneficiary: Families identified under
– National Food Security Act (NFSA) and
– Rashtriya Swasthya Bima Yojana (RSBY).
• Health Insurance Coverage: Rs. 30,000 (for
general illnesses) and Rs. 3.00 lacs (for critical
illnesses) per family per year.
• Disease Coverage: Total 1715 disease packages
– 1148 Secondary
– 500 Tertiary
– 67 Govt. reserved packages
– Covering 14 specialties.

6. Secondary Packages (1148) Tertiary Package (500) Government PKg (67)
Specialty No. of Pkg
Dentistry 36
ENT 155
General Medicine 36
General Surgery 402
Neurosurgery 59
Obstertics &
Gynaecology
93
Oncology 10
Ophthalmology 64
Orthopedics 202
Paediatrics 31
Urology 124
Specialty No. of Pkg
Cardiology & CTVS 122
Chest Surgery 20
ENT 2
General Medicine 16
General Surgery 21
Neurosurgery 64
Oncology 178
Orthopedics 10
Paediatrics 8
Plastic Surgery 13
Urology 46
Specialty No. of Pkg
ENT 14
General Surgery 18
Obstertics &
Gynaecology
25
Ophthalmology 10

7. Continue…
• Govt Hospitals (n=480): Medical College &
associated hospitals, DH, SDH, Satellite
hospitals and CHCs
• Private Hospitals (n=568) empanelled under
the scheme,
• Empanelment of Pvt hospitals is responsibility
of Insurance Company.
Information on govt and empanelled private
hospitals is available at webpage of scheme
http://health.rajasthan.gov.in/bsby

8. No. of Private Hospitals Empanelled SoNo. of Private Hospitals Empanelled So
FarFar
Increasing
number of
hospitals depicts
increasing
interest of private
sector
Increasing
number of
hospitals depicts
increasing
interest of private
sector

9. Stakeholders in the Scheme

10. Responsibility of Stakeholders
• Medical & Health:
– Overall planning & execution of scheme
– Payment of premium to Insurer
– Monitoring & Grievance Redressal of pvt & govt hospitals
• NIAC:NIAC:
– Providing Insurance Cover to entitled families
– Empanelment of private hospitals
– Training & orientation of SM & Nodal Officers
– Claim processing and payment
• DoIT:DoIT:
– Preparing software for the scheme
– Establishment of Call Center
– Support in IT related issues
– Issuing Bhamashah Card to all.

11. Admission
& TID
Generation
by Hospital
Admission
& TID
Generation
by Hospital
Eligibility
Verification of
Family and
individual
Identity using
Bhamashah
Card /
Bhamashah
Slip / RSBY
Card
Eligibility
Verification of
Family and
individual
Identity using
Bhamashah
Card /
Bhamashah
Slip / RSBY
Card
Checking
available
amount in
wallet of
family
Checking
available
amount in
wallet of
family
Starting
Treatment
Starting
Treatment
Blocking
Package
Blocking
Package
Online Pre-
Authorization
Request and
Approval by
NIAC
Online Pre-
Authorization
Request and
Approval by
NIAC
Discharge &
online claim
submission
Discharge &
online claim
submission
Claim Approval &
Online Payment to
Hospital
Claim Approval &
Online Payment to
Hospital
Secondary
Package
Secondary
Package
Tertiary
Package
Tertiary
Package
Patient will be received
at hospital by Swasthya
Margdarshak after IPD
advise by doctor
Patient will be received
at hospital by Swasthya
Margdarshak after IPD
advise by doctor
Process Flow under BSBY

12. What makes us different……
Rajasthan RSBY Maharashtra Tamil Nadu
Sum insured
Secondary – 30,000
Tertiary – 3,00,000
30,000 2,50,000 1,50,000
Coverage
Comprehensive
Secondary and
Tertiary
Secondary Tertiary Tertiary
Target population
NFSA (includes 15
categories)
and RSBY
BPL families
BPL & APL
families
BPL families
Packages 1715 1300 972 1016
Verification of
beneficiary
Bhamashah Card Biometric
Yellow / Orange
card
Biometric
Multipurpose call
center
Yes No No No

13. Progress So Far..

14. Total No. of Claims Enlisted
0
50000
100000
150000
200000
250000
300000
350000
400000
3228 20063
52906
97800
154178
228800
300751
364187
386433
NumberofClaims

15. Total Amount of Enlisted Claims
(Rs. in Lac)
164.23
1016.43
2742.05
4873.94
7397.41
10736.41
14045.47
17069.84
18177.17
0
5000
10000
15000
20000
31-12-2015 29-02-2016 30-04-2016 30-06-2016 10/8/2016
Rs.InLac

16. Total No. of Claims Submitted
0
50000
100000
150000
200000
250000
300000
350000
2611 16590
44319
83406
132820
197070
261073
313893
335992
NumberofClaims

17. Total Amount Submitted (Rs. in Lac)
0
2000
4000
6000
8000
10000
12000
14000
16000
124.9 769.55
2135.56
3888.84
6086.3
8903.33
11771.29
14112.3
15192.39
Rs.InLac

18. Total No. of Claims Approved
0
50000
100000
150000
200000
250000
1736 12142
31221
57384
89043
130702
177485
216938
239524
NumberofClaims
Claim approvals raised
by around 86,000 in
last two months

19. Total Claims Approved (Rs. in Lac)
0
2000
4000
6000
8000
10000
12000
31-12-2015 31-01-2016 29-02-2016 31-03-2016 30-04-2016 31-05-2016 30-06-2016 31-07-2016 10/8/2016
73.75
493.74
1419.89
2520.02
3693.65
5194.58
7196.23
9015.43
10270.27
Rs.InLac
Approvals raised by
around 40.00 cr in only
two months

20. Total No. of Claims Paid
15979
22042 34580
83639
142605
209558
0
50000
100000
150000
200000
250000
NumberofClaims
Rise of
approximately
1,25,000 claims in
last two months

21. Total Amount Paid (Rs. in Lac)
0.00
2000.00
4000.00
6000.00
8000.00
10000.00
till29th
Feb,2016
31-03-2016 30-04-2016 31-05-2016 30-06-2016 28-07-2016
338.26 678.35 1303.53
3098.67
5260.00
8117.47
Rs.InLac
Rise of 51 crores
in last two
months

22. Pvt Contribution in Total Claim Booking

23. Critical Diseases Treated under The
Scheme
•Cardiovascular & Cardio Thoracic and Vascular Surgery:
 Bypass surgery (CABG): 305 claims amounting Rs. 2.27 crore
 Heart Valve Repair: 512 claims amounting Rs. 5.43 crore.
 Angioplasty: 2135 claims worth of Rs. 11.61 crore.
 Congenital Heart Disease:102 claims amounting Rs. 67.44
lac.
•Cancer: 11602 claims of cancer treatment (Chemotherapy,
Radiotherapy and Surgery) amounting Rs. 14.96 crore.
•Brain Surgery: 1112 claims amounting Rs. 3.26 crore.
•Spinal Surgery: 796 claims amounting Rs. 2.41 crore.
•Lung Surgery: 75 claims amounting Rs. 24.08 lac rupees.
•Plastic Surgery: 233 claims amounting Rs. 81.67 lac.
•Cardiovascular & Cardio Thoracic and Vascular Surgery:
 Bypass surgery (CABG): 305 claims amounting Rs. 2.27 crore
 Heart Valve Repair: 512 claims amounting Rs. 5.43 crore.
 Angioplasty: 2135 claims worth of Rs. 11.61 crore.
 Congenital Heart Disease:102 claims amounting Rs. 67.44
lac.
•Cancer: 11602 claims of cancer treatment (Chemotherapy,
Radiotherapy and Surgery) amounting Rs. 14.96 crore.
•Brain Surgery: 1112 claims amounting Rs. 3.26 crore.
•Spinal Surgery: 796 claims amounting Rs. 2.41 crore.
•Lung Surgery: 75 claims amounting Rs. 24.08 lac rupees.
•Plastic Surgery: 233 claims amounting Rs. 81.67 lac.

24. IEC Activities

27. BSBYBSBY
LED BOARDLED BOARD
ON TOP OFON TOP OF
PVTPVT
HOSPITALSHOSPITALS

28. LED Boards on Roads

29. Pamphlet Printed for IEC of the Scheme
& Pvt. Empanelled Hospitals

30. Facebook page- regular updationFacebook page- regular updation

33. Regular Updates on Google+ and blog

34. Success Stories of BSBY across Districts

35. • ASHA Samwad with more
than 46,000 ASHAs
through Video
Conference under the
chairmanship of Hon’ble
Health Minister, GoR
• Three rounds
accomplished so far for
orientation regarding
BSBY
Video Conferences with ASHA

36. BSBY ASHA KIT

37. IEC of BSBY Through Auto Riksha

38. Bhamashah Samsya Samadhan Shivir
• Extensive IEC of the BSBY in Bhamashah Samsya
Samadhan Shivir being held during 25th
July, 2016 to 5th
August, 2016 at each panchayat HQ.

39. Official Webpage of BSBY

40. Grievance Redressal

41. Redressal of Grievances
• State (SGRC) and District Grievance Redressal
Committees (DGRC) are formulated.
– SGRC: under the Chairmanship of CEO, RSHAA
– DGRC: under the Chairmanship of District Collector
• Formulation of State Appellate Authority under
the chairmanship of Principal Secretary, M&H
• Rajasthan Sampark Portal: Public grievance
portal for inhabitants of state, can also register
their complain at this portal.
• Integrated Toll Free Centre: 1800-180-6127 for
redressal of any query and registering complaint.

42. • Most comprehensive health cover
• Provision for Fund Enhancement- Rs. 10.00 cr as
corpus
• 2% of the premium is dedicated for IEC.
• Minimum Document Protocol (MDP)
• No Third Party Administrator
• Unique profit refund clause to ensure optimum
premium utilization and discourage insurer from
rejecting genuine claims
• Reimbursement to the hospital within 21 days of
submission of claim.
Unique Features

44. Thanks