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