|| OM SHREE MANJUNATHAYA NAMAHA ||

1. || OM SHREE MANJUNATHAYA NAMAHA ||

2. SHREE MANJUNATHA SWAMY TEMPLE

3. THE TRUSTEES Shri Kshethra Dharmasthala Rural Development Project popularly known as SKDRDP is a registered charitable trust promoted by Dr. D. Veerendra Heggade. The SKDRDP is managed by Board of Governors consisting of 7 members (At present four members). Smt. Hemavathi V. Heggade President Jnana Vikasa Women Programme Sri D. Surendra Kumar Trustee Dr. D. Veerendra Heggade President Sri K.M. Udupa Trustee Sri B.B.Shanubhogue Trustee Sri Udaya Kumar Trustee Sri. R.V.Shasthri Trustee

4. Dharmasthala the abode of Dharma Shri Kshethra Dharmasthala Rural Development Project popularly known as SKDRDP is a registered charitable trust promoted by Dr. D. Veerendra Heggade the sole trustee of Shri Dharmasthala temple. Dharmasthala is a famous Hindu religious shrine of South India with about 700 years of History. The presiding deity of Dharmasthala is Lord Manjunatha Swamy reincarnation of Lord Shiva. Dharmasthala is known for religious harmony yet with a lot of Bhakthi and religious fervor. Although the deity is Shiva, the Priests are Vaishnavaites. The trustee of the temple belongs to Jain community. Many festivals in Dharmasthala attract tourists and faithfulls, all over the country. The festivals of Dharmasthala have a tinge of religion, bhakthi, social value, cultural ethos, rituals. Annadhana and Abhayadhana are two of the major functions ordained to be performed by Dr. D. Veerendra Heggade as the trustee of the temple. Sarvadharma and Sahithya Sammelana are annual features of Dharmasthala

5. Dharmasthala the abode of Dharma Excellent facilities have been provided for visitors of Dharmasthala. The massive “Annapoorna” Dining hall provides lunch and dinner for all the visitors of Dharmasthala. The quality of food and hygiene practiced in Annapoorna Kitchen is phenomenal. Charity is supposed to be practiced by Dr. D. Veerendra Heggade in its purest form. No seeker goes empty handed from Dharmasthala. To promote the philosophy of directed charity Dr. D. Veerendra Heggade has promoted many Institutions in the field of Education, Health, Promotion of Indian Medicine, Naturopathy, Yoga, Life Education, improving the living environment.

6. || OM SHRI MANJUNATHAYA NAMAHA || Welcome to an introduction of SAMPOORNA SURAKSHA PROGRAMME (A unique Health Care Model) A product of SHRI KSHETHRA DHARMASTHALA RURAL DEVELOPMENT PROJECT (R.) (A secular, not for profit, non political, registered voluntary organisation) For us Progress with values is a passion To reach the unreached is our vission

7. Hindu Rudra Bhoomi Jnana Deepa Grama Kalyana Community Development Jana Jagruthi SIRI Programmes Of SKDRDP Pragathi Bandhu & SHG Micro Finance KUDCEMP Agriculture SGSY Sampoorna suraksha 5 Districts 131 Net work Hospitals 17 Taluks Insurance company 4739Villages. 290000 Families 1084000 Members

9. COVERAGE AREA OF THE SCHEME Shri Kshethra Dharmasthala Rural Development Project is functioning in 6 Districts of Karnataka State of INDIA SAMPOORNA SURAKSHAHEALTH CARE PROGRAMME. * The Scheme covering 2,94,151 families and 11,76,433 members .

10. OUR VISION TO REACH THE UNREACHED IS OUR VISION The greatest hurdle for the financial development of the SHG members and their families have been the sudden incidence of disease, accidents and hospitalization expenses which put them to the vicious cycle of debts. Therefore our vision is to provide “Cashless” quality health care to all the members of the family of the self-help groups.

11. OUR MISSION The mission is to provide financial protections to the poor in their emergencies cashless quality health care treatment through net work hospitals at affordable rate, Financial consolation at the time of birth (delivery) Normal or Accidental death, permanent physical disability, domiciliary treatment, and damage to the dwelling house due to natural fury.

12. SAMPOORNA SURAKSHA Scheme Name: • Duration: For 12 months commencing from 1st April to 31st March of subsequent year –Renewal every year. • Eligibility: S H G member and his / her family members maximum 10 member with age 3 months to 80 years. • Family : Husband, wife, sons, unmarried daughter, parents, In-laws (in case of dependents,) brothers, and their spouse and children, unmarried sisters, widow sisters/daughters and their minor children.

13. SUBSCRIPTION AND FACILITIES • Subscription Rs. 220 for the APL SHG member and Rs.145 per member of his family • Rs:200 for the BPL SHG member and Rs: 110 per member of his Family • Cashless Hospitalization facility is Rs.5000 per member in multiples or Rs.5000 each member of the family registered on floater basis. • Additional Special benefits:- Delivery expenses reimbursement, Death (Accident or Normal) Consolation, Domiciliary treatment Rest allowance, Permanent disability compensation, consolation on loss to dwelling House.

14. OUR INSURANCE PARTNERS • Oriental Insurance Company • New India Assurance Company Ltd. • National Insurance Company Ltd.

15. 2. Special Benefits by Sampoorna Suraksha (S.K.D.R.D.P.) • 1st and 2nd delivery maternity benefit to the members. • Normal Delivery – Rs. 2000/- maximum. • Caesarian Delivery – Rs. 5000/- maximum. • Domiciliary treatment - rest allowance to the S H G member (Stake holder) at Rs. 50/- per day maximum for 30 days. • S H G member’s (Stake holder’s) Natural death consolation to nominee Rs. 5000/- with in 24 hours. • S H G member’s (Stake holder’s) death due to accident consolation to nominee Rs. 25,000. Full disability of Stakeholder Rs. 25,000/-, partial disability is 12,500/- • Dwelling house damage due to nature’s fury Rs. 1000/- consolation.

16. Service Delivery Mechanism • Registration & Subscription collection and delivery of Registration card by S. K. D. R. D. P. Field staff. • Time of Registration during second week of February & march every year. • Cashless Treatment benefit • Registration card to be produced in the network hospital to avail cashless treatment facility. • Net-work hospital should seek Pre-authorization by Fax with in 24 hours of the hospitalization . • Pre-authorisation is decided by Medical officer as per norms and condition.

17. On Pre-Authorisation Net work hospital extends cashless treatment to the member. • Suraksha Assistants in Taluk office visits the hospital and Identifies the member. • Bills of the cashless treatment should be sent to suraksha office on weekly basis • Bills will be verified on both accounting and medical angle in suraksha office then to Insurer who will release the amount to suraksha office. • Suraksha Office settles the bills to Hospitals. • Pre authorisation , Claim processing and accounting system in suraksha office is computerized.

18. 2. Special Benefits and paid treatment claims • Paid treatment and Special benefits claims are submitted to the concerned project office through the village level field staff and forwarded to suraksha office on weekly basis. • These claims are processed in accounting and medical angle. • Paid treatment claims reimbursed by insurance company, Special claims sanctioned by SKDRDP. • Settlement of these claims by cheque through concerned project office & village level field staff

19. FACILITY FLOW CHART OF THE SCHEME SKDRDP SAMPOORNA SURAKSHA PAID & SPECIAL CLAIMS SUBSCRIPTION PROCESSED CLAIMS SETTLEMENT P.A .REPLAY PREMIUM P.A.REQUEST SETTLEMENT SETTLEMENT CLAIMS I D CARD 131 Net work Hospitals 48 Net work Hospitals Insurance company SHG GROUPS CASHLESS TREATMENT

20. List of Net -work Hospitals

29. Package ListThis Package is inclusive of Bed, Doctor's Fees, Nursing, Service, Medicines, Surgery and Pre Surgery medical expenses, medical consumables & relevent investigations etc., in general ward.Package is Inclusive of Bed, Doctor's Fees, Nursing, Medicines, Pre Surgery medical expenses medical consumables etc. in general ward.

34. Sl. No PERFORMANCE CHART

35. FUTURE PLANS • Access to good diagnostics and OPD care for effective disease management • Community education in health, nutrition and sanitation, • Training of village level workers on basic testing and disease identification for early intervention • Introduction of standard treatment guidelines • Research on impact assessment to commence soon

36. Our exerience

37. Implmentation stage Problems • Our inexperience in the insurance field • Group members education standard • Hesitation to pay hard earned money for unforeseen events / ailment • Lack of pre plan, and necessary system development • High expectations of the members and misunderstanding that scheme covers all hospitalisation expenses • Unnecessary admission , high billing, ineligible claims, caused financial burden to both Insurance Company . To the organisation

38. Insurance Co had no experience with similar product for rural. • No Proper and adequate infrastructure for claim management and guidelines by the Insurance Company. • No Control gate for admission in the hospitals • No Fixed billing tariff to the hospitals • Due to hurried implementation of the scheme without prior knowledge, lack of trained staff and full knowledge of the scheme. • Not fully succeed to create awareness, importance and necessity of the scheme among the members.

39. Probable Cause • Heavy workload • Poor enrollment Rate • Dissatisfaction by the members • Delay in claim settlement • Pendency and rejection of claims • Heavy claim in flow leading to high claim Ratio • Hospital and Patient induced admission

40. Changes done on the basis of I Year Experience • Changed the Insurance Company • Reduced the no. of network hospitals • Fixed tariff to the procedure and treatment • Pre – authorization system • Personal Identification system of the hospitalised member gave human touch to the care of the members • Pre– planned – calendar of events of implementation such as. Training the field staff • Creating awareness Among the members, by addressing in their meetings and gathering • Systems and procedure - how to avail the facility ……… • Accounting and medical servicing of claims before submitting to Insurance company • To earn confidence of hospitals – advance payment by obtain is that money from Insurance co.

41. RESULT • “ Trust “ Created among members • No of members increased • Claims are controlled – Unnecessary admissions reduced to minimum • Because of trained field staff – members doubts and grievances are solved to the maximum extent • Members are increased every year

42. CHALLANGES • 100% enrollment not obtained We are unable to convince 100% members • Unable to full fill members all health needs • We are not succeeded in creating spirit of among the network hospitals. • Still there high claim, therefore Insurance Co. is not comfortable • Because the tariff does not cover the cost of treatment entirely – hospitals are not comfortable – hence collecting money over & above the tariff. • Members are not comfortable , because they are not getting facility to all o their ailments • Members financial condition is not fair to give higher premium. So Loading the premium and increasing tariff is difficult. • Loading the premium and increasing the tariff • Planning to Making use of Govt. hospitals for medical service to minimise the treatment cost.

43. Thank you