Bhamashah Swasthya Bima Yojana Rajasthan

1. BhamashahSwasthyaBimaYojana Rajasthan An overview of the scheme…….

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3. What is BhamashahSwasthyaBimaYojana? • It is a scheme to provide cashless facility to the IPD patients. • For the identified families covered under National Food Security Act (NFSA) and Rashtriya Swasthya Bima Yojana (RSBY). • By the Government (Medical and Health Department) • Through an Insurance Company “New India Assurance Company” • On a fixed premium per family per year on floater basis

4. Aims of the scheme • To Hedge Govt. moneys • To provide quality health care that avoids large out of pocket expenditure • To provide financial security against illness • To Improve health status of the State. • To create a data base which could be used to make policy level changes in Healthcare. • To bring a revolution in healthcare in rural area – by providing stimulus to Private Sector to open hospitals in rural areas and reducing the increasing burden on Government facilities .

5. Salient features of BSBY • Cashless for beneficiary • Only for IPD procedures. • 1715 disease packages are covered under the scheme which includes 1045 packages for Secondary illness, 500 for Tertiary illnesses. • 170 disease packages are reserved for Govt. Institutions. (these includes 65) • For the families covered under NFSA or RSBY. • To be coupled with Bhamashah Scheme. • Treatment through Govt. and accredited private hospitals. • Coverage of Rs. 30,000 for general illnesses and Rs. 3 lakh for serious ailments. • Provision for fund enhancement. • MNDY ,MNJY and MMBPLJRK to continue as usual.

6. Salient features of BSBY • Beneficiaries will be covered for secondary and tertiary illness according to the pre decided package rates. • Pre-existing conditions or diseases will be covered from beginning of the scheme. • Transportation allowance of INR 100 in cash to be given during discharge of the beneficiary with an annual ceiling of INR 500 and shall be a given only for Cardiac & Polytrauma cases. • Transportation allowance is included in the package cost. • Pre hospitalization of 7 days and post hospitalization of 15 days to be covered under the scheme.

7. The package cost includes….. • Bed charges • Nursing and boarding charges • Surgeons, Anaesthetists and other Consultants fees • Aanaesthesia, Blood, oxygen, implants, medicines, consumables etc. • Cost of radiological and pathological diagnostic Tests like blood, urine, x-ray etc. • Transportation allowance for poly-trauma and cardiac cases • Food for beneficiary during hospital admission

8. Advantages • To the Health Institution • Direct Benefits:--- • Financial Strengthening of RMRS of the institution. • As private hospitals are also empanelled , this scheme will result in lessened workload on Govt. Institution. • Indirect Benefits:- • Increased satisfaction level of patient. (as it is complete package, patient doesn’t have to go for any extra medicines or investigations) • Lesser incidents of bribing/overbilling etc as all activities will be monitored through IT portal.

9. Advantages • To the beneficiary • Direct Benefits:--- • Cashless, hassel free. • Low OOP expenditure. • Opportunity to get treatment in private hospitals. • All pre-existing diseases covered. • 7 days pre and 15 days post hospitalization expenses covered. • Indirect Benefits:- • Improved Health status • Improved Economic Status • Improved satisfaction level

10. Scheme Structure

11. Scheme Structure

12. Scheme Structure

13. At Institution level

14. At Institution level

15. SERVICE PROVIDERS UNDER THE SCHEME • Government Hospitals CHC and above level upto Medical College Hospitals shall stand empanelled. • All private hospitals empanelled under RSBY shall also be stand empanelled. • Other private hospitals fulfilling the empanelment criteria, shall be empanelled by Insurer after approval of Government. Empanelment Process • The Insurance Company will empanel the hospitals on set parameters for quality after approval of Government. • The geographical spread of the hospitals to be considered to prevent any disparity in the access to health facilities. • Empanelment would require approval of SHAA.

16. HOSPITAL EMPANELMENT • Minimum criteria for hospital empanelment – • It should have at least 30 inpatient beds. • It should be equipped in providing medical and surgical and diagnostic facilities. • General Ward: Should have separate wards for Males and Females • A well-equipped operation theatre • It should have qualified doctor(s) and nurse(s) and paramedic staff • Round the clock in house/tied up blood bank facility

17. HOSPITAL EMPANELMENT • Obligations towards beneficiaries - • Shall not offer discriminatory treatment of patients on the basis of status/caste/money etc. • In case the hospital does not have the facilities required to provide treatment to the patients it shall refer the patient to a suitable health facility after providing of first aid/ services. • The hospital shall arrange for transport of the patient to the referred health facility. • Shall not deny treatment to any beneficiary

18. GRIEVANCE REDRESSAL • Call centre/software would receive grievances from the beneficiaries/empanelled hospitals/Insurer . It would be under direct control of the Government • A strong grievance Redressal mechanism for quick and appropriate grievance disposal • The Grievance committee would be pro beneficiary • Grievance reported at the call centre would be presented to the District Grievance Committee. Either of the parties if not satisfied may make an appeal to state Grievance Committee. • Any grievances and appeal against the decision of the State Grievance Committee may be referred to the Appellate Authority for arbitration

19. GRIEVANCE REDRESSAL • District Monitoring & Grievance Committee:The committee to be chaired by District Collector and will have Chief Medical and Health Officer, District level representative of the Insurer and a nominated member by Insurance Company • State Monitoring & Grievance Committee: The committee will be chaired by CEO, SHAA and will have Additional Mission Director, NHM, Rajasthan State Health Society, Director- Public Health, Dean- Government Medical College, Insurance Company Representative, GM/CMD from a Public Sector Insurance Company, representative of the Risk Management Organization. • Appellate Authority: The appellate authority will comprise of four members, and they shall include, Principal Secretary (Health), Secretary/Joint Secretary (Medical Education), Secretary/ Joint Secretary (health) andan officer nominated by PSF not below the rank of Joint Secretary.

20. IT ENABLED MONITORING MECHANISM • Information technology would facilitate implementation of the scheme by Department of Medical, Health and Family Welfare under the broad framework / umbrella of Bhamashah Yojana. The IT department is undertaking following responsibilities • To design a web-based application for implementation of SBY. • To link the web-based application for SBY with following important applications:- • Bhamashah Database Hub • UIDAI Database Hub • Arogya Online • e-Aushadhi • e-Mitra

21. URGENT TO DO FOR DISTRICTS……. • Procurement of Hardware as indicated in letter dated 31.10.15. • Engagement of Swasthya Margdarshaks on these institutions as directed vide letter dated 5.11.15 and 17.11.15. • Swasthya Margdarshaks are to be appointed on an IPD of 50 patients daily and 24X7 for one counter. However; Institution may appoint higher/lesser number of Swasthya Mardarshaks as per requirement. • Inputs/suggestions on Disease packages latest by 20.11.15 as directed by Hon’ble MH in VC dated 17.11.15.

22. URGENT TO DO FOR DISTRICTS……. • Dry Run has to start in all District Hospitals from 30.11.15. Therefore all necessary activities vis procurement of hardware and engagement of Swasthya Margdarshks etc. is to be completed by 25.11.15. • Information to state latest by 26.11.15 with details of the trainee’s name, designation, place of posting.

23. Package List

24. Thank You!