Post on 04-May-2018
Bhamashah Swasthaya Bima YojanaRajasthan
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.
Organogram-State Level
Organogram-District Level
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.
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
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
No. of Private Hospitals Empanelled So No. 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
Stakeholders in the Scheme
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.
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
familyStarting
TreatmentStarting
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
What makes us different……
Rajasthan RSBY Maharashtra Tamil Nadu
Sum insuredSecondary – 30,000Tertiary – 3,00,000
30,000 2,50,000 1,50,000
Coverage ComprehensiveSecondary and
TertiarySecondary Tertiary Tertiary
Target populationNFSA (includes 15
categories) and RSBY
BPL familiesBPL & APL families
BPL families
Packages 1715 1300 972 1016
Verification of beneficiary
Bhamashah Card BiometricYellow / Orange
cardBiometric
Multipurpose call center
Yes No No No
Progress So Far..
Total No. of Claims Enlisted
0
50000
100000
150000
200000
250000
300000
350000
400000
3228 2006352906
97800
154178
228800
300751
364187386433
Number of Claims
Total Amount of Enlisted Claims (Rs. in Lac)
164.23 1016.432742.05
4873.94
7397.41
10736.41
14045.47
17069.8418177.17
0
5000
10000
15000
20000
31-12-2015 29-02-2016 30-04-2016 30-06-2016 10/8/2016
Rs. In Lac
Total No. of Claims Submitted
0
50000
100000
150000
200000
250000
300000
350000
2611 1659044319
83406
132820
197070
261073
313893335992
Number of Claims
Total Amount Submitted (Rs. in Lac)
0
2000
4000
6000
8000
10000
12000
14000
16000
124.9 769.552135.56
3888.84
6086.3
8903.33
11771.29
14112.315192.39
Rs. In Lac
Total No. of Claims Approved
0
50000
100000
150000
200000
250000
1736 1214231221
57384
89043
130702
177485
216938239524
Number of Claims
Claim approvals raised by around 86,000 in
last two months
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
73.75493.74
1419.89
2520.02
3693.65
5194.58
7196.23
9015.43
10270.27
Rs. In Lac
Approvals raised by around 40.00 cr in only
two months
Total No. of Claims Paid
1597922042 34580
83639
142605
209558
0
50000
100000
150000
200000
250000
Number of Claims
Rise of approximately
1,25,000 claims in last two months
Total Amount Paid (Rs. in Lac)
0.00
2000.00
4000.00
6000.00
8000.00
10000.00
till 29th Feb, 2016
31-03-2016 30-04-2016 31-05-2016 30-06-2016 28-07-2016
338.26 678.35 1303.533098.67
5260.00
8117.47
Rs. In Lac
Rise of 51 crores in last two
months
Pvt Contribution in Total Claim Booking
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.
IEC Activities
BSBYBSBYLED BOARD LED BOARD ON TOP OF ON TOP OF
PVT PVT HOSPITALSHOSPITALS
LED Boards on Roads
Pamphlet Printed for IEC of the Scheme & Pvt. Empanelled Hospitals
Facebook page- regular updationFacebook page- regular updation
Regular Updates on Google+ and blog
Success Stories of BSBY across Districts
• 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
BSBY ASHA KIT
IEC of BSBY Through Auto Riksha
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.
Official Webpage of BSBY
Grievance Redressal
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.
• 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
Thanks