Section 4(1)b of the Act, in particular, requires every public

Right to Information Act 2005
Section 4(1)b of the Act, in particular, requires every public
authority to publish
I.
The particulars of its Organisation, Functions and Duties:
Name of the
Organization
Karnataka
Address
Karnataka
Functions and Duties
Rastriya
The Functions and Duties for which the society is
Rastriya Swasthya Swasthya Bima Yojana
established are as under.
Bima
Selection of Health Insurance provider
Society
Yojana Society, Room No.09,
“Karmika Bhavan”,
through tendering process inviting both
Dairy Circle,
public and private Insurers entering into
Bannerghatta
Road,
contract with the Insurance Provider signing
Bangalore-560 029.
of MOU as per Government of India
℡-080-
guidelines.
26654884/26650154,
Fax: 080-26654884
Email-ID:
To co-ordinate with the State and Central
Government.
Drawing programme for enrolment and
ceorsbykarnataka@gmail
issuance of smart card in consultation with
.com
Insurance Provider.
To formulate District Level Co-ordination
Committee.
Documentation of Project Reports and also
Monitoring, Evaluation, Review of the work
of progress at District Level and cause mid
course correction whenever needed.
Facilitate Organizing of workshops at Taluk,
District and State Level to bring awareness
among beneficiaries about the scheme.
Provide cashless Health Insurance benefits to
all
BPL
categories.
families
and
other
identified
II.
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01
02
The powers and duties of its officers and employees:
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Shri Harsh Gupta IAS
Commissioner of
Labour and Chairman
Shri Narasimha Murthy
S
Joint Labour
Commissioner and CEO
PÉ®¸À ºÀAaPÉ/¤ªÀð»¸ÀÄwÛgÀÄªÀ PÁAiÀÄðUÀ¼ÀÄ
To preside over all the Managing Committee
meetings and see that the meeting is conducted
properly.
To be responsible for the working of the Society.
To supervise and guide the overall activities of the
Society.
Chairman may approve matters of expenditure up to
two lakhs at a time for items which are provided in the
budget.
To call meeting of the Managing Committee with the
consent of the Chairman.
To keep and preserve all the records of the
Society/Managing Committee
To keep minutes of all the meeting of Managing
Committee
To submit to the Managing Committee the annual
accounts and budget of the Society in time.
To carry on correspondence on behalf of the Societies
Managing Committee
He/she will be overall in charge of the administration
and executions of all the programmes of the
society/includes financial affairs on behalf of the
Managing Committee.
To keep accounts of all Financial Transaction of the
Society and of all the sum of money received and
spent by the society and maintains records of receipts
and expenses relating to such matters, and of assets,
credits and liabilities.
To get the accounts audited by the Chartered
Accountant appointed by the Managing Committee at
the close of the accounting year, every year.
To furnish all relevant information to the State and
Central Government.
He along with member secretary shall jointly sign the
cheques of the society.
III.
The procedure followed in the decision making process, including
channels of supervision and accountability:
Channel of Supervision and Accountability
Chairman
Chief Executive Officer
Senior
Advisor
Senior
Consultant
Managers,
Technical Asst.,
Asst cum DEO
DEO &
Group-D
The Chairman is the final Decision making authority pertaining to Karnataka State Rastriya
Swasthya Bima Yojana Society. The CEO, Karnataka State Rastriya Swasthya Bima Yojana
Society takes routine operational decisions and as per the delegation of financial power up
to Rs.100000/-.
IV.
The norms set by it for the discharge of its functions:
As per the Bylaws (copy enclosed)
V.
The rules, regulations, instructions, manuals and records, held by it or
under its control or used by its employees for discharging its functions:
RSBY – ROLE OF STATE GOVERNMENT
1. Commitment for 25% contribution of the premium and for incurring the
administrative costs. Get the necessary approval from the concerned State
Departments to ensure timely flow of State contribution towards the premium as
per the following formula in consonance with Insurance Act, 1938
2. Set-up / identify an independent State Nodal Agency (SNA) to implement the
scheme in the State. The Nodal agency shall be appropriately staffed to carry out its
functions effectively in implementing the scheme. This should be a separate legal
entity under the control of the State Government. Most of the responsibilities of the
state government could be executed by the SNA.
3. Interdepartmental Task Force consisting of at least Labour, Health and Rural
Development Ministries in the State.
4. Identification of Districts to be taken up in for implementation of RSBY.
5. Prepare BPL data in the prescribed format as provided on the RSBY website
www.rsby.gov.in conforming to Planning Commission specifications for each project
district and send to Government of India for internal consistency checking. This
process should be completed for the district before the scheme is launched. Central
Government after verifying the data wand generating Unique Relationship Number
for each target family will upload the data should be on the RSBY website
(www.rsby.gov.in).
(Data once uploaded cannot be changed during the year)
6. State Nodal Agency to advertise/tender for selection of Insurance Company for
each of the identified districts. State Government can select one or more insurance
company for different set of districts but only one insurance company shall be
selected for each district.. Draft tender document available on the RSBY website
www.rsby.gov.in shall be used for this purpose.
(State Nodal Agency should share the draft document in advance with the Central
Government with a view to ensuring conformity with the guidelines)
7. Form a committee for technical and financial bid evaluation. Committee shall have
Government nominee and may include technical experts). Preferably both technical
and financial evaluation shall be done on the same day. (Share the date in advance
with the Central Government. In case assistance from Central Government is
required, convey a request).
8. Send the proposal in the prescribed format to the Government of India where it will
be placed before the Monitoring and Approval Committee. Once the proposal is
accepted and approved by the committee State Government can move ahead with
the implementation process.
9. Prepare a Contract document to be signed with the selected Insurance Company
(ies) based on the draft contract document provided on the RSBY website
www.rsby.gov.in. Get the contract document legally vetted, if needed.
10. Appoint a Nodal Officer for RSBY in each District. He will also be the District Key
Manager (DKM). Convey the details to the Central Government at the earliest for
issue of DKM card by CKGA.
(Role and functions of the DKM are defined in the document at Annexure.3 )
11. Organise a State-level Workshop. An MoU between Central and State Government
will be signed in this workshop. Preferably the Contract between State Government
and Insurance Company (ies) shall be signed in this workshop. The agenda and other
details of the State Workshop has been provided on the RSBY website
www.rsby.gov.in)
(Funding of the Workshop by Central Government. Resource persons can be obtained
from Central Government. )
12. Provide assistance to the Insurance Company in the registration of beneficiaries and
issue of smart cards by:
a. identifying and appointing a Nodal Officer for RSBY in each District called District
Key Managers (DKM) before signing of the agreement with the Insurer. Convey
the details to the Central Government within 7 days of signing the agreement
with the Insurance Company. Role and functions of DKM have been provided in
Annexure ……..
b. providing DKMA Server at District Headquarter within 7 days of signing of the
agreement with the Insurer. Install DKMA software for issue of FKO cards and for
downloading of data subsequently from FKO cards.
c. nominating Field Key Officers (FKO) in the required numbers shall be identified at
the time of signing of the agreement with the Insurer. (FKOs will jointly visit each
enrollment station along with the Insurance company representative for the
enrollment of the beneficiaries)
d. Receive DKM and FKO cards from Central Government and maintain the records
of it in the format prescribed by the Central Government.
13. Assist the Insurance Companies in organizing District-level Workshops and ensure
that all related officials participate in the workshop.
(Suggested details are provided in Annexure.4)
14. Provide assistance to the Insurance Company through the district and block level
officials in the Issuance of Smart cards in the village by:
a. Finalising village-wise schedule with the Insurance Company.
b. Helping to publicise the visit of the enrollment team in advance.
c. Support in identifying location for the enrollment inside the village
d. Ensure presence of nominated official FKO for authenticating cards at the
time of issue.
15. Allow the State Nodal Agency to retain Rs. 30/- collected from the beneficiary as
registration fees for meeting administrative expenses in implementing the scheme.
16. Make available the public health care facilities, such as District Hospital and
Community Health Centres (CHCs), for being considered for ‘network’ hospitals by
the Insurance Company and allow the existing Rogi Kalyan Samitis which are
separate legal entities in the form of Society/Trust/Agency to administer funds
received directly from the insurance companies.
17. Ensure through the district level officials that sufficient number of hospitals have
been empanelled before start of the enrollment of beneficiaries in the concerned
district.
18. Ensure that the toll free call centre are functioning at the time of enrollment starts in
the district.
19. Ensure that the District kiosks are set up in each of the project districts and are
operational before the start of the enrollment process in the district. State
Government through the district administration shall provide space for the district
kiosks in a Government place. Insurance Company may be asked to pay rent for the
space provided
20. Make sure that the public owned hospitals are equipped with necessary hardware
and software which enables the transaction in the hospital by the Smart card..
(These should be PC based systems as defined in Annexure-16 of the Revised Tender
document. Identify at least two persons in each hospital who would be trained by
the Insurance co representatives to man the RSBY help desk at the hospital. Make
sure that the Insurance Company or their representative trains these people about
RSBY and usage of hardware and software at the hospital.
21. Evolve a system of timely release of premium of State share to the Insurance
company.
22. Send the request for the release of fund to Government of India for a complete
month within 7 days of releasing State share of premium to the Insurance Company.
Proposal for reference of Central share shall be sent to the Central Government only
after the release of its share by the State Nodal Agency to the Insurance Company.
23. Transfer the Central Share of the premium to the Insurance Company within seven
days of the receipt of the amount from the Central Government.
24. Bear such administrative cost in implementing the scheme as are not included as
responsibilities of the Insurance Company and its implementing partners under the
contract agreed between the State Government and the Insurance Company.
25. Take necessary steps for improving the awareness level by organising different
activities like health camps etc. through State Nodal Agency or authorising the SNA
to hire Civil Society organisations/ NGOs/ experts to improve awareness and to
facilitate access to health services.
Putting in place mechanisms for incentivizing staff at various levels like FKO,
hospitals, etc to improve both enrollment and utilization.
26. Facilitate, monitor and evaluate the implementation of the scheme as per the
guidelines issued from time to time by the Central Government and such additional
guidelines as the State Government itself shall adopt from time to time in relation to
the scheme.
27. Organise periodic review meetings with the Insurance company to review the
implementation of the scheme.
28. Set-up a server at the State level to store the enrollment and hospitalisation data
from all the districts. Working with the technical team of the Insurance co to study
and analyse the data for improving the implementation.
29. Collect Fingerprint and Photograph data from the Insurance Company from all the
districts and store it safely.
30. Conduct Evaluation of RSBY performance in the State. The process of selection of
agencies for doing this independent evaluation and tools involved therein have been
provided on the RSBY website www.rsby.gov.in.
31. Provide such information, either directly or through the insurance company, in
prescribed format and in such manner, as desired by the Central Government from
time to time. The required information and the reporting format shall be intimated
by the Central Government.
32. Set up a Grievance redressal mechanism and cell as provided for by the MoLE.
Note: All email communications to the Central Government may be sent at:
[email protected]
ANNEXURE.2
RASHTIRYA SWASTHYA BIMA YOJANA
STATE LEVEL WORKSHOPS
SUGGESTED AGENDA ITEMS
•
•
•
Welcome Speech etc.
Film on RSBY followed by discussions
A general presentation on the highlights of the scheme and the role of Different
Stakeholders including State Government, Insurance Company, Hospitals, NGOs etc..
(Representative of DGLW, MOL&E, GOI)
Separate presentations by the Insurance Company (ies) on their proposed plan for
the implementation of the scheme in the districts for which they have been selected
(Representative the Insurance company (ies))
• Smart Card and Key Management System (Representative of DGLW, MOL&E, GOI )
{Organisations which could make presentations are indicated in brackets}
•
LIKELY PARTICIPANTS
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
State Governments officials
- State Labour Department representatives
- State Nodal Agency representatives
- State Health Department representatives
- State and District level Rural Department representatives
- District Collectors
- Chief Medical Officers of the concerned districts
- District hospital representatives:
- State NIC representatives.
Respective Insurance Companies and TPAs
Representative of Private hospitals
Representatives of Trust/ Charitable hospitals
NGOs and representative of International agencies which are working through NGOs in
the State
Smart Card Service Providers
Data Entering Organisation
Central Government officials
- DGLW / MOL&E
Other International Organisations
- World Bank
- GTZ
FUNDING
The State-level-Workshop would be funded under the RSBY.
ORGANISING THE WORKSHOP
•
•
The Workshop will be jointly organized by the MOL&E, GOI and the State
Government/State Nodal Agency.
Invitations would be issued by the State Government/Nodal Agency (jointly on
behalf of the Central Government as well).
LITERATURE/DOCUMENTS FOR THE WORKSHOP
Following documents can be distributed in the welcome kit:
•
•
•
•
Policy and Guidelines of the scheme.
Tender Document of the scheme
Process Flow Document on the implementation of the scheme
FAQs on the scheme
Following documents can be provided only to the relevant people:
•
•
•
User manual for issuing smart cards (only for those who would be involved in the
exercise of issuing smart cards).
User manual for using smart cards (for hospital employees and NGOs).
User manual for Government officials for Key Management System (KMS)
TIMING OF THE WORKSHOP
•
Workshop should be organized once the Insurance Company (ies) has (ve) been
selected by the State Government. The Implementation in the districts will start only
after the organisation of State Workshop.
****
ANNEXURE.3
ROLE OF DISTRICT KEY MANAGER (DKM)
•
District Nodal Officer to be designated as District Key Manager (DKM).
•
•
DKM information to be sent by State Nodal Agency to Central Key Generation
Authority (CKGA).
He/She will be issued DKMA Card by CKGA.
•
DKM will change the PIN on the DKMA Card.
•
•
DKMA will send request to CKGA in a prescribed format for number of required Field
Key Officer (FKO) Cards.
DKMA will receive the required number of cards from the CKGA.
•
DKMA will be responsible for the safe custody of the cards in a safe place and keep
account of these cards.
DKMA would personalize the card and issue it to the FKOs after obtaining proper
receipt from FKOs.
The DKMA would keep the receipt safely with him.
•
FKO should be asked to change the PIN of his Card.
•
•
As the FKOs Cards have limited capacity to issue user cards, the DKMA would
recharge the FKO cards as and when required.
The DKMA would ensure that the FKOs change the default PIN.
•
The DKMA would unblock Pins of FKOs, if required.
•
In case of change of FKOs, represonalize the card for new FKOs.
•
FKO would be responsible for the safe custody of the Card issued to him.
•
•
The FKO would be present at the enrollment stations assigned to him by the DKM.
FKO would ensure that the person to whom the user card is being issued is an actual
BPL person.
•
•
*****
ANNEXURE.4
RASHTRIYA SWASTHYA BIMA YOJANA
Organiasation of District Level Workshop
OBJECTIVE
To sensitize and train the ground level functionaries in the implementation of the scheme.
LIKELY PARTICIPANTS
1.
-
District Level Governments officials
District Labour Department representatives
District Key Manager of RSBY
District Health Department representative
District level Rural Department representatives
District Collectors
Chief Medical Officers of the concerned districts
District hospital representatives:
Two to three personnel who will handle the desks in the district hospitals.
District NIC representatives
Field Key Officers
2.
3.
4.
5.
6.
7.
Respective Insurance Company and TPA from the district level offices
All the members of the smart card teams constituted by the Insurance
Company / Smart Card Service Provider for issue and delivery of smart cards.
Representative of Private hospitals
Representatives of Trust/ Charitable hospitals
Representatives of NGOs / Intermediaries which are working in the district
and may be engaged by Insurance Companies for implementing the scheme.
Smart Card Service Providers
FUNDING
The District Workshop would be funded By the Insurance Company selected for that
district
TIMING
The district workshop shall be organised at least one week before the start of the
implementation of RSBY in the district.
ORGANISING THE WORKSHOP
The workshop shall be organized by the Insurance company. However, the State
Government / Nodal Agency would assist in organizing this workshop by:
(a) Ensuring attendance of Government officials.
(b) Facilitating selection of venue and other logistic support in organizing the workshop
DOCUMENTS TO BE CIRCULATED
•
•
•
•
Frequently Asked Questions of RSBY
Role of Insurance Company at the district level
Role of the District Key Manager
Role of FKOs
AGENDA
1. Ideally the district workshop shall be Chaired by the District Magistrate/ District
Collector of the district.
2. The primary objective of the district workshop is to make all the stakeholders aware if
the implementation of the scheme and explain their role in it,
3. Another very important task to be undertaken during the Workshop is to sensitize and
train the Field Key Officers about their role at the time of issue of Smart Cards and
afterwards.
4. The structure of the district workshop can be as follows:
a. Opening remarks by the DC
b. Remark by the DKM
c. RSBY film shall be shown to the audience.
d. A presentation by the Insurance Company/ TPA on the scheme and role of different
stakeholders at the district level, especially focusing on the role of DKM and FKOs
e. A presentation on the preparation of the implementation of the scheme in the
district by the Insurance company/ TPA
f. Presentation on the role of NGOs / Intermediaries.
g. Discussion with the district authorities regarding the space for setting up of the
district kiosk at the district headquarter.
h. Information about the toll free call centre
i. Sharing of some publicity material which will be used by the Insurance Company/
TPA for RSBY
j. Demonstration on the process of issuance of the smart card the the village level
k. Training of FKOs on their roles and responsibilities
5. Announcement of the date for a separate hospital workshop in the district shall be made
in this workshop
***********
ANNEXURE.5
RSBY DISTRICT-WISE REPORT
State:
____________________
Date of Report:
____/_____/_______
District Name:
____________________
_______/_________
District ID:
____________________
Insurance Company:
Correction
____________________
Insurance Company ID:
____________________
Month(quarter) of report:
Original
Report A: Client Services
Hospital ID
Hospital
Name
Visits
Admissions
Denied
service
Hospital
days
Postadmission
deaths
1
2
3
4
5
6
7
Report B: Insurance Claims
Hospital
ID
Hospital
Name
Submitted
Submitted
Settled
Settled
Refused
Refused
(No.)
(Rs)
(No.)
(Rs)
(No.)
(Rs)
8
9
10
11
12
13
14
15
Received Date: ________________
Received By: ________________
_______________
Entered Date: _______________
Entered By:
RASHTRIYA SWASTHYA BIMA YOJANA
GUIDELINES
1.
INTRODUCTION
The workers in the unorganized sector constitute about 94% of the total work force
in the country. One of the major insecurities for workers in the unorganized sector is
absence of health cover for such workers and their family members. Insecurity relating to
absence of health cover, heavy expenditure on medical care and hospitalization and
recourse to inadequate and incompetent treatment is not only a social and psychological
burden borne by these workers but there are significant economic costs resulting from loss
of earning and progressive deterioration of health. Thus, with a view to providing health
insurance cover to Below Poverty Line (BPL) workers in the unorganised sector and their
families, the Central Government has announced the “Rashtriya Swasthya Bima Yojana”.
2.
HOUSEHOLD ELIGIBILITY CRITERIA
2.1
Coverage under the scheme would be provided for BPL workers and their families
[up to a unit of five). A family would thus comprise the Household Head, spouse, and up to
three dependents. The dependents would include such children and/or parents of the head
of the family as are listed as part of the family in the BPL data base. If the parents are listed
as a separate family in the data base, they shall be eligible for a separate card. The definition
of BPL would be the one prescribed by the Planning Commission for the purposes of
determining the eligible BPL population in each State/district. It would be the responsibility
of the respective State Government to verify the eligibility of specific BPL workers and their
family members who would be the beneficiaries of the scheme, and to share such
information with the insurance provider. To this end, an authenticated BPL list [or lists
where the covered area includes urban and rural areas] providing the details of each BPL
family will be prepared by the State Government/Nodal agency. The data would be provided
in the prescribed electronic format to the insurer. The State Governments may, if required,
seek the assistance of an outside agency for the task of data entry. However, the
responsibility for providing the correct data shall be that of the State Government and it
would be expected of the State Government that it shall put in place a foolproof system of
supervision and authentication of the data.
2.2
Proof of the eligibility of BPL households for the purposes of the scheme will be
provided by issuance of smart cards to all beneficiary households.
3.
ENROLMENT OF BENEFICIARIES
The enrolment of the beneficiaries will be undertaken by the Insurance company
selected by the State Government and approved by the Government. The Insurer shall
enroll the BPL beneficiaries based on the soft data provided by the State Government/Nodal
Agency and issue Smart card as per Central Government specifications through Smart Card
Vender and handover the same to the beneficiaries at enrolment station/village level itself
during the enrolment period. Further the enrolment process shall continue at designated
centers agreed by the Government /Nodal Agency after the enrolment period is over to
provide the smart card for remaining beneficiaries. Insurer in consultation with the State
Government/ Nodal Agency shall chalk out the enrolment cycle up to village level in a
manner that representative of Insurer, Government/Nodal Agency and smart card vender
can complete the task in scheduled time. The process of enrolment shall be as under:
(a)
The data relating to BPL families in the selected districts shall be entered into
prescribed software by the concerned State Government/Nodal Agency.
(b)
A soft and hard copy of this data shall be provided by the State
Government/Nodal Agency to the INSURER selected by the State
Government/Nodal Agency.
(c)
The Insurer will arrange for preparation of the smart card as per the prescribed
stipulation.
(d)
A schedule of programme shall be worked out by the Government/Nodal
Agency in consultation with the Insurer for each enrolment station/village in
the district.
(e)
Advance publicity of the visit of representatives of the State Government and
the Insurance Provider shall be done by the State Government/Nodal Agency in
respective villages.
(f)
List of BPL should be posted prominently in the enrolment station/village by
the Insurer.
(g)
The representatives shall visit each enrolment station/village in the selected
district jointly on the pre-schedule dates for purpose of taking photograph of
the head of the family and the thumb impression of the head of the family and
the other eligible member of the family, enrolment and issuance of smart card.
(h)
The softwares to be used by the Insurance Company for the purpose of
enrolment and thereafter for the purpose of transaction at the hospitals and
data transmission therefrom shall be the ones approved by the Central
Government.
(i)
At the time of enrolment, the government official shall identify each
beneficiary in the presence of the insurance representative.
(j)
At the time of handing over the card, the INSURER shall collect the registration
fee of Rs.30/- from the beneficiary.
(k)
This amount will be adjusted against the amount of premium to be paid to the
INSURER by the Nodal Agency.
(l)
The Insurer’s representative shall also provide a pamphlet along with Smart
Card to the beneficiary indicating the list of the networked hospitals, the
availability of benefits and the names and details of the contact
person/persons. To prevent damage to the smart card, a plastic jacket should
be provided to keep the smart card.
(m) The beneficiary shall also be informed about the date on which the card will
become operational (month).
4.
IMPLEMENTATION SCHEDULE
The scheme will be implemented by the State Government in a phased manner in
the next five years. The entire country will be covered by 2012-13. In districts where the
Scheme is introduced, it would supercede the Universal Health Insurance Scheme (UHIS).
State wise coverage of the number of districts is at Annexure-I.
5.
FINANCING FOR THE SCHEME
Financing of the scheme would be as follows:
(a) Contribution by Government of India: 75% of the estimated annual premium
of Rs.750, subject to a maximum of Rs.565 per family per annum.
Additionally, the cost of the smart cards will also be borne by the Central
Government @ Rs.60/- per card.
(b) Contribution by the respective State Governments: 25% of the annual
premium, as well as any additional premium in cases where the total
premium exceeds Rs.750.
(c) The beneficiary would pay Rs.30 per annum as registration/renewal fee.
(d) Any administrative and other related cost of administering the scheme in
each State, not otherwise included in the premium cost, shall be borne by the
respective State Governments.
6.
HEALTH SERVICES BENEFIT PACKAGE
6.1
The beneficiary shall be eligible for coverage of the financial costs of such in-patient
health care services as would be negotiated by the respective State government with the
insurer(s), as well as agreed daycare procedures not requiring hospitalization. However, the
following minimum features of the health insurance plan would be as follows :
(a) Total sum insured of Rs.30,000 per BPL family per annum on a family floater
basis.
(b) Pre-existing conditions to be covered, subject to minimal exclusions. An
indicative list of exclusions is provided in Annexure II.
(c) Coverage of health services related to hospitalization and services of a surgical
nature which can be provided on a daycare basis. Annexure-III contains an
indicative list of daycare treatment.
(d) Cashless coverage of all health services in the insured package.
(e) Provision for a smart-card based system of beneficiary identification/verification
and point of service processing of client transactions.
(f) Provision for reasonable pre and post-hospitalization expenses for one day prior
and 5 days after hospitalization, but subject to a maximum share of the total
costs of the hospitalization.
(g) Provision for transport allowance (actual with limit of Rs.100 per visit) but
subject to an annual ceiling of Rs.1000.
6.2
In addition to the above minimum, in their proposals, States should specify in detail
the proposed package of health services to be covered under the Scheme, as well as the
proposed exclusions.
7.
PAYMENT OF PREMIUM
Payment of registration fee and premium installment will be as follows:
a) The registration fee of Rs.30 by the beneficiary to the insurance company.
b) The first installment will come from the State Nodal Agency to the insurance
company in the nature of 25% of (X-60)-30.
(X being the premium amount per beneficiary).
c) The second installment will be paid by the Central Government through the State
Nodal Agency as per the following formulation:
75% of (X-60)+60
(Subject to a maximum of Rs.565/- + Rs.60/-)
{Any amount beyond the contribution by the Central Government will be borne
by the State Government.}
8.
ELIGIBLE HEALTH SERVICES PROVIDERS
Both public (including ESI) and private health providers which provide hospitalization
and/or daycare services would be eligible for inclusion under the insurance scheme, subject
to such requirements for empanelment as agreed to between the State Government and
insurers.
9.
REQUIREMENT
PROVIDER
OF
TENDER
TO
SELECT
INSURANCE
The State Government will be required to select one or more health insurers on a
periodic basis according to a tender process which would take account of both the price of
the insurance package and technical merit of the proposal. The tender should be open to
both public and private sector health insurers who meet the relevant IRDA standards. If the
period of the contract with the successful bidder exceeds one year, the State should provide
for performance indicators or other mechanisms to extend the contract annually.
10.
SUBMISSION AND APPROVAL OF THE PROPOSAL
10.1 The proposals of the State Governments will be considered by the Approval and
Monitoring Committee set up by the Central Government. The elements that States would
need to address in their proposals include the following:
(a) Tendering and contracting procedure for insurer/partners.
(b) Overseeing arrangements (e.g. district and block monitoring bodies).
Representatives of civil society, including Panchayati Raj institutions, should be
adequately represented on relevant State, District and Block level overseeing
bodies.
(c) Status of BPL data and its conformity with the prescribed standards, readiness
for provision to insurer and estimates of BPL population in covered districts.
(d) Training plan of State Government, insurers and others to ensure adequate
capacity for Scheme implementation.
(e) IEC/awareness raising mechanisms (start-up and ongoing), including any
special/extra
channels
for
harder-to-reach
groups.
Role
of
intermediaries/NGOs/MFIs/Cooperatives therein.
(f) Enrollment and renewal procedures, including identification of beneficiaries.
(g) Empanelment/accreditation of health providers, including minimum requirements
for health facilities to be included in the Scheme and administrative capacity. An
indicative list of requirements is provided in
Annexure IV.
(h) Process for smart card provision and operation.
(i) MIS and database management,
patients/providers and its use.
including
collection
of
data
on
(j) Evaluation of impact and performance, including provision for baseline survey(s).
(k) Grievance redressal mechanisms.
(l) Financing plan for State Government premium contributions and other
administrative expenses to be incurred in Scheme operation.
(m) How the proposed Scheme would interact with any existing health insurance
schemes in the proposed district(s).
10.2 The Central Government Approval and Monitoring Committee would assess all State
Government proposals to ensure that credible implementation arrangements were in place
for all of the above.
RESPONSIBILITIES OF GOVERNMENT OF INDIA
11.
In addition to its financing commitment outlined in Point 4, the Government of India
shall undertake the following actions in order to operationalize the Health Insurance
scheme:
(a)
Issuance and periodic revision of guidelines for the Scheme.
(b)
Establishment of an Approval and Monitoring Committee to assess health
insurance proposals submitted by State Governments for Government of India
financing contribution.
(c) In consultation with the States, development of such protocols and common standards as
may be necessary to ensure effective functioning of the Scheme on a national basis.
This would include determination of the protocol for nationally unique identification
numbers for BPL families, specification of the minimal technical standards of the
smart card, ensuring timely transfer of the Central financing share of insurance
premia, establishment of common reporting protocols for States as part of Scheme
monitoring and such other design and implementation issues considered necessary
for the functioning of a coherent national system.
(d)
Establishment of a Technical Support Cell within the Ministry of Labour and
Employment which would provide expert inputs to Central and State
Governments on matters pertaining to the design, implementation and
monitoring/evaluation of the Scheme. The Cell would be headed by a Senior
Advisor, who would be assisted by two Advisors, database management team,
support staff, and such other expert personnel as determined from time to time
to be necessary to support effective implementation of the Scheme. The Cell
would carry out the following functions, inter alia:
i. Provide technical support to States in development of health insurance
schemes for submission to the Central Government.
ii. Provide ongoing support to State Governments (coordinating with
similar Cells at State level) on technical issues in implementation of
the Scheme in individual States, including monitoring and evaluation.
iii. Provide the Approval and Monitoring Committee with such financial
estimates as may be necessary to assess the budgetary implications of
both Central and State Government commitments under the Scheme.
iv. Provide technical inputs to the Approval and Monitoring Committee
which will allow it to carry out its monitoring and evaluation functions
effectively.
v. Undertake and/or commission detailed evaluation studies on Scheme
functioning.
12.
DISTRICT SELECTION BY STATES
States would be responsible for proposing selected district(s) for inclusion in the
Scheme, subject to the phased maximum number of districts per State as outlined in
Annexure I. In proposing districts for inclusion in the Scheme, States should ascertain that
districts have:
(a)
An adequate network of hospitals/health facilities which meets minimum standards
for service delivery and operation of transactions related to the Scheme.
(b)
Adequate presence of potential intermediaries which can partner with health
insurers to ensure effective outreach and grassroots support to beneficiaries in
various aspects of operation of the Scheme.
(c)
Other basic infrastructure necessary to ensure successful implementation of the
Scheme (e.g. electricity; roads).
****
ANNEXURE -I
SUGGESTED IMPLEMENTATION SCHEDULE
Sl.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
STATE
ANDHRA
PRADESH
ASSAM
ARUNCHAL
PRADESH
GUJARAT
BIHAR
HARYANA
HIMACHAL
PRADESH
JAMMU &
KASHMIR
KARNATAKA
KERALA
MADHYA
NO. OF
DISTRICTS
23
YEARS
2008-09 2009-10 2010-11 2011-12
1
2
3
4
5
5
5
4
2012-13
5
4
23
14
5
2
5
3
5
3
4
3
4
3
25
37
19
12
5
8
4
2
5
7
4
2
5
7
4
2
5
8
4
3
5
7
3
3
14
2
3
3
3
3
27
14
48
6
2
10
6
3
9
5
3
10
5
3
9
5
3
10
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ORISSA
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TRIPURA
UTTAR PRADESH
WEST BENGAL
DELHI
GOA
PONDICHERY
LAKSHDWEEP
DAMAN & DIU
DADRA & NAGAR
CHANDIGARH
ANDAMAN &
NICOBAR
UTTARANCHAL
JHARKHAND
CHATTISGARH
TOTAL
35
9
7
8
8
30
17
32
4
29
4
70
19
9
2
4
1
1
1
1
2
7
1
1
1
1
6
3
7
1
6
1
14
3
1
1
1
1
1
1
1
1
7
2
1
1
1
6
3
6
1
6
1
14
4
2
1
1
13
22
16
600
2
4
3
120
2
5
3
120
7
2
1
2
2
6
3
6
1
6
1
14
4
2
7
2
2
2
2
6
4
6
1
5
1
14
4
2
1
1
3
4
3
120
3
4
3
120
7
2
2
2
2
6
4
7
6
14
4
2
1
3
5
4
120
9
ANNEXURE -II
INDICATIVE LIST OF BASIC EXCLUSIONS:
In line with the financial protection objective of the Scheme, there should be
minimum exclusions. The list of exclusions would be negotiated between State Government
and insurers, and be subject to assessment by the Approval and Monitoring Committee to
ensure that it was not overly wide. Common exclusions that would be expected would
include:
1. Conditions that do not require hospitalization
2. Congenital external diseases
3. Drug and Alcohol Induced illness
4. Sterilization and Fertility related procedures
5. Vaccination
6. War, Nuclear invasion
7. Suicide
8. Naturopathy,Unani, Siddha, Ayurveda
** *
ANNEXURE- III
INDICATIVE LIST OF DAY CARE TREATMENT
Given advances in treatment techniques, many health services formerly requiring
hospitalization can now be treated on a day care basis. Examples of such services which
States should consider negotiating in their coverage package with health insurers include:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Haemo-Dialysis
Parenteral Chemotherapy
Radiotherapy
Eye Surgery
Lithotripsy (kidney stone removal)
Tonsillectomy
D&C
Dental surgery following an accident
Surgery of Hernia
Surgery of Hydrocele
Surgery of Prostrate
Gastrointestinal Surgery
Genital Surgery
Surgery of Nose
Surgery of Throat
Surgery of Ear
Surgery of Appendix
Surgery of Urinary System
Treatment of fractures/dislocation (excluding hair line fracture),
Contracture releases and minor reconstructive procedures of limbs which
otherwise require hospitalisation
Laparoscopic therapeutic surgeries carried out in day-care
Any surgery under General Anaesthesia
Any disease/procedure mutually agreed upon.
**
ANNEXURE IV
GUIDANCE FOR ENROLLMENT OF HOSPITALS
Hospital and other health facilities with desired infrastructure for inpatient and
daycare services will need to be empanelled. It is essential to have a proper system of
empanelment. The process will be carried out by the Insurer. However, States may assist to
complete the task.
All Government hospitals (including Primary and Community Health Centres) and ESI
hospitals can be empanelled provided they possess they facility to read and manage smart
cards. The criteria for empanelling private hospitals and heath facilities would be as follows:
VI.
At least 10 inpatient medical beds for primary inpatient health care.
b)
Fully equipped and engaged in providing Medical and Surgical facilities, including
diagnostic facilities, i.e. pathology testing and X-ray, E.C.G. etc for the care and
treatment of injured or sick persons as in-patient.
c)
Fully equipped Operating Theatre of its own where surgical operations are
carried out.
d)
Fully qualified doctors and nursing staff under its employment round the clock.
e)
Maintaining of necessary records as required to provide necessary records of the
insured patient to the Insurer or his representative/Government/trust as and
when required.
f)
Registration with Income Tax Department.
g)
Telephone/fax and internet facilities, and machine(s) to read and manage smart
card transactions.
A statement of the categories of documents that are held by it or
under its control:
1.
2.
3.
4.
VII.
a)
MoU with Insurance Companies
Performance Bank Guarantee Under procurement of server
Byelaws
Society Registration Certificate
The particulars of any arrangement that exists for consultation with, or
representation by the members of the public in relation to the formulation
of its policy or implementation thereof:
Yet to be established.
VIII.
A statement of the boards, councils, committees and other bodies
consisting of two or more persons constituted as its part or for the purpose
of its advice, and as to whether meetings of those boards, councils,
committees and other bodies are open to the public, or the minutes of
such meetings are accessible for public.
The committees under RSBY Society
1.
2.
3.
4.
5.
IX.
Rastriya Swasthya Bima Yojana Society State level Co-ordination Committee
Inter-Departmental Task Force Committee
State Level Grievance Redressal Committee
District Redressal Committee at District Level
District Implementation Committee at District Level
Directory of its officers and employees:
SNo
X.
Name of officers and
Employees
Contact
Number
Designation
1
Shri Harsh Gupta IAS
Labour Commissioner and Chairman
PA No:26531252
2
Shri Narasimha Murthy S
Joint Labour Commissioner and Chief
Executive Officer
9731441439
The monthly remuneration received by each of its officers and employees,
including the system of compensation as provided in its regulations;
Karnataka State Rashtriya Swasthya Bima Yojana
Sl
No
XI.
Name of Employee
Designation
1
Shri Harsh Gupta IAS
2
Shri Narasimha Murthy
S
Remuneration/
Month
Labour Commissioner and
Chairman,
Joint Labour Commissioner and
CEO
-
The budget allocated to each of its agency, indicating the particulars of all
plans, proposed expenditures and reports on disbursements made:
RASHTRIYA SWASTHYA BIMA YOJANA
GOVERNMENT OF KARNATAKA (STATE SHARE)
Sl. No.
Year
Budget Allocated
(in Rs)
Budget released
(in Rs)
Total Expenditure
(in Rs)
B
E=C+D
1
2008-09
----
Nil
----
2
2009-10
5,51,00,000.00
5,26,00,000.00
----
3
2010-11
15,00,00,000.00
7,50,00,000.00
90,15,246.00
4
2011-12
12,00,00,000.00
11,00,00,000.00
4,27,03,656.50
5
2012-13 (Up
to JAN 2013)
7,00,00,000.00
----
8,90,21,483.75
23,76,00,000.00
14,07,40,386.25
RASHTRIYA SWASTHYA BIMA YOJANA
DETAILS OF CENTRAL SHARE RELEASED AND DISBURSED
Sl.
No.
Year
Budget released
Amount spent
Rs.
XII.
Rs.
1
2010-11
4,91,07,797.00
4,91,07,797.00
2
2011-12
96,20,460.00
96,20,460.00
3
2012-13
16,15,16,900.00
16,15,16,900.00
4
2012-13
8,69,97,652.00
8,69,97,652.00
5
2012-13
3,18,03,702.00
3,18,03,702.00
6
2012-13
17,10,53,831.00
17,10,53,831.00
TOTAL
51,01,00,342.00
51,01,00,342.00
The manner of execution of subsidy programmes, including the amounts
allocated and the details of beneficiaries of such programmes;
Cashless Health Insurance to all enrolled beneficiaries
KARNATAKA STATE RASHTRIYA SWASTHYA BIMA YOJANA SOCIETY
DISTRICT-WISE PREMIUM PAYMENT DETAILS OF THE YEAR 2011-12
Total
District Name
Enrollment
Total Premium
Central Share
State Share
Bagalkot
BG Rural
BG Urban
Belgaum
Bellary
Bidar
Bijapur
Chamarajanagar
Chikkaballapur
Chikmagalur
Chitradurga
68585
25687
47941
100804
63090
51204
57938
40319
47259
55783
65913
2,46,90,600.00
92,47,320.00
1,93,20,223.00
3,62,89,440.00
2,27,12,400.00
1,84,33,440.00
2,08,57,680.00
1,45,14,840.00
1,90,45,377.00
2,00,81,880.00
2,65,62,939.00
1,95,46,725.00
73,20,795.00
1,52,09,282.25
2,87,29,140.00
1,79,80,650.00
1,45,93,140.00
1,65,12,330.00
1,14,90,915.00
1,49,92,917.75
1,58,98,155.00
2,09,10,899.25
30,86,325.00
11,55,915.00
26,72,710.75
45,36,180.00
28,39,050.00
23,04,180.00
26,07,210.00
18,14,355.00
26,34,689.25
25,10,235.00
36,74,649.75
DakshinaKannada
33816
74996
58530
32293
74238
83573
64204
27587
48325
64771
66113
51123
92532
34384
76650
107508
20323
62541
47431
Davangere
Dharawad
Gadag
Gulbarga
Hassan
Haveri
Kodagu
Kolar
Koppal
Mandya
Mysore
Raichur
Ramanagara
Shimoga
Tumkur
Udupi
UttaraKannada
Yadgir
TOTAL
XIII.
1,21,73,760.00
3,02,23,388.00
2,10,70,800.00
1,16,25,480.00
2,67,25,680.00
3,00,86,280.00
2,31,13,440.00
99,31,320.00
1,94,74,975.00
2,33,17,560.00
2,38,00,680.00
1,84,04,280.00
3,33,11,520.00
1,23,78,240.00
2,75,94,000.00
4,33,25,724.00
73,16,280.00
2,25,14,760.00
1,70,75,160.00
96,37,560.00
2,37,92,481.00
1,66,81,050.00
92,03,505.00
2,11,57,830.00
2,38,18,305.00
1,82,98,140.00
78,62,295.00
1,53,31,106.25
1,84,59,735.00
1,88,42,205.00
1,45,70,055.00
2,63,71,620.00
97,99,440.00
2,18,45,250.00
3,41,06,913.00
57,92,055.00
1,78,24,185.00
1,35,17,835.00
15,21,720.00
41,81,027.00
26,33,850.00
14,53,185.00
33,40,710.00
37,60,785.00
28,89,180.00
12,41,415.00
26,94,118.75
29,14,695.00
29,75,085.00
23,00,535.00
41,63,940.00
15,47,280.00
34,49,250.00
59,93,571.00
9,14,535.00
28,14,345.00
21,34,395.00
1745461 645219466.00 510096514.50 82759121.50
Particulars of recipients of concessions, permits or authorisations granted
by it:
District Name
Bagalkot
BG Rural
BG Urban
Belgaum
Bellary
Bidar
Bijapur
Chamarajanagar
Chikkaballapur
Chikmagalur
Chitradurga
DakshinaKannada
Davangere
Dharawad
Gadag
Gulbarga
Hassan
Haveri
Kodagu
Total
Beneficiaries
68585
25687
47941
100804
63090
51204
57938
40319
47259
55783
65913
33816
74996
58530
32293
74238
83573
64204
27587
Kolar
Koppal
Mandya
Mysore
Raichur
Ramanagara
Shimoga
Tumkur
Udupi
UttaraKannada
Yadgir
XIV.
48325
64771
66113
51123
92532
34384
76650
107508
20323
62541
47431
Details in respect of the information, available to or held by it, reduced in
an electronic form:
State Nodal Agency (SNA) Presently not maintained any Electronic formats.
XV.
The particulars of facilities available to citizens for obtaining information,
including the working hours of a library or reading room, if maintained for
public use;
The working hours of society will be 10.00 am to 5.30pm and there is no library or
reading room facility to citizens. The facilities available to citizens in the society called
Grievance counter/cell. The grievance may receive through letters, telephone and
direct contact. The information will be given in the state through letter communication
and through telephonic conversations.
XVI.
The names, designations and other particulars:
Shri Narasima Murhty S, Additional Labour Commissioner(IR) I/C & Chief
Executive Officer, Karnataka State Rastriya Swasthya Bima Yojana Society, Karmika
Bhavan, Bannerghatta Road, Bangalore-560 029.

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