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Bhamashah Swasthaya Bima YojanaRajasthan
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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.
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Organogram-State Level
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Organogram-District Level
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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.
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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
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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
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No. of Private Hospitals Empanelled So No. of Private Hospitals Empanelled So FarFar
Increasing number of
hospitals depicts increasing
interest of private sector
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Stakeholders in the Scheme
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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.
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Admission & TID
Generation by Hospital
Eligibility Verification of
Family and individual
Identity using Bhamashah
Card / Bhamashah Slip / RSBY
Card
Checking available
amount in wallet of
familyStarting
Treatment
Blocking Package
Online Pre-Authorization Request and Approval by
NIAC
Discharge & online claim submission
Claim Approval & Online Payment to
Hospital
Secondary Package
Tertiary Package
Patient will be received at hospital by Swasthya Margdarshak after IPD
advise by doctor
Process Flow under BSBY
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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 population
NFSA (includes 15 categories) and RSBY
BPL families BPL & APL families BPL families
Packages 1715 1300 972 1016Verification of beneficiary Bhamashah Card Biometric Yellow / Orange
card Biometric
Multipurpose call center Yes No No No
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Progress So Far..
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Total No. of Claims Enlisted
050000
100000150000200000250000300000350000400000
3228 2006352906
97800
154178
228800
300751
364187386433
Num
ber o
f Cla
ims
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Total Amount of Enlisted Claims (Rs. in Lac)
164.23 1016.432742.05
4873.947397.41
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
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Total No. of Claims Submitted
0
50000
100000
150000
200000
250000
300000
350000
2611 1659044319
83406
132820
197070
261073
313893335992
Num
ber o
f Cla
ims
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Total Amount Submitted (Rs. in Lac)
02000400060008000
10000120001400016000
124.9 769.552135.56
3888.84
6086.3
8903.33
11771.29
14112.315192.39
Rs. I
n La
c
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Total No. of Claims Approved
0
50000
100000
150000
200000
250000
1736 1214231221
5738489043
130702
177485
216938239524
Num
ber o
f Cla
ims
Claim approvals raised by around 86,000 in
last two months
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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
73.75 493.741419.89
2520.023693.65
5194.58
7196.23
9015.43
10270.27
Rs. I
n La
c
Approvals raised by around 40.00 cr in only
two months
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Total No. of Claims Paid
15979 22042 3458083639
142605
209558
0
50000
100000
150000
200000
250000
Num
ber o
f Cla
ims
Rise of approximately
1,25,000 claims in last two months
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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 La
c
Rise of 51 crores in last two
months
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Pvt Contribution in Total Claim Booking
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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.
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IEC Activities
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BSBYBSBYLED BOARD LED BOARD ON TOP OF ON TOP OF
PVT PVT HOSPITALSHOSPITALS
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LED Boards on Roads
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Pamphlet Printed for IEC of the Scheme & Pvt. Empanelled Hospitals
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Facebook page- regular updationFacebook page- regular updation
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Regular Updates on Google+ and blog
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Success Stories of BSBY across Districts
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• 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
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BSBY ASHA KIT
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IEC of BSBY Through Auto Riksha
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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.
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Official Webpage of BSBY
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Grievance Redressal
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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.
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• 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
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Thanks