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 Rastriya Swasthya Bima Society Yojana Address Karnataka Rastriya Swasthya Bima Yojana Society, Room No.09, Karmika Bhavan, Dairy Circle, Bannerghatta Road, Bangalore-560 029. -080-26654884/26650154, Fax: 080-26654884 Email-ID: ceorsbykarnataka@gmail.com Functions and Duties The Functions and Duties for which the society is established are as under. Selection of Health Insurance provider through tendering process inviting both public and private Insurers entering into contract with the Insurance Provider signing of MOU as per Government of India guidelines. To co-ordinate with the State and Central Government. Drawing programme for enrolment and issuance of smart card in consultation with 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 families and other identified categories.
II. The powers and duties of its officers and employees: PÀæªÀÄ ÀASÉå ÀzÀ ÁªÀÄ ªÀÄvÀÄÛ ºÀÄzÉÝ PÉ À ºÀAaPÉ/ ªÀð» ÀÄwÛgÀĪÀ PÁAiÀÄðUÀ¼ÀÄ 01 Shri Harsh Gupta IAS Commissioner of Labour and Chairman 02 Shri Narasimha Murthy S Joint Labour Commissioner and CEO 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: urmila.goswami@nic.in
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. 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. ii. Respective Insurance Companies and TPAs iii. Representative of Private hospitals iv. Representatives of Trust/ Charitable hospitals v. NGOs and representative of International agencies which are working through NGOs in the State vi. Smart Card Service Providers vii. Data Entering Organisation viii. Central Government officials - DGLW / MOL&E ix. 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. Respective Insurance Company and TPA from the district level offices 3. All the members of the smart card teams constituted by the Insurance Company / Smart Card Service Provider for issue and delivery of smart cards. 4. Representative of Private hospitals 5. Representatives of Trust/ Charitable hospitals 6. Representatives of NGOs / Intermediaries which are working in the district and may be engaged by Insurance Companies for implementing the scheme. 7. 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 *********** RSBY DISTRICT-WISE REPORT ANNEXURE.5 State: Date of Report: / / District Name: Month(quarter) of report: / District ID: Insurance Company: Original Correction Insurance Company ID:
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 (No.) Submitted (Rs) Settled (No.) Settled (Rs) Refused (No.) Refused (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) (f) (g) 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. List of BPL should be posted prominently in the enrolment station/village by the Insurer. 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) (j) At the time of enrolment, the government official shall identify each beneficiary in the presence of the insurance representative. At the time of handing over the card, the INSURER shall collect the registration fee of Rs.30/- from the beneficiary.
(k) (l) This amount will be adjusted against the amount of premium to be paid to the INSURER by the Nodal Agency. 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 OF TENDER TO SELECT INSURANCE PROVIDER 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, including collection of data on patients/providers and its use. (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. 11. RESPONSIBILITIES OF GOVERNMENT OF INDIA 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) (b) Issuance and periodic revision of guidelines for the Scheme. 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) (b) (c) An adequate network of hospitals/health facilities which meets minimum standards for service delivery and operation of transactions related to the Scheme. 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. Other basic infrastructure necessary to ensure successful implementation of the Scheme (e.g. electricity; roads). **** SUGGESTED IMPLEMENTATION SCHEDULE ANNEXURE -I Sl. STATE NO. OF YEARS No. DISTRICTS 2008-09 2009-10 2010-11 2011-12 2012-13 1 2 3 4 5 1. ANDHRA 23 5 5 5 4 4 PRADESH 2. ASSAM 23 5 5 5 4 4 3. ARUNCHAL 14 2 3 3 3 3 PRADESH 4. GUJARAT 25 5 5 5 5 5 5. BIHAR 37 8 7 7 8 7 6. HARYANA 19 4 4 4 4 3 7. HIMACHAL 12 2 2 2 3 3 PRADESH 8. JAMMU & 14 2 3 3 3 3 KASHMIR 9. KARNATAKA 27 6 6 5 5 5 10. KERALA 14 2 3 3 3 3 11. MADHYA 48 10 9 10 9 10
PRADESH 12. MAHARASHTRA 35 7 7 7 7 7 13. MANIPUR 9 1 2 2 2 2 14. MEGHALAYA 7 1 1 1 2 2 15. MIZORAM 8 1 1 2 2 2 16. NAGALAND 8 1 1 2 2 2 17. ORISSA 30 6 6 6 6 6 18. PUNJAB 17 3 3 3 4 4 19. RAJASTHAN 32 7 6 6 6 7 20. SIKKIM 4 1 1 1 1 21. TAMIL NADU 29 6 6 6 5 6 22. TRIPURA 4 1 1 1 1 23. UTTAR PRADESH 70 14 14 14 14 14 24. WEST BENGAL 19 3 4 4 4 4 25. DELHI 9 1 2 2 2 2 26. GOA 2 1 1 27. PONDICHERY 4 1 1 1 1 28. LAKSHDWEEP 1 1 29. DAMAN & DIU 1 1 30. DADRA & NAGAR 1 1 31. CHANDIGARH 1 1 32. ANDAMAN & 2 1 NICOBAR 1 33. UTTARANCHAL 13 2 2 3 3 3 34. JHARKHAND 22 4 5 4 4 5 35. CHATTISGARH 16 3 3 3 3 4 TOTAL 600 120 120 120 120 120 ANNEXURE -II 9 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. Haemo-Dialysis 2. Parenteral Chemotherapy 3. Radiotherapy 4. Eye Surgery 5. Lithotripsy (kidney stone removal) 6. Tonsillectomy 7. D&C 8. Dental surgery following an accident 9. Surgery of Hernia 10. Surgery of Hydrocele 11. Surgery of Prostrate 12. Gastrointestinal Surgery 13. Genital Surgery 14. Surgery of Nose 15. Surgery of Throat 16. Surgery of Ear 17. Surgery of Appendix 18. Surgery of Urinary System 19. Treatment of fractures/dislocation (excluding hair line fracture), Contracture releases and minor reconstructive procedures of limbs which otherwise require hospitalisation 20. Laparoscopic therapeutic surgeries carried out in day-care 21. Any surgery under General Anaesthesia 22. 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: a) 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. VI. A statement of the categories of documents that are held by it or under its control: 1. MoU with Insurance Companies 2. Performance Bank Guarantee Under procurement of server 3. Byelaws 4. Society Registration Certificate VII. 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. Rastriya Swasthya Bima Yojana Society State level Co-ordination Committee 2. Inter-Departmental Task Force Committee 3. State Level Grievance Redressal Committee 4. District Redressal Committee at District Level 5. District Implementation Committee at District Level IX. Directory of its officers and employees: SNo Name of officers and Employees Designation Contact Number 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 X. The monthly remuneration received by each of its officers and employees, including the system of compensation as provided in its regulations; Sl No Name of Employee 1 Shri Harsh Gupta IAS 2 Shri Narasimha Murthy S Karnataka State Rashtriya Swasthya Bima Yojana Designation Labour Commissioner and Chairman, Joint Labour Commissioner and CEO Remuneration/ Month - - XI. 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. 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 Rs. TOTAL 51,01,00,342.00 51,01,00,342.00 XII. 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 68585 2,46,90,600.00 1,95,46,725.00 30,86,325.00 BG Rural 25687 92,47,320.00 73,20,795.00 11,55,915.00 BG Urban 47941 1,93,20,223.00 1,52,09,282.25 26,72,710.75 Belgaum 100804 3,62,89,440.00 2,87,29,140.00 45,36,180.00 Bellary 63090 2,27,12,400.00 1,79,80,650.00 28,39,050.00 Bidar 51204 1,84,33,440.00 1,45,93,140.00 23,04,180.00 Bijapur 57938 2,08,57,680.00 1,65,12,330.00 26,07,210.00 Chamarajanagar 40319 1,45,14,840.00 1,14,90,915.00 18,14,355.00 Chikkaballapur 47259 1,90,45,377.00 1,49,92,917.75 26,34,689.25 Chikmagalur 55783 2,00,81,880.00 1,58,98,155.00 25,10,235.00 Chitradurga 65913 2,65,62,939.00 2,09,10,899.25 36,74,649.75
DakshinaKannada 33816 1,21,73,760.00 96,37,560.00 15,21,720.00 Davangere 74996 3,02,23,388.00 2,37,92,481.00 41,81,027.00 Dharawad 58530 2,10,70,800.00 1,66,81,050.00 26,33,850.00 Gadag 32293 1,16,25,480.00 92,03,505.00 14,53,185.00 Gulbarga 74238 2,67,25,680.00 2,11,57,830.00 33,40,710.00 Hassan 83573 3,00,86,280.00 2,38,18,305.00 37,60,785.00 Haveri 64204 2,31,13,440.00 1,82,98,140.00 28,89,180.00 Kodagu 27587 99,31,320.00 78,62,295.00 12,41,415.00 Kolar 48325 1,94,74,975.00 1,53,31,106.25 26,94,118.75 Koppal 64771 2,33,17,560.00 1,84,59,735.00 29,14,695.00 Mandya 66113 2,38,00,680.00 1,88,42,205.00 29,75,085.00 Mysore 51123 1,84,04,280.00 1,45,70,055.00 23,00,535.00 Raichur 92532 3,33,11,520.00 2,63,71,620.00 41,63,940.00 Ramanagara 34384 1,23,78,240.00 97,99,440.00 15,47,280.00 Shimoga 76650 2,75,94,000.00 2,18,45,250.00 34,49,250.00 Tumkur 107508 4,33,25,724.00 3,41,06,913.00 59,93,571.00 Udupi 20323 73,16,280.00 57,92,055.00 9,14,535.00 UttaraKannada 62541 2,25,14,760.00 1,78,24,185.00 28,14,345.00 Yadgir 47431 1,70,75,160.00 1,35,17,835.00 21,34,395.00 TOTAL 1745461 645219466.00 510096514.50 82759121.50 XIII. Particulars of recipients of concessions, permits or authorisations granted by it: District Name Total Beneficiaries Bagalkot 68585 BG Rural 25687 BG Urban 47941 Belgaum 100804 Bellary 63090 Bidar 51204 Bijapur 57938 Chamarajanagar 40319 Chikkaballapur 47259 Chikmagalur 55783 Chitradurga 65913 DakshinaKannada 33816 Davangere 74996 Dharawad 58530 Gadag 32293 Gulbarga 74238 Hassan 83573 Haveri 64204 Kodagu 27587
Kolar 48325 Koppal 64771 Mandya 66113 Mysore 51123 Raichur 92532 Ramanagara 34384 Shimoga 76650 Tumkur 107508 Udupi 20323 UttaraKannada 62541 Yadgir 47431 XIV. 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.