1. Rashtriya Swasthya Bima Yojna –
Capacity Building of District Key Manager
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2. Current Status of RSBY Implementation in India
 Cards issued – App. 27.6 Million
 People enrolled – App. 100 million
 Number of People benefitted till
now – App. 3.2 million
 Number of Hospitals Empanelled
– App. 8600
 States where Service delivery has
started – Twenty Five
 Number of Insurance Companies
Involved – Thirteen
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3. What is RSBY
 Benefits
 Cover for Hospitalisation Expenses of Rs. 30,000/- (EUR 500 ) per family
per annum on a family floater basis (Upto five family members)
 1020 pre-defined surgical packages including Maternity & Newborn Care
 Cover for Day Care Surgeries
 All Pre-existing Diseases to be covered
 1 day pre and 5 day post hospitalisation Expenses
 Transportation costs (Rs. 100 per visit) with overall limit of Rs.1000
 Sources of funding for program
 Rs. 30 (EUR 0.5) per family per year from Beneficiaries
 75% of Premium from Central Government
 25% of Premium from State Government
 Both Public and Private providers can be empanelled
 Beneficiary can get cashless treatment in empanelled hospital
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4. Smart Card
 Smart Card with embedded chip which
stores details:
 Fingerprint and photos (up to five members)
 Other details like Name, Age, Gender,
Relationship etc. of up to five family members
 Unique identification number
 Insured Amount (Rs. 30,000/- in the beginning)
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5. eb site www.rsby.gov.in
ad on w
n
3. Uplo rificatio 4. Selection through tendering
r ve
Government af t e State Nodal 9. Submission of data and bill Insurance
of India Agency Company
2 10. Payment to Insurer
v e . Se e in
rif nd re par at
ica f Beneficiary 1. P n f or m
tio or e
n Data giv s
Proces rie
s
12 . Claim ent
a nelm ia
5. Em
p
e fic
n
p f Be FKO
H ah
elt g-up -u o
ettin tt ing e nt
Cr
ae 5. S Se n
ol
lm atio rd
8. Download of FKO
rific a
Data at DKM server
Poidr
rv es District Call r
Kiosk Centre En Ve art C
7. m
7.
of S
6. Issuance of
BPL
FKO Card
Awareness Beneficiaries
Health
11. Camps
U ti
lisa
t i on
of S
er v DKM
ice
s
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6. Enrollment Station
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7. Key transfer
Verification by FKO by
fingerprint and smart card
FKO
RSBY
Card
Card
Data of Beneficiary family
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8. Role of State Government
1. Set up/ Identify State Nodal Agency for RSBY
 Develop a full time team for State Nodal Agency with some
experts in IEC, Data Analysis, IT etc.
 District Coordinators for RSBY
 Get Financial Accounts audited
2. Provide certified & validated BPL data as per Planning
Commission guidelines and in prescribed format.
3. Designate DKMA and FKOs for each selected district
a. Help Insurance company prepare enrollment schedule and
prepare Awareness campaign for beneficiaries
b. Help identify locations to hold enrollment camps and facilitate
such camps
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9. Other Key Roles of State Government
Pre-Enrollment
Incentive for
FKOs
(if necessary)
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10. Other Key Roles of State Government
Post Enrollment
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11. Role of State Government
1. Premium Payment
 State Nodal Agency to Pay state share to the Insurer within 15
days of receiving bills in the prescribed format
 State Nodal Agency to pay Central Share to the Insurer within 7
days of receiving from Central Government
 Payment to the Insurer shall be on a Monthly basis and not after
completion of enrollment period
2. Organise weekly review meetings at State and District level
3. Organise awareness activities post-enrollment
4. Enable Government hospitals to compete with private
Hospitals by providing incentives
5. A State server shall store all the data of last year and
coming year for all the operational districts
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12. Role of State Government
1. This data shall be analysed based on:
– Conversion ratio
– Hospitalisation ratio - Average and Genderwise
– Average Family size
– Disease pattern
– Burnout Ratio
2. Monthly reports based on data analysis can be prepared
and shared with different stakeholders
3. Concurrent evaluation of the scheme shall be done
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13. What is Key Management System
Central Key Generating
Authority
Hospital Code issued
Issues personalised DKM Cards, FKO Cards,
HAC Cards, District Kiosk cards
Issue
District
Kiosk
District Key Manager Card District Kiosk
Personalise and issue FKO Cards Post issuance Issues personalised HAC Card
issues
Authentication of
smart card at the time
Field Key Officer of enrollment
Hospital
Beneficiaries
Hospitalisation
Insurance Company
Issues personalised Beneficiary Smart Card
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14. Role of District Key Manager
1. Receive DKMA card and issue following cards:
a. Field Key Officer Cards according to the specified schedule
b. Hospital Authority Cards
c. District Kiosk Cards
3. Set up DKM Server at District level
5. Monitor the participation of FKOs in enrollment
7. Get enrollment data downloaded from FKO cards to DKM
Sever
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15. Role of District Administration
 Provide support to Insurance Company in Implementation
of the scheme
 Ensuring participation of FKOs in enrollment process
 Helping in empanelment of good private hospitals
 Help in organising the District workshops
 Help in linking with BDOs, Panchayats
 Provide space for District kiosk at a Government location
 Organise Periodic review meetings
 Provide them list of Good NGOs who can be hired for
sensitisation
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16. Role of Health Department
 Install necessary hardware and software in the public
hospitals
 Provide help desk in the hospital alongwith person
 Training of Hospital Personnel
 Provide cashless treatment on package rates
 Get the Reimbursement from the Insurer
 Organise Health Camps
 Enable RKS to receive money from Insurer and use it in a
flexible way
 Tie up with Pharmacies and Diagnostic Centres
 Provide for cash incentives for staff
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17. Signage Outside Empanelled Hospitals
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19. Potential for Government Hospitals
 The claim payment from Insurance Company will come
directly to the hospitals
 Hospitals can use all the money through RKS for
development of the hospitals and improving infrastructure
 Government hospitals in many States are able to earn a
lot through RSBY
 In Kerala out of 50 crores which was paid by Insurance
Company as claim payment, Government hospitals have
earned more than 27 crores
 Government of Kerala has also given 25% of this as cash
incentive to the staff working in these Government hospitals
 Rest 75% have been used to
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20. BEFORE AFTER
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21. Administrative Wing
(before) (after)
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22. Role of Insurance Company
1. Finalise the TPA/ Smart Card Pre-Enrollment
service provider
2. Set up team at State and
District level for the
implementation
3. Organise District-level
workshops with all
stakeholders
4. Organise separate District
workshop with health care
providers before the
empanelment
Print these three details in the Enrollment Brochure
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23. Role of Insurance Company
1. Enrollment of the beneficiaries Post Enrollment
1. Prepare villagewise plan
2. Communicating this plan to the Send
villages consolidated data
the Government
3. Identify locations in each village
for enrollment
4. Coordinate with State Government
for the FKOs
Send Back end
5. Visit villages according to the plan data to Central
with enrollment team Govt..
6. Personalise the smart card and
print and give on the spot and take
Rs. 30 from the beneficiaries
7. Arrange for contingencies like
electricity failure etc.
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24. Few Important Documents
 Tender Document
 Contract Document between Nodal Agency and
Insurance Company
 About RSBY and FAQs on RSBY
 District Kiosk and Server Specifications
 Roles and Responsibilities of State Government
 Roles and Responsibilities of the Insurer
 Guidelines for DKM and FKOs
 Format of Review Meetings
 Guidelines for Business Continuity Plan
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25. Thank You
nishant.jain@giz.de
urmila.goswami@nic.in
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