1. Mukhya Mantri State
Health Care Scheme
(MMSHCS)
HP Swasthya Bima Yojna Society
Dept. Health & FW
Shimla, Himachal Pradesh
2. Brief About the Scheme
• The Govt. of Himachal Pradesh has decided to provide health
insurance coverage to population which is not covered under RSBY.
• Hence the new scheme “MMSHCS” is formulated in 2015.
• First State to launch health coverage for unique categories.
• Software and hardware used that of RSBY to cut the cost.
• The size of the family would be 5 only.
• 100% State funded.
3. Benefits of the Scheme
• Rs. 30,000/- per year on family floater basis
• Hospitalization (Indoor & Daycare).
• In 174 Hospitals.
• More than 1400 procedures defined under RSBY
• 100 Rs. Transportation cost to be reimbursed by hospital (cap: 1000 per
year).
• Maternity benefit & new born care is covered.
• Completely cashless
• Pre & Post hospitalization expenses (1 day prior & 5 day post hospitalization)
• Day Care procedures also covered (listed)
• Package rates are defined as that of RSBY only.
4. Benefits of the Scheme cont….
• Rs. 1, 75,000/- per year on family floater basis
• 3 Hospitals viz. IGMC, RPGMC Tanda, PGI Chandigarh are empanelled.
• More than 320 procedures are covered, including cancer
• Packages are defined by the State Govt.
• 15 days prior and 60 days post hospitalization expenses are covered.
• Rs. 1000/- transporation cost at the time of discharge (cap: Max. 3000/year)
5. Categories Covered
There are 9 Categories covered under the Scheme
• Senior Citizens (Above 80 Years of Age)
• Ekal Naris
• Anganwari Workers
• Anganwari Helpers
• Mid-day Meal Workers
• Persons with more than 70% disability
• Contractual Employees (Govt., Auto. Bodies, Societies, Boards, corp.)
• Part time Workers (Govt., Auto. Bodies, Societies, Boards, corp.)
• Daily Wage Workers (Govt., Auto. Bodies, Societies, Boards, corp.)
Note: The beneficiaries who are not enrolled under RSBY & any other
medical reimbursement Scheme are eligible
6. Definitons of Categories
Note: The beneficiaries who are not enrolled under RSBY & any other medical
reimbursement Scheme are eligible
• Senior Citizens: > 80 years, Dependents are above 80 years only.
• Ekal Naris: Widows, Divorced, Abandoned, with missing husband and Un-married
women. (Certified from Panchyat/Block or membership in Ekal nari Shakti
Sangatan)
• Anganwari Workers: All. (Dept. Verification must)
• Anganwari Helpers: All. (Dept. Verification must)
• Mid-day Meal Workers: All. (Dept. Verification must)
• Persons with more than 70% disability: Medical Certificate is must.
• Contractual Employees: On contract basis. (Dept. Verification must)
• Part time Workers: All (Dept. Verification is must)
• Daily Wage Workers: All (Dept. Verification must)
7. Total No. of Families
2, 00, 000 approximately across
Himachal Pradesh
Ref: Statistical outline- HP
10. Stake Holders Involved
HP Swasthy Bima Yojna society, Dept. of Health &
FW- State Nodal Agency (SNA)
Rural Technologies Solutions Pvt. Ltd., New Delhi-
Support Agency
District Administration
All other Concerned departments
11. Difference B/w RSBY and MMSHCS
MMSHCS RSBY
Smart Card is valid for 5 years.
Smart Card is valid for 1 year (subject to
renewal of policy).
Smart Card has to be renewed after 3
years.
New Smart Card is issued every year.
No insurance company is involved
Scheme is contracted out to Insurance
Company (PPP model)
Claim amount will be reimbursed by
HPSBYS (claims are processed by RTS)
Claims are settled by the insurance
company
On the spot data Capturing
Pre-enrollment data of beneficiaries is
collected
Permanent Enrollment Centre at district
level
No Permanent enrollment Centre
Smart Card is valid only within Himachal
Pradesh
Smart Card is valid across India
(Hospitals empanelled under RSBY)
12. MMSHCS RSBY
Completely State funded Centre:State (90:10)
Rs. 30 is collected only one time (at the
time of registration)
Rs. 30 is collected during each and every
enrollment
Beneficiary Category is identified by the State
Government
Categories are identified by Government of
India
Difference B/w RSBY and MMSHCS
14. Enrollment Software
• The Existing RSBY Software will be used. Same key
management system viz. DKMA and FKO cards
• On-the-spot data capturing & enrollment software will be used.
• Modified version of RSBY kiosk will be integrated.
Transaction Management Software (Hospitals)
• The Hospitals can process the claims using same RSBY TMS
(Transaction Management Software)
• The Claims uploaded by the hospitals will be received on SNA
server
17. Documents (Beneficiaries) at
time of Enrollment
• Photo identity card
I. Aadhar card (1st preference) or
II. Voters Id card or
III. Pan card
IV. Ration card
• Enrollment & Declaration form - can be
downloaded online/ copies also available at
enrollment centre. (www.nrhmhp.gov.in)
• Department Verification: Other than senior
citizens rest of the categories must submit the
certificate ex: contractual employees- certificate from
the respective institution. (Mentioned at the bottom of
Enrollment form)
18.
19.
20.
21. What beneficiary will receive
after enrollment?
• A Smart Card
• Smart card Cover
• A 3-fold leaflet containing information
22. Role of State Nodal Agency
• Overall designing & Implementation of the Scheme
• Monitoring & Evaluation
• Reimbursing of the claim amount to hospitals
• Grievance redressal
• Coordinating with district administration
• Conducting IEC activities
23. Role of Support Agency
Rural Technology Solutions Pvt. Ltd. will be
conducting below functions
• Planning & Conducting enrollment process
• Conducting IEC activities
• Installing software (TMS) in hospitals
• Data processing of claims and submitting to SNA for
reimbursement
24. Role of District Administration
Provide support to “Agency” in implementing the
scheme
Ensuring participation of FKOs in enrollment process
Help in organizing the District/Block workshops
Help in linking with various departments involved in the scheme
Provide space for PEC & District kiosk at a Government location
Organize Periodic review meetings
25. Role of FKO (Field Key
Officer)
Who is FKO?
Field key officer is a government employee who is
nominated by district/block administration.
• Identifying the beneficiary eligibility (cross verifying the
documents)
• Ensuring proper enrollment of the beneficiary family
• Authorizing enrollment team to print and issue the smart
card
26. Role of Hospitals
Providing “Cashless” treatment to beneficiaries.
Providing Rs. 100/- to beneficiary at the time of discharge
(Transportation cost)- limited to 1000/year.
Maintaining records and reports separately from that of
RSBY
Uploading the claims within 24 hours of discharge of
patient
Periodic checking of bank account for reimbursement
27. IEC Activities
Hoardings
Advertisement in new papers
Advertisement in Local TVs and FM radios
Bulk SMS
Department Notifications
Direct post
Pamphlets at the time of enrollment
29. FAQ- Frequently Asked
Questions
• Are outsourced employees also covered?
No. As of now they are not covered.
• Incase of identified beneficiaries’ wife/dependents are
covered under other medical reimbursement scheme, are
they eligible?
No. If the dependents are covered under other schemes,
they are not eligible
• What happens if contractual employee becomes regular?
Concerned dept. will send letter to SNA, and his card will
be hot listed.
