Bhamashah Swasthaya Bima YojanaRajasthan

Bhamasha Swasthaya Bima YojanaLaunched on 13th December, 2015 for around 1 crore eligible families of Rajasthan in compliance of Budget Declaration of Honble Chief Minister, Rajasthan.

Organogram-State Level

Organogram-District Level

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Bhamasha Swasthaya Bima YojanaBeneficiary: 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 packagesCovering 14 specialties.

Secondary Packages (1148)Tertiary Package (500)Government PKg (67)

SpecialtyNo. of PkgDentistry36ENT155General Medicine36General Surgery402Neurosurgery59Obstertics & Gynaecology93Oncology10Ophthalmology64Orthopedics202Paediatrics31Urology124

SpecialtyNo. of PkgCardiology & CTVS122Chest Surgery20ENT2General Medicine16General Surgery21Neurosurgery64Oncology178Orthopedics10Paediatrics8Plastic Surgery13Urology46

SpecialtyNo. of PkgENT14General Surgery18Obstertics & Gynaecology25Ophthalmology10

ContinueGovt Hospitals (n=480): Medical College & associated hospitals, DH, SDH, Satellite hospitals and CHCsPrivate 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

No. of Private Hospitals Empanelled So FarIncreasing number of hospitals depicts increasing interest of private sector

Chart1

167

189

202

320

358

453

498

545

568

Series 1

Sheet1

Series 1Series 2Series 3

14-12-151672.42

18-12-151894.42

29-12-152021.83

25-01-163202.85

17-02-16358

17-03-16453

20-04-16498

29-06-16545

26-07-16568

Stakeholders in the Scheme

Responsibility of StakeholdersMedical & Health: Overall planning & execution of schemePayment of premium to InsurerMonitoring & Grievance Redressal of pvt & govt hospitalsNIAC:Providing Insurance Cover to entitled familiesEmpanelment of private hospitalsTraining & orientation of SM & Nodal OfficersClaim processing and paymentDoIT:Preparing software for the schemeEstablishment of Call CenterSupport in IT related issues Issuing Bhamashah Card to all.

Admission & TID Generation by HospitalEligibility Verification of Family and individual Identity using Bhamashah Card / Bhamashah Slip / RSBY CardChecking available amount in wallet of familyStarting Treatment

Blocking PackageOnline Pre-Authorization Request and Approval by NIACDischarge & online claim submissionClaim Approval & Online Payment to HospitalSecondary PackageTertiary PackagePatient will be received at hospital by Swasthya Margdarshak after IPD advise by doctorProcess Flow under BSBY

What makes us different

Rajasthan RSBYMaharashtraTamil Nadu Sum insuredSecondary 30,000Tertiary 3,00,00030,0002,50,0001,50,000Coverage ComprehensiveSecondary and TertiarySecondaryTertiary Tertiary Target populationNFSA (includes 15 categories) and RSBY BPL familiesBPL & APL families BPL familiesPackages 171513009721016Verification of beneficiaryBhamashah CardBiometricYellow / Orange cardBiometricMultipurpose call centerYesNoNoNo

Progress So Far..

Total No. of Claims Enlisted

Chart1

3228

20063

52906

97800

154178

228800

300751

364187

386433

Total Claims Booked

Number of Claims

Sheet1

Column1Total Claims Booked

31-12-20153228

31-01-201620063

29-02-201652906

31-03-201697800

30-04-2016154178

31-05-2016228800

30-06-2016300751

31-07-2016364187

10/8/16386433

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Total Amount of Enlisted Claims (Rs. in Lac)

Chart1

164.23

1016.43

2742.05

4873.94

7397.41

10736.41

14045.47

17069.84

18177.17

Total Claims Booked

Rs. In Lac

Sheet1

Column1Total Claims Booked

31-12-2015164.23

31-01-20161016.43

29-02-20162742.05

31-03-20164873.94

30-04-20167397.41

31-05-201610736.41

30-06-201614045.47

31-07-201617069.84

10/8/1618177.17

Total No. of Claims Submitted

Chart1

2611

16590

44319

83406

132820

197070

261073

313893

335992

Total Claims Booked

Number of Claims

Sheet1

Column1Total Claims Booked

31-12-20152611

31-01-201616590

29-02-201644319

31-03-201683406

30-04-2016132820

31-05-2016197070

30-06-2016261073

31-07-2016313893

10/8/16335992

Total Amount Submitted (Rs. in Lac)

Chart1

124.9

769.55

2135.56

3888.84

6086.3

8903.33

11771.29

14112.3

15192.39

Total Claims Booked

Rs. In Lac

Sheet1

Column1Total Claims Booked

31-12-2015124.9

31-01-2016769.55

29-02-20162135.56

31-03-20163888.84

30-04-20166086.3

31-05-20168903.33

30-06-201611771.29

31-07-201614112.3

10/8/1615192.39

Total No. of Claims ApprovedClaim approvals raised by around 86,000 in last two months

Chart1

1736

12142

31221

57384

89043

130702

177485

216938

239524

Total Claims Booked

Number of Claims

Sheet1

Column1Total Claims Booked

31-12-20151736

31-01-201612142

29-02-201631221

31-03-201657384

30-04-201689043

31-05-2016130702

30-06-2016177485

31-07-2016216938

10/8/16239524

Total Claims Approved (Rs. in Lac)Approvals raised by around 40.00 cr in only two months

Chart1

73.75

493.74

1419.89

2520.02

3693.65

5194.58

7196.23

9015.43

10270.27

Total Claims Booked

Rs. In Lac

Sheet1

Column1Total Claims Booked

31-12-201573.75

31-01-2016493.74

29-02-20161419.89

31-03-20162520.02

30-04-20163693.65

31-05-20165194.58

30-06-20167196.23

31-07-20169015.43

10/8/1610270.27

Total No. of Claims PaidRise of approximately 1,25,000 claims in last two months

Chart1

15979

22042

34580

83639

142605

209558

Series 1

Number of Claims

Sheet1

Series 1Series 2Series 3

till 29th Feb, 2016159792.42

31-03-2016220424.42

30-04-2016345801.83

31-05-2016836392.85

30-06-2016142605

28-07-2016209558

To resize chart data range, drag lower right corner of range.

The data is taken from the email received from Sh Lalit Jain, NIAC*

Total Amount Paid (Rs. in Lac)Rise of 51 crores in last two months

Chart1

338.26485

678.35097

1303.52985

3098.67

5260

8117.47

Amount

Rs. In Lac

Sheet1

AmountSeries 2Series 3

till 29th Feb, 2016338.262.42

31-03-2016678.354.42

30-04-20161303.531.83

31-05-20163098.672.85

30-06-20165260.00

28-07-20168117.47

To resize chart data range, drag lower right corner of range.

The data is taken from email received from Sh. Lalit Jain, NIAC*

Pvt Contribution in Total Claim Booking

Critical Diseases Treated under The Scheme

Cardiovascular & Cardio Thoracic and Vascular Surgery: Bypass surgery (CABG): 305 claims amounting Rs. 2.27 croreHeart 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.

IEC Activities

BSBYLED BOARD ON TOP OF PVT HOSPITALS

LED Boards on Roads

Pamphlet Printed for IEC of the Scheme & Pvt. Empanelled Hospitals

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Facebook page- regular updation

Regular Updates on Google+ and blog

Success Stories of BSBY across Districts

ASHA Samwad with more than 46,000 ASHAs through Video Conference under the chairmanship of Honble Health Minister, GoRThree rounds accomplished so far for orientation regarding BSBY

Video Conferences with ASHA

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.

Official Webpage of BSBY

Grievance Redressal

Redressal of Grievances State (SGRC) and District Grievance Redressal Committees (DGRC) are formulated. SGRC: under the Chairmanship of CEO, RSHAADGRC: under the Chairmanship of District CollectorFormulation of State Appellate Authority under the chairmanship of Principal Secretary, M&HRajasthan 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 corpus2% 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 claimsReimbursement to the hospital within 21 days of submission of claim

. Unique Features

Thanks

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*The data is taken from the email received from Sh Lalit Jain, NIAC*The data is taken from email received from Sh. Lalit Jain, NIAC*

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