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    Frequently Asked Questions

                                RASHTRIYA SWASTHYA BIMA YOJANA

                                          Frequently Asked Questions

                                               I.  INSURANCE

  1. Duration

  

What is the duration of insurance? One full year?  Or till the end of Financial Year? Or for a fixed period?  If yes, then what is the fixed period?  When would insurance commence?  On the date of issue of Smart Card? Or from a fixed date?  Or after a predetermined period after the issue of card?  Or after the issue of card and payment of premium by the State Government? Or after payment of premium both by the Central and State Governments?  Is the premium given for the entire year?  Is it for the period of insurance?  Or is it a combination of two?

Duration of insurance is for a fixed period in each District.  The commencement and termination is determined by the day on which first set of cards are issued.  In case the first set in that District is issued in April, the scheme will commence from 1st of June and will terminate on 31st of May in the following year.   First installment must be paid by the State before the inception period.  All cards issued in the intervening period will also have a terminal date of 31st of May.  It is presumed that the premium for the policy would be paid in the period between the date on which the card is issued and the date on which the insurance commences.  For the cards issued during the first three months, full premium would be paid.  Thereafter, it would be paid on pro-rata basis.  The enrolment will freeze from 1st November (five months after the commencement of the scheme) in the above mentioned illustration so as to ensure a minimum six month insurance period.

  

  1. Definition of Family and Family Data
  • What is the definition of “family”?  Does it include the parents?  If the family size is more than five, who should be left out?  Who would take this decision?

  

Coverage under the scheme is being provided for BPL workers and their families (upto a unit of five).  A family would comprise the household head, spouse and upto 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 database.  If the family size is more than five, the head of the family would decide as to who all should be left out.  However, in case the name of the spouse is listed as part of the family in the database, the second member would necessarily be the spouse and the selection would be for the remaining three slots. 

  

  • Which data is to be used for the scheme? Is the available BPL data provided by the State to be used? Should the data be validated against certain parameters? What are those parameters? Who would undertake the tasks of validation?

  

The data provided and certified by the State Government shall be used for the purpose of insurance, This is expected to be BPL data as per the Planning Commission guidelines and in the same format as provided by the Central Government.  Before certification, this data will need to be validated against defined parameters.  The task of validation will be undertaken by the State Government through the software prepared by the Central Government.

  

  1. Benefits

Is OPD covered?  Is OPD consultation free?  If not free, who would pay those charges?  Which all ailments are excluded?  Are these ailments be specified?  Is there an indicative list?  What is that list?

The OPD facilities are not covered under this scheme.  However, OPD consultation is free.  Beyond consultation, if any expenditure is incurred in the OPD, which does not lead to hospitalization, will be met by the beneficiaries.  Common exclusions have been listed out in Annexure II of the Guidelines.  These common exclusions include:

      • Conditions that do not require hospitalization
      • Congenital external diseases
      • Drug and Alcohol Induced illness
      • Sterilization and Fertility related procedures
      • Vaccination
      • War, Nuclear invasion
      • Suicide
      • Naturopathy, Unani, Siddha, Ayurveda

 

However, the aforementioned are only indicative in nature and it has been specified in the Guidelines that there should be minimum exclusions and the list of exclusions would be negotiated between State and the Insurers and would be subject to assessment by the Approval and Monitoring Committee to ensure that it is not overly wide.


  1. Qualification for Insurance Companies

  

Is there any qualification criteria for insurance companies to bid? What is the criteria?  Is there a minimum experience qualification? What is this minimum experience?

The qualification criteria for insurance companies is as follows:

i) Insurance company should have full fledged establishment with experience in conceptualizing, designing and implementing large healthcare schemes and should be registered with IRDA or enabled by a Central legislation to undertake insurance related activities.
 
ii) At least one year experience in catering to health insurance of 50,000 families or more under one group health insurance policy in 2005-2006 or 2006-2007 or 2007-2008.                                                                                                

 

  1. Empanelment of Hospitals

What is the criteria for empanelling the hospitals?    Is it mandatory?  Who should do the empanelment? Whether it should be done before tendering? or after tendering?  Should there be a back-to-back agreement between the Insurance Company and the Hospitals before the contract between Insurance companies and the State Government?

The criteria for empanelment of hospitals and health facilities described in draft Tender Document is as follows:

Hospital and other health facilities with desired infrastructure for inpatient and day care 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.  Insurers can seek assistance of the State Nodal Agency.

  • All Government hospitals (including Community Health Centers) and ESI hospitals can be empanelled provided they possess the facilities of Telephone/Fax, 64 KBPS connectivity and machine to read and manage smart card transactions.  Thus, each hospital/health service provider shall possess a Personal Computer with two smart card readers and a finger point reading or a standalone machine in tune with the specifications provided in Annexure 16 of the Tender Document. 

 

Apart from the requirement as in (i) above, the additional criteria for empanelling private hospitals and health facilities would be as follows:

  • At least 10 inpatient medical beds for primary inpatient health care.  The requirement of minimum number of beds can be reduced based on available infrastructure in rural areas.

 

  • Fully equipped and engaged in providing Medical and or Surgical facilities. The facility should have an operational pharmacy and diagnostic services, or should be able to link with the same so as to provide ‘cash less’ service to the patient. The diagnostic service should include testing of clinical specimens, X-rays and ECG etc.
  • Those facilities undertaking surgical operations should have a fully equipped Operating Theatre of its own.

 

  • Fully qualified doctors and nursing staff under its employment round the clock.
  • Maintaining of necessary records as required and providing necessary records of the insured patient to the Insurer or his representative/Government/Nodal Agency as and when required.
  • Registration with Income Tax Department.
  • The Hospital should agree to the cost of packages for each identified intervention/procedures as approved under the scheme. These package rates will include Bed charges (General Ward), Nursing and Boarding charges, Surgeons, Anesthetists, Medical Practitioner, Consultants fees, Anesthesia, Blood, Oxygen, O.T. Charges, Cost of Surgical Appliances, Medicines and Drugs, Cost of Prosthetic Devices, implants, X-Ray and Diagnostic Tests, Food to patient etc. Expenses incurred for diagnostic test and medicines up to 1 day before the admission of the patient and cost of diagnostic test and medicine up to 5 days of the discharge from the hospital for the same ailment / surgery and transport expenses will also be the part of package.  The package should cover the entire cost of treatment of the patient from date of reporting to his discharge from hospital and 5 days after discharge and any complication while in hospital, making the transaction truly cashless to the patient.

The Hospital should be in a position to provide following additional benefits to the BPL beneficiaries related to identified systems:

    • Free OPD consultation.
    • Discounts on diagnostic tests and medical treatment required for beneficiaries. 

 

The empanelment of the hospital shall be undertaken by the concerned insurance companies.  It has been left to the State Government to decide whether they would like to get the empanelment done before seeking tenders from the insurance companies or after selection of the insurance company for a particular district.  However, the insurance companies are mandated to furnish a list of hospitals with whom they have entered into an informal arrangement so that formal agreement could be entered into subsequent to the selection of the insurance company.,

  1. Medical Procedures

Are medical procedures listed out?  Is the cost also listed out?  Who should determine the cost?  Is it mandatory for the hospitals?  Are the States be permitted to re-determine?  Is there a uniformity of costs for public and private hospitals?  Is it uniform throughout the State?  Is it uniform throughout the country?

With a view to providing security to the beneficiaries in terms of the charges levied for a particular treatment and to standardize the cost of each medical procedure, it was found necessary to list out the medical procedures and the cost thereof.  However, the cost of each medical procedure is not mandatory for the State which can negotiate it separately with the insurance company who in turn would enter into a contract with the network hospitals accordingly.  However, the States have been mandated to fix some cost.  There is, therefore, no uniformity mandated throughout the country but the cost has to be fixed in each State making use of the suggestions given by the Central Government.

  1. Standardisation of Documents

  

Is there a template of Tender document prepared Centrally?  Is the  template mandatory? 

The template of Tender Document has been prepared centrally with a view to assisting the State in finalizing its own Tender Document.  These templates are not mandatory in nature except such clauses which are mandatory under the policy and the guidelines. 

  1. Coverage

  

  • Should there be one Insurance Company selected for a State? Or should there be one Insurance Company for each district?  Or should there be multiple insurance companies?  Could certain districts be clubbed?

District is the unit under the scheme.  Thus, there could be more than one insurance company in a State but only one in each district.  The States can club the district for the purpose of the scheme. 

  • Should State be allowed only 20 percent of the districts in the first year?  Or should such States who are willing and prepared to launch in more districts in lieu of such States who are either unwilling or have not responded?  Should there be any timeframe given to the States to submit their proposals?

 

As per the guidelines each State has to take up 20% of the districts each year  in the next five years.  However, the Central Government would consider additional districts if slots become available on account of inability of other States in furnishing their proposals.  As of now, no time frame has been fixed but it would be done in due course.

  1. Dispute Resolution  

How would the disputes between Insurance Companies and other players be resolved?  Is there be a system of arbitration?  What is that system? 

The dispute resolution mechanism has been outlined in Point XVI of the Bid Proposal in the Tender Document as follows:
 
If any dispute arises between the parties hereto during the subsistence of this Agreement or thereafter, in connection with the validity, interpretation, implementation or alleged breach of any provision of this Agreement, the parties shall refer such dispute to the respective Chairmen/CEO’s/CMD’s of the Insurer for resolution.  In the event that the Chairmen/CEO’s /CMD’s are unable to resolve the dispute within {60} days of it being referred to them, then either Party may refer the dispute for resolution to a sole arbitrator who shall be jointly appointed by both parties, or, in the event that the parties are unable to agree on the person to act as the sole arbitrator within {30} days after any party has claimed for an arbitration in written form, by three arbitrators, one to be appointed by each party with power to the two arbitrators so appointed, to appoint a third arbitrator.

  1. Role of Intermediaries  

Should there be intermediaries between the Insurance Companies and the beneficiaries?  What is their relationship?  Has the Government determined this relationship?   What would be the commission to be given to the intermediaries?  Should the Government determine it?
 
The role of intermediaries under the scheme is extremely important.  It is likely that the insurance company will outsource activities like issue of smart cards, publicity, etc. to such agency who have core competence in such areas.  However, the scheme does not determine the relationship that would exist between the insurance company and the other intermediaries.  It has to be an arrangement worked out between the insurance company and the intermediary.

  1. Settlement of Claims  

How should insurance claims be settled?  Should the States have a role?  If yes, what?  Should there be a time frame for settlement of claims?  What should be the frequency of submission of claims?  Can there be an electronic settlement of insurance claims? What would be the hardware requirement at the front end?  What would be the software at the front end?  Who would prepare this software? Who would maintain the software?  Who would own it?  What would be the cost implications?  Who would bear this cost? Should hard copies of documents be retained by the hospitals?  Should insurance companies have access to them?

The claims of the hospital shall be settled by the insurance company.  The States will only oversee whether the claims are being settled in a timely manner.  The frequency of settlement of these claims has been left to the mutual convenience of the hospitals and the insurance companies.  However, an electronic database shall be available to ascertain the time taken in settlement of the claims.  It has been ascertained that the claim data can be digitized and can be sent electronically to the insurance companies.  Specifications of the software for data compilation and transmission shall be worked out by the Central Government on the basis of which the software shall be developed by the insurance company.  This software would also be maintained by them and they shall bear the cost thereof.  The hard copies of the documents shall be kept in the hospital and the insurance companies will have access to these documents.

 

  1. Miscellaneous
      • Will there be a helpline accessible to all the beneficiaries?  Who would maintain it?

The Insurance companies are mandated to set up helpline in each district and it shall be their responsibility to maintain it.

  • If the bill goes beyond Rs.30,000/- who bears the cost?  

If the bill goes beyond Rs.30,000/-, the cost thereof shall be borne by the beneficiary.
  

  • Can a beneficiary be transferred to another empanelled hospital?  What are the cost implications for the beneficiary?  Who will bear the cost?

The beneficiary can be transferred to another empanelled hospital and so long as there is amount available in the insurance cover, the beneficiary will not bear the cost.  The second network hospital will pay the amount for the concerned insurance company

* * *


II. SMART CARD

  

  1. Design and Configuration
  • What is the design of the Smart Card?  What are the specifications?

The design of the smart card has been made uniform for the country.  The artwork is available on the RSBY website.  Its specifications are listed out in para 7.1 and 7.1.1 of the Annexure-16 of the Tender Document as under:

7.1   Specifications for Smart Cards

Card  Operating System shall comply to SCOSTA standards ver. 1.2b  with latest addendum and errata.(refer web site http://scosta.gov.in)  Health service providers  The Smart Cards to be used must have the valid SCOSTA Compliance Certificate from National Informatics Center, New Delhi (refer http://scosta.gov.in). Exact Smart card specifications are listed as below.
7.1.1  SCOSTA Card

  • Microprocessor based Integrated Circuit(s) card with Contacts, with minimum 32 Kbytes available EEPROM for application data.
  • Compliant with ISO/IEC 7816-1,2,3
  • Compliant to SCOSTA 1.2b Dt. 15 March 2002 with latest addendum and errata
  • Supply Voltage 3V nominal.
  • Communication Protocol T=0 or T=1.
  • Data Retention minimum 10 years.
  • Write cycles minimum 100,000 numbers.
  • Operating Temperature Range –25 to +55 Degree Celsius.
  • Plastic Construction PVC or Composite with ABS with PVC overlay.
  • Surface – Glossy.

 

  • What is the Chip Size?  Are such chips readily available?  If not, can they be made readily available?  Who would provide them?

The chip size, as mentioned in A.1 above, has been fixed at 32 KB.  These chips are not readily available but would become available in due course.  Till such time, 16 KB cards would be used.  The idea is to provide additional space for the card to be used in future for other purposes also. As per information from the Smart card industry, the 32 KB cards are likely to become available from 1st May, 2008.


  • What is the operating software in the Chip? 

The actual operating system may be written by any vendor, the only constraint is that as mentioned in A.1, the smart card operating system should be SCOSTA certified and should be compliant with ISO/IEC 7816-1,2,3

  • Which languages are to be used on the face of the Card? 

For the sake of convenience, the card on its face will carry the name of the head of the family in local language as well as in English.

  • What is the data on the face of the Card? 

The following data will be on the face of the card:

      • Name of the head of the family in local language and in English
      • Age
      • Gender
      • Photograph of the head of the family

 

  • Whose photograph will be on the face of the Card? 

The photograph of head of the family would be on the face of the card.  A joint photograph of the enrolled family members including the head of the family will be on the chip. 
 

  • Is there a unique identification number?  How is it determined? 

There would be a unique identification number.  The parameters for determining this number have been decided by the Central Government for ensuring uniformity throughout the country. The government has used the year of birth & gender of the head of the family; location codes (state & village/ ward/ circle), running serial number for generating the Unique number and a checksum number is added at the end for security purpose. This format has been decided keeping in mind that each card should be issued a number that is unique across the country even if generated in an offline and distributed manner.

Enrolment Software
  • What would be the enrolment software?  Who would design it?  Would specifications be released by the Government?  Would the Government prepare a standard software?   Would it also release the specifications?

  

To roll out the scheme, the initial enrolment software has been designed by the Central government.  However, subsequently, specifications have also been released by the Central Government so as to enable the smart card service provider to develop a software, based on these specifications.   

  • Is there a certification system? Who would run it? What would be the procedure? What would be the cost? Who would bear the cost? Would the service provider be allowed to sell the software after certification? Will the Govt. control the pricing thereof?  

A Certification system has also been put in place.  A government organization, STQC, has been designated for testing various processes for the purpose of certification.  The cost of certification will be borne by the respective insurance company/ smart card service provider.  However, the cost itself has been determined by the Information Technology Committee chaired by the AS(L&E). The service provider may tie up with various insurance companies for use of its software however any commercial arrangements by the service provider and/or insurance company has to be between them.

 

C. Key Management System/Security
  • Is there a need to authenticate the cards when they are issued?  Who would authenticate them?

In order to ensure that the card is issued to the right person, an authentication process has to be put in place at the time of issue of card.  This authentication is to be done by a government official at the time of issue using the Field Key Officer card issued to them.

  • Is there a Key Management System (KMS) for Smart Card security?  Who will evolve the keys at each stage?  Who will manage the system?  What would be the role of Central and State Governments in KMS?  Where will the root keys be generated?  What would be security?  Who will be associated with root key generation?  Where will the next stage key generation take place?  How would these keys be transferred?  To whom would the keys be transferred?  What would be the number of cards?  How will such key cards be delivered?  To whom would they be delivered?  Who will use these keys?  How will they be trained?  Who will train them?  Where will they be trained?

In order to impart security to the entire process of issuing and use of smart card, an elaborate key management system (KMS) has been evolved by NIC.  A Central Key Generation Authority (CKGA) has been created for creating root keys and to manage the entire key management system at the Central level.  The district keys will also be generated by CKGA.  Thereafter, the keys for field key officers (FKOs) will be generated at the district level.  The district keys will be transferred by the CKGA to the district key managers.  An elaborate training schedule has been worked out for field key officers at the time of district level workshop, the FKO cards would be issued to them at the same time using the DKMA software developed by NIC. Though operated by the DKMA, the smart card service provider selected by the insurance company for the district would be expected to provide the required infrastructure at the district workshop and assist for training & issuance of FKO cards

Issue & Delivery of Smart Card

  • Who would issue the Card? Who would own the card?  Will the smart card be delivered on-the-spot?  Will it be printed centrally?     

The smart card will be issued by the insurance company through the instrumentality of the smart card service providers.  However, the ownership, of the card will remain with the Central government.  The smart card would be delivered on the spot after printing on the location itself.  The cost, if any, would be borne by the insurance company as a part of the overall bill.

  • Can the card be issued in the absence of head of the family? Can it be issued in the absence of member/members of the family? Can the additions be made post-issue of the card?  

The smart card cannot be issued in the absence of head of the family as his photograph has to appear on the face of the card.  However, it can be issued in case the head of the family is present but the members of the family are missing.  Their details can be added subsequently at the district kiosk to be maintained by the insurance companies.
 
E.     Splitting of Cards

  • Is there  a facility to split cards?  How?  Where and when can it take place? What would be the value of split cards? Who would be authorized to issue these cards?

In view of the possible migration of BPL workers, there is a facility of split card available under the scheme.  These cards can be split at the time of first issue or subsequently at the district kiosk. Split value can be decided by the head of the family provided the total amount on both the cards is equivalent to the total amount available on the primary card before the split.  The insurance company will authorize issue of these cards.

Loss of Cards

  

What would be the consequences of loss of smart card? How would it be re-issued?  Who would issue it?  Where would it be issued?  Who would bear the cost?  Would there be an authentication?  How will it be done?

A new card can be issued in case of loss of smart card.  However, the beneficiary will have to bear the cost of duplicate card.  As the details of the family would be available in the database, the card could be issued at the district kiosk.

 

Smart Card Operating Devices

   1.    Are specs be specified for Smart Card operating devices? What are these specs?

The specifications for smart card operating devices have been determined and indicated in para 9 Annexure 16 of the Tender Document which is as follows:

PC based Smart Card Device
In cases where Computers are available at the health Service providers, additional devices would be attached to the existing PC. The computer would be loaded with the centrally prepared software for transactions and data transmission. The devices required for the system would be

    • Optical Biometric Scanner for Fingerprint verification

  

  • Thin optical sensor
  • 500 dpi @ 8bit per pixel
  • Active area: 13mm x 20mm
  • Interface: USB 1.1 and 2.0
  • Operating temperature: -10°C to +50°C
  • 1:1 verification
  • Verification time < 0.8s
  • Identification time< 1s
  • Tunable false acceptance rate
    • Smart Card readers

  

2 Smart card readers would be required for each device, One each for Service Provider and Beneficiary card. In case of split card, a 3rd smart card reader should be used to ensure simultaneous updation of primary and add-on card.

  • PCSC and ISO 7816 compliant
  • Read and write all microprocessor cards with T=0 and T=1 protocols
  • USB 2.0 full speed interface to PC with simple command structure 

  

    • Receipt Printer

There is also a provision for standalone devises whose parameters are as follows:
Standalone Smart Card Device (Non-PC based)
These devices are standalone devices capable of reading
& updating Smart cards based on the programmed business logic and verifying Live Fingerprints against those stored on a smart card. These devices do not require a computer for transacting.
The device would be loaded with certified software as per specifications provided by the Ministry of Labour, Government of India.

The main features of these devices are:

  • Reading and updating Microprocessor Smart Cards as specified for RSBY
  • Fingerprint verification as per specifications
  • They should be programmable with inbuilt security features to secure against tampering.
  • Memory for Data storage
  • Capable of printing receipts without any external interface
  • Capable of data transfer to Personal computers/server or over phone line/ GPRS/ CDMA/ Broadband/ LAN
  • Rechargeable Batteries for portable devices and main power source for desktop device

      Specifications

  • A minimum internal memory  of 4 Mb
  • At least 1 Full size smart card reader
  • At least 1 SAM slot
  • Back-lit graphic display
  • Numeric Keypad with at least Function keys for Accept, Clear, Cancel and Navigation keys.
  • Inbuilt Printer
  • Optical biometric Verification capability. Verification time less than 10 secs, Allowing 1:1 verification in the biometric module.
  • Optional buzzer
  • Rechargeable Batteries with fully charged standby time of at least 200 hrs, (for portable devices),  possible to make 100- 150 transactions
  • Ports required: 1 RS232, Telephone, Optional USB port, SIM Slot if GPRS enabled
  • Inbuilt Modem
  • Who would purchase the hardware to be used for Smart Card Operations in the hospital?  Who should pay for it? and own it?  How would the hardware be maintained?  Who would bear the maintenance cost?

  

Installation of hardware to be used for smart card operations in the hospital is the responsibility of the insurance company because that is the pre-condition for networking a hospital.  However, the cost of this hardware as well as its maintenance may be incurred by the hospitals.  This would depend upon the arrangement between the insurance companies and the health service providers.

 

H.     Transaction Software

  • What would be the transaction software? 

  

  • Who would design it?
  • Will specifications be released by the Government?

  

  • Will the Government prepare a standard software?

The specifications for transaction software to be used on the hardware in the hospital have already been issued by the Central Government and the insurance companies/smart card service providers are to prepare a software based on the specifications.

  • Will there be a certification system? Who would run it? What would be the procedure? What would be the cost? Who would bear the cost? Will the service provider be allowed to sell the software after certification? Will the Govt. control the pricing thereof?

  

There is an elaborate certification system.  A government organization, STQC, has been designated for testing various processes for the purpose of certification.  The cost of certification will be borne by the respective insurance company/smart card service provider.  However, the cost itself has been determined by the Information Technology Committee chaired by the AS(L&E). The certification process for the software is also available on the RSBY website.

 

     I.   Other Issues.

  • In case of death of head of the family will the card continue to operate?

  

In case of death of head of the family, the card can continue to operate for other members of the family whose details exist in the chip of the card.

  • In case of death of a family member can he be replaced by another member who was not originally listed in the card?

  

In case of death of a family member, he can be replaced by another member who was not originally listed in the card.  However, the name of this additional member should have been there in the BPL database available at the time of enrollment.
* * *


III.  TRAINING

  • Who would be trained for using the hardware and the software?  Who would train?  How? Where? And when would the training take place?  What would be the cost?  Who will bear this cost?  Would there be State level Workshops?  Frequency?  What would be the Agenda? Participants?  What would be the literature to be distributed?  Who would prepare it?  Funding?  Who would be the resource persons to make presentations?  District level Workshops?  Frequency?  What would be the Agenda?  Participants?  Literature to be distributed?  Who would prepare it?  Funding?    Resource persons? 

  

The training/sensitization has been structured at three levels:

  • National level
  • State level
  • District level

 

National level workshops will be organized to sensitise key officials of the Central Government, primarily Ministry of Labour & Employment, and senior officers of the State Governments. 

The State level workshops are meant primarily for sensitizing the district level key functions, District Magistrate, Chief Medical Officer, District Data management officials (SIO/ DIO)  and the Nodal Officers in each district. 

The district level workshops are to sensitise the field key officers (FKOs) and the hospital representatives, apart from other district level officials. 

The broad structure of these workshops has been pre-designed and literature prepared centrally to be used at various levels.  The resource persons have been drawn from a pool of World Bank Consultants, NIC representatives and the insurance companies, apart from Ministry officials.  A documentary film has been prepared for use at these workshops and the literature to be used has been standardized. 

The cost of the National and State-level workshops will be borne by the Central Government.  Insurance company will bear the cost of District-level workshops.

 

* * *


IV.  FINANCE / FUND FLOW

  • Will a Government Deptt. handle the funds in the State?  Or an independent agency do that?  Will this agency be wholly owned by the State Government?

For a seamless flow of fund to the insurance companies, an independent legal entity, under the control of State Government, has to be designated as nodal agency.  The fund flow will take place through this agency.

  • How will the fund flow take place?  Will the States pay the entire premium and then claim reimbursement from Central Government?  Will the Central Government give its share of the premium to the State Government?  To the Nodal Agency?  To the Insurance Company?  Will there be a mandatory time frame for this fund flow from State to Insurance Companies? From Centre to State Nodal Agency? Will the funds be released every month by the State Nodal Agency to the Insurance Company on the basis of the Smart Cards issued?

The fund flow mechanism has been indicated in Para 9 of the Tender Document as follows:

  • The registration fee of Rs.30 by the beneficiary to the insurance company.
  • The first instalment 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).

  • 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.}

Frequency of payment would be monthly on the basis of the number of smart cards issued.  Though there is no mandatory time frame for this fund flow prescribed in the scheme, a separate monitoring system is being evolved for ensuring timely payment.

  • Who would collect Rs.30/- from the beneficiary?  How will it be accounted for?

 

As mentioned above, Rs.30 would be collected from the beneficiary by the insurance company and adjusted against the payment of premium to be made to the insurance company by the State Government.

* * *

 
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