1. RASHTRIYA SWASTHAY BIMA YOJANA (RSBY)
In Gujarat, Department of Health and Family Welfare is implementing the RSBY scheme since Initially it is piloted in five district of state and then extended to entire state.

2. OBJECTIVES OF THE SCHEME
To provide health insurance coverage to Unorganized Workers.
In Gujarat BPL-Rural & urban, NREGA workers, Railway porters, and BoC workers are covered
Beneficiaries are entitled to get hospitalization coverage up to Rs. 30,000/‐.
Package rates for a large number of interventions (1090 Procedures) are fixed.
Pre‐existing conditions are covered.
Five members of the family are covered.
Newborn are covered as sixth member.
Beneficiary pay Rs. 30/‐ as registration fee while Central (75%) & State (25%) Government pays the premium.
Insurance Companies are selected through competitive bidding (e-tender).

3. Cont…
Every enrolled family is issued a smart card containing family details along with members fingerprints and photographs.
Claim transaction occurs at hospital through a hospital transaction software developed by MoLE.
The beneficiaries gets cashless treatment at any of the empanelled hospital.
He/she only need to carry his/ her smart card and provide verification through his/ her fingerprint.
Health Service Providers send online claims to the insurer and get paid electronically.

4. GRIEVANCE REDRESSAL MECHANISM
Chair – Deputy Director DGLW
Convener – Under secretary RSBY
Member – IC NaNO (National Nodal officer)
NGRC
Chair – Principal Secretary H&FW.
Convener – State nodal officer-MD NHM
Member – IC representative
SGRC
Chair – Dist Magistrate-Collector
Convener – District Key Manager-CDHO
DGRC
9/17/2018

5. Key Management System FKO DKM BPL families Issuance of MIC card
DKMA(District Key Management Authority):
Managed by DKM. Runs on a software used to issue FKO cards.
FKO/MIC (Field Key Officer/Master Issuance card):
Cards issued by DKM, used during enrollment by Govt. Representative to verify identity of beneficiary.
MHC (Master Hospital Card):
Issued by GoI and activated by DKM, used in Hospitals to validate Transaction Authenticity of Transaction Process.
DKC (District Kiosk Card):
Issued by GoI and activated by DKM, used at Dist. KIOSK for validation process.
Issuance of
MIC card
FKO
DKM
Smart card verification
BPL families
Provide back
MIC card to DKM
After enrollment

6. RSBY POLICY YEAR 2016 BENEFICIARY
BPL (RURAL & URBAN), MNREGA, Western Railway Porter, Building and Construction Workers
PERIOD OF INSURANCE
ONE YEAR
HOSPITALIZATION EXPENSES
Rs. 30,000
MEMBERS COVERED
MAX. FIVE (SELF + SPOUSE + 3 DEP.)
(Maternity and new born care is included)
PROCEDURES
1090
PREMIUM
60% will be paid by Central Govt. and 40% by the State Govt.
PRE-EXISTING DISEASE COVERED
YES (SUBJECT TO MINIMAL EXCLUSIONS)
DAY CARE SERVICES
IF RELATES TO SURGICAL NATURE
TRANSPORT ALLOWANCE
ACTUAL WITH LIMIT OF RS 100/VISIT
(ANNUAL CEILING OF RS 1000)
PRE HOSPITALIZATION
ONE DAY PRIOR
POST HOSPITALIZATION
FIVE DAYS (From Date Of Discharge)

7. Key Management System FKO DKM BPL families Issuance of MIC card
DKMA(District Key Management Authority):
Managed by DKM. Runs on a software used to issue FKO cards.
FKO/MIC (Field Key Officer/Master Issuance card):
Cards issued by DKM, used during enrollment by Govt. Representative to verify identity of beneficiary.
MHC (Master Hospital Card):
Issued by GoI and activated by DKM, used in Hospitals to validate Transaction Authenticity of Transaction Process.
DKC (District Kiosk Card):
Issued by GoI and activated by DKM, used at Dist. KIOSK for validation process.
Issuance of
MIC card
FKO
DKM
Smart card verification
BPL families
Provide back
MIC card to DKM
After enrollment

8. Introduction to HardwarePC
FKO Card Reader
DKMA Card Reader
MSO

9. Enrollment Process for DKMA

10. Login window appears.
Fill login ID and Password and select continue button

11. Card Request>>New Request

12. A request entry form

13. Personalization

14. Personalization of RSBY Authority Cards
One or more FKO cards can be personalized using this module. Insert DKMA card in one of the readers, Select reader name from the list and press. Connect DKMA button

15. Enter the PIN for DKMA card and press OK.

16. Enter DKMA Reference No
On pressing the OK button a message is displayed as “Insert a MIC Card in the available Reader, Select Reader Name and Press 'Personalize Card' Button.” Press ‘OK’ to proceed.

17. Select a Reader

18. Recharging

19. Select a Reader

20. Card Surrender

21. FKO Card Surrender
Select a Reader

22. PIN Change/Unblock

23. DKMA Pin Change
PIN Change/Unblock  DKMA  Pin Change

24. Enter New Pin

25. District Codes

26. District Codes Master

27. Reports
Personalization Report, Card Stock Balance

28. Report

29. Personalization Reports

30. Enrolment Role of District Key Manager
Get FKO training organised at Block level
Provide support to the IC/ TPA in making the route chart for enrolment through block officials
Get DKM Computer operator trained in using New DKM Software
Receive FKO cards from SNA and Issue them to FKOs
Provide FKO Undertaking to FKOs and collect it when they return Visit Enrolment Stations on a random basis and use checklist
Receive back FKO card from FKOs, download the data on computer and issue card to new FKO if needed

31. Enrolment Insurance Company/ TPA SCSP
Prepare a IEC materials to be given at the time of enrolment with following details:
List of hospitals empanelled
Details of the scheme
Details of the district kiosk and call centre.
SCSP
Organise number of Enrolment kits as per the Tender conditions
Awareness exercise in the villages as per the route plan before the enrolment date
Visit the villages as per the route plan with the enrolment kit
Enroll the beneficiaries as per the guidelines and provide smart card on the spot alongwith the brochure
Evaluations have revealed that in a lot of cases Brochure was not provided to beneficiaries so this needs to be ensured.

32. Enrolment FKO (Field Key Officer)
Receive the FKO card along with Undertaking
Be present at the enrolment station as per the route plan intimated
Identify the beneficiaries and verify them on the spot through its fingerprint and smart card
After the enrolment process is over give back the FKO card to the DKM along with the filled undertaking
Without Presence of FKOs , the Smart Cards Cannot be Printed now.
FKOs shall fill the undertaking and provide back to district authorities after the Enrolment.

33. Pre – Enrollment Activities
District
Insurance company
Prepare route plan
Sharing enrollment dates to all District authorities for making ground level awareness (E.g. Police for safety, electricity board for continuous supply of electricity)
Conduct enrollment workshop (block level)
Ensuring sufficient FKOs
Sharing ASHA Incentive guidelines
Prepare IEC material Dissemination plan
Identification slips to be distributed to identified families
IEC dissemination report from Sarpanch/ASHA/FKO/THO
Follow Route plan
Enrollment Kit Installation
District KIOSK Set-Up
Publicity through Mike announcement at Temples, Mosques, Church and
Gurudwaras,etc.
Handbills Distribution, Posters
Banners and Hoardings
Payment to ASHA worker
Video shows using projectors

34. RSBY Enrollment Station

35. DKMA & FKO’s Role
Pre Enrollment
During Enrollment
Post Enrollment

36. Role of DKM – Pre enrolment
Receive DKMA card from State Nodal agency
Issue three authority cards: (a) Field Key Officer - FKO (Master Issuance Card - MIC), (b) Hospital Authority (Master Hospital Card - MHC) and (c) District Kiosk (Master Kiosk Card - MKC) cards.
Ensure safe upkeep of Cards, maintain record of receipt, issuance, missing etc. Keep PIN in safe custody.
Set up DKM Computer with necessary hardware and software in own office
Understand the additional features & requirements for 64KB Card migration for all – DKM, FKO, Hospital
Ensure Training of FKOs, IT, other support staff at the district
Issue Field Key Officer (FKO) Cards to FKOs according to the specified schedule.
Issue MHC Card and MKC Card to the Insurance Company or its representatives.
Ensure Insurance company organize District Workshop at least 7 days before commencement of enrolment
Facilitate the Route Plan with the insurance company/its intermediaries for effective coverage of beneficiaries in the district

37. Role of DKM – Pre enrolment
Verify insurance enrolment manpower and machines/kits status as per tender document
Ensure effective IEC by the insurance company and lend all possible support
Ensure empanelment of optimum number of eligible hospitals – public and private
Ensure that hospitals are functional before enrolment
Ensure hospital training workshop is conducted by the insurance company and be present during that
Allocate space for setting up of district kiosk by insurance company free of cost or at.
Ensure that district kiosk is functional before the enrolment starts.

38. Role of DKM – During Enrolment
Monitor the participation, timely attendance, presence and role fulfillment of FKOs in the enrollment process
Keep few extra FKOs as stand by
Provide support to the Insurance Company
Field visit to the enrollment stations and record observations in the prescribed format
Review the performance of Insurance Company as regards the enrolment status, review meeting format attached

39. Role of DKM – Post Enrolment
Get the enrollment data downloaded from FKO cards to the DKMA computer
Reissue FKO cards to new FKOs after personalizing again
Collect FKOs Undertaking document and wasted cards
Ensure submission/download of enrolment data from insurance/intermediary team (automatic through software)
Monitor & compare the enrollment data at DKMA computer (as downloaded from FKO cards with that provided by insurer to determine the premium payable
Coordinate with district administration to organize health camps for building awareness about RSBY
Visit empanelled hospitals to check beneficiary facilitation and record observations as per standard format

40. Role of DKM – Post Enrolment
Hold grievance committee meetings on pre-scheduled days every month, ensure that necessary entries are made on the website regarding all the complaints/grievances received
24 Hour helpline – check the functioning of Helpline on regular basis
Communicate with SNA in case of any problem related to DKMA software, authority cards
Prepare detailed report on enrolment, empanelment, utilization and beneficiary feedback

41. Data of Beneficiary family
Verification by FKO
Key transfer
Verification by FKO by fingerprint and smart card
FKO Card
RSBY Card
Data of Beneficiary family

42. Role of FKO – Pre Enrolment
A .Pre-Enrollment
Receive personalized Master Issuance Card from the DKM after providing own fingerprint
Make sure to remember the Pin number of the FKO card as it would be needed at the enrolment camp and wrong Pin number will block the card which will stop the whole enrolment process
Receive information about the name of the village (s) and the location of the enrollment
Station(s) inside the village for which FKO role has to be performed
Receive the contact details of the Insurance Company or their field agency representative forming part of enrollment team
Receive information about the date and time on which enrolment is to take place
Provide own contact details to the DKM and the Insurance Company field representatives

43. Role of FKO –Pre Enrolment
Check the display of the beneficiary list in the village
Make sure that the FKO card is personalized with his/her own details and fingerprints and is not handed over to anyone else at any time.
Should ensure that at least 1 FKO card for every 450 beneficiaries, expected at the enrollment camp, is issued to him/her i.e., in case the beneficiary list for a location is more than 450, they should get more than 1 FKO card personalized with their details & fingerprint and carry with them for the enrollment.

44. Role of FKO – Enrolment
Reach the enrollment station punctually at the given time and date without fail and Inform the Insurance Company/DKM a day in advance in case unable to come
Ensure that the beneficiary list is displayed at the enrollment station
Identify the Beneficiary at the enrollment station either by face or with the help of specified identification document, can also make use of the Gram Pradhan to correctly identify the beneficiary
Make sure that the enrollment team corrects the name and relationshipof dependents in the field in case of any mismatch
Make sure that the enrollment team enters the gender and age data of all members in the field
Make sure that the enrollment team is not deliberately excluding any member (upto maximum of 5) of the identified and verified beneficiary households for RSBY enrollment
Ensure that the card is printed only after he/she has authenticated the card by inserting his/ her FKO card and provided fingerprint

45. Role of FKO – Enrolment
Ensure that the card is printed only after he/she has authenticated the card by inserting his/ her FKO card and provided fingerprint
After the smart card is printed, make sure the enrollment team validates the fingerprint of atleast one enrolled member of the beneficiary family against the smart card being issued to them. In case this validation fails, then a new smart card has to be issued to the family following the same process again without charging any extra money. The wasted card should be retained by the FKO and deposited to the DKM.
Make sure that the enrollment team is issuing the smart card on the spot to the beneficiary
Ensure that the details of all eligible (within RSBY limits of Head of family + spouse + 3 dependents) family members as per beneficiary list and available at the enrollment station are entered on the card, and their fingerprint & photograph taken
Ensure that the enrollment team is provides a brochure(including hospital list) to each beneficiary family along with the smart card

46. Role of FKO – Enrolment
Ensure that the Scheme benefits are explained to beneficiaries while they are waiting for enrolment/card (could be done through running audio media at the camp)
Make sure that the smart card is given inside a plastic cover and beneficiaries are told not to laminate it
If a beneficiary complains that his/her name is missing from the Beneficiary list, then collect the information in the specified format and share with the DKM
If all the eligible dependents of a beneficiary family are not present at the camp, the family should be informed that the other members can be added to the card at the District kiosk.

47. Role of FKO –Post Enrolment
Return the FKO card to the DKM after the enrollment is over at the location (s) for which the FKO is responsible
At the time of returning the card, ensure that the data is downloaded from the card and that the number of records downloaded is the same as the number he verified at the camp. In case of any discrepancy, make a note of the difference and ask the DKM to send the card and the note back to CKGA
Submit the FKO undertaking in the prescribed format to the DKM
Submit the waste cards collected at the enrolment camps to the DKM
Hand over the list of left out people, collected at the enrollment camp to the DKMA.
Prepare the Zero enrollment village list.

48. Awareness Activities
Handbills

49. Hospital banner
Information Slip

50. POSTER

51. RSBY Film-Night Show Sagbara, Narmada

53. Target Families as per 33 Districts
Sr.No
District Name
Total Data
Enrolled Families as per DKMA 1
Ahmedabad
392670
99719 2
Amreli
111279
34754 3
Anand
200616
67856 4
Aravalli
79881
40186 5
Banaskantha
312236
103793 6
Bharuch
139532
58562 7
Bhavnagar
122859
54111 8
Botad
37355
15669 9
Chhotaudepur
136550
64391 10
Dahod
275470
78988 11
Dangs
69241
28575 12
Devbhoomi Dwarka
39038
16001 13
Gandhinagar
66713
32121 14
Gir Somnath
84192
37154 15
Jamnagar
93431
25792 16
Junagadh
107010
52869
Sr.No
District Name
Total Data
Enrolled Families as per DKMA 17
Kheda
176355
76742 18
Kutch
126971
42609 19
Mahisagar
110874
61964 20
Mehsana
143604
76929 21
Morbi
62925
26792 22
Narmada
95684
54696 23
Navsari
86581
49806 24
Panchmahal
176248
68314 25
Patan
164598
62985 26
Porbandar
23329
12171 27
Rajkot
195531
69930 28
Sabarkantha
131956
46974 29
Surat
177169
78169 30
Surendranagar
161527
60258 31
Tapi
93588
64889 32
Vadodara
202418
84443 33
Valsad
148985
76035

54. Thank you www.rsbygujarat.org newrsbygujarat@gmail.com
RSBY-Toll free no