HEALTH CARE FACILITIES TO GDS

For the present, GDS are allowed assistance from circle welfare fund to the extent of Rest. 5000/- in case of prolonged & serious illness/major surgeries. Circle and Regional Heads have been empowered with discretionary powers to allow assistance up to Rest. 10000/- in each case. In rare and exceptional circumstances, financial assistance beyond Rest. 10000/- can be considered from Central Welfare Fund. Besides they are allowed assistance from circle welfare fund Rest. 400/- & Rest. 200/- per month for nutritional diet in case of suffering from tuberculosis for indoor and outdoor treatment respectively. Currently GDS are not covered by CS (MA) rules or extended CGHS facilities or any reimbursement in case of hospitalization.

Salient features of the scheme:

• GDS [engaged on regular basis] having one year or more service shall be covered under the scheme. Thus, provisionally engaged and substitutes would not be eligible to be covered under the Scheme.
• Total five members of the family of the GDS including GDS will get coverage
• The Scheme covers existing health problems including those occurring subsequent to getting coverage
• The Scheme covers all health problems requiring hospitalization.
• GDS & his family members (maximum 5 in all) shall be entitled to coverage for expenses up to Rest. 30000 per annum.
• Tests and medicines one day prior to hospitalization and five days after discharge from hospital including treatment and Rest. 100 for travel expenses shall also be payable at the time of discharge subject to a maximum of Rest. 1000/- per year. The amount of travel expenses is inclusive in the total coverage of Rest. 30000.
• Annual premium per GDS & his family will be contributed equally by the GDS in advance and the Government
• On discharge on attaining the age of 65, GDS will be covered up till the last day of the existing policy and for the further coverage; GDS will have the option to avail the scheme at his own cost without any contribution from the Government. In case of death; they will only be covered till the last day of the existing policy. In case of absorption on regular posts, they will have the option to avail either the existing scheme or the CS (MA) Rules, 1944/CGHS facilities.
• The inpatient treatment shall be available through Government Hospitals and private hospitals empanelled by the insurance company. GDS or his/ her family members can use any hospital across India which is empanelled in RSBY
• The treatment will be through using a smart card carrying details and identification of GDS and his family members in any of the empanelled hospital at the choice of the GDS or his family member.
• The insurance company will directly make payment of the bill subject to overall limit of Rest. 30000/- per year for GDS and his family (all inclusive). Ministry of Labor and Employment has fixed the amount for various treatments and in most of the cases; the cost on treatment does not exceed the insured amount. However, in cases where the limit gets crossed, the amount over and above this limit shall be met by the GDS out of his pocket.
• Cost of smart card to the GDS and his family shall be borne by insurance company and will be part of the premium.
• Cost of registration fee of Rest. 30/- is paid to the SCSP [rep of insurance company], who collects it on behalf of the State Nodal Agency, at the time of registration and is to be borne by the GDS beneficiary over and above the premium contribution.

Current status:

The proposal is under active examination and is likely to be introduced after its examination by Integrated Finance Wing and approval of the Ministry of Finance, Department of Expenditure. The proposal involves an expenditure of 7.29 cores from Government’s side.

Role of States/State Nodal Agencies (SNAs)

· To set up State Nodal Agency (SNA) to implement the Scheme in the State & to appropriately staff this agency.

· Commitment for the premium & identification of districts for implementation of RSBY for BPL and other identified categories where State has to share the premium.

· Preparation of BPL and other beneficiary data in prescribed RSBY format.

· Allow the SNA to retain cores. 30/- collected from beneficiary as registration fee for meeting administrative expenses in implementing the Scheme.

· To advertise/tender for selection of insurance company for each of identified district [only one insurance company for each district].

· To form a committee for technical and financial bid evaluation consisting of Government nominee and including technical experts.

· To send proposal to MoLE for approval of Monitoring and Approval Committee before moving ahead with the implementation process.

· To prepare contract document to be signed with the insurance company as per draft document available on www.rsby.gov.in.

· To appoint a nodal officer for RSBY in each district to act as District Key Manager (DKM) & to convey its details to MoLE for issue by DKM Card by CKGA (Central Key Generation Authority).

· To organize a State level workshop. MOU will be signed in this workshop between Central and State Government as also contract between the State Government and Insurance Company. Funding is done by Central Government and resource persons can be obtained from Central Government.

· To provide assistance to the insurance company in the registration of beneficiaries and issue of smart cards by identifying and appointing a nodal officer for RSBY in each district called DKM before signing of agreement with the insurer, convey details to Mole within 7 days of signing the agreement with the insurance company; to provide DKMA server at district HQ within 7 days of signing of agreement with the insurer, install DKMA software for issue of FKO [Field Key Officer] Cards and for downloading of data subsequently from FKO Cards; to nominate Field Key Officers (FKO) in the required numbers at the time of signing of agreement with the insurer, who will visit each enrollment station along with insurance company representative for enrolment of beneficiaries; and to receive DKM and FKO cards from Mole and maintain the records.

· To assist insurance company in organizing district level workshops ensuring participation of all related officials in the workshop.

· To provide assistance to the insurance company through the district and block level officials in the issuance of smart cards by finalizing schedule, helping to publicize the visit, support in identified location for enrolment and to ensure presence of nominated official FKO for authenticating cards at the time of issue.

· To make available the public health care facilities such as district hospital and Community Health Centers for being considered for network hospitals by the insurance company.

· To ensure through the district level officials that sufficient number of hospitals have been empanelled before start of the enrolment of beneficiaries in the concerned district.

· To ensure functioning of toll free call centers at the time the enrolment starts in the district.

· To ensure setting up of district kiosks and its operation before the start of the enrolment process. Space to be provided in the districts and insurance company pays its rent.

· To ensure that public owned hospitals are equipped with necessary hardware and software to enable transaction in the hospitals by smart card.

· To evolve a system of timely release of premium of state share to the insurance company and to send request for release of funds to the Government of India for a complete month within 7 days of releasing state share of premium to the insurance company.

· To transfer the central share of premium to the insurance company within 07 days of receipt of amount from the Central Government.

· To take necessary steps for improving the awareness level by organizing different activities like health camps.

· To put in place mechanisms for incentivizing staff at various levels like FKO, hospitals, etc to improve both enrolment and utilization.

· To facilitate, monitor and evaluate the implementation as per Mole guidelines.

· To organize periodic review meetings with the insurance company to review implementation of the scheme.

· To set up a server at the State level to store the enrolment and hospitalization data from all the districts & working with technical team of insurance company to study and analyze the data improving the implementation.

· To collect fingerprint and photograph data from the insurance company from all the districts and store it safely.

· To conduct evaluation of RSBY performance in the State.

· To provide such information either directly or through the insurance company as desired by Mole from time to time.

· To set up grievance redressal mechanism and cell as provided for by the Mole.