HI - SCHEME Enrolment Process
- 1. Health Insurance Scheme Enrolment Process & Enrolment MIS Development Waseela-e-Sehet BISP Syed Anwar Hussain MIS Expert (WS)
- 2. Agenda • Presentation Objectives • Waseela-e-Sehet Objectives • HI Salient Features • HI Dynamics • HI Overall Scheme • HI Main Processes • Workflow at Enrolment Site • Enrolment MIS (Initiation Doc & RFP) • Why Smartcard ? • NADRA Proposal Highlights Waseela-e-Sehet (HI) 2
- 3. Presentation Objectives • To present Overall Health Insurance (HI) Scheme • To explain Enrolment MIS Project • To highlight NADRA’s Proposal
- 4. WASEELA-e-SEHET OBJECTIVE • Improving access to health services and reducing income loss from catastrophic health shocks. "Be Healthy – Be Productive”
- 5. HI SALIENT FEATURE • The insured would be covered for hospitalization resulting from illness or injury with an annual maximum of Rs. 25,000 per family (total of six members); • Benefits package would cover normal deliveries and hospitalizations due to complicated deliveries and C- Sections; • Diagnostic tests/procedures conducted during hospitalization will be covered; • Surgical procedures provided on a day care basis will be covered; • The scheme will cover all ages; • Health insurance would not exclude pre-existing conditions;
- 6. HI SALIENT FEATURE …. cont. • The scheme would provide opportunity to the insured to get services from any enlisted hospital; • The premium as determined by the insurance company and agreed with BISP for the insured family would be paid annually in advance by BISP; • The insured will be provided transportation costs for bringing the patients to the hospital with a maximum of Rs.1000 • The payments would be made to the hospitals and this would be a cashless/paperless mechanism for the patients.
- 7. HI SCHEME DYNAMICS • Partner-Agent Model (SLIC & BISP) • Behavior Change & Communication (BCC) • MIS & M&E System Development • Enrolment of BISP Beneficiaries • Selection and Empanelment of hospitals • Transaction System Implementation • Claims Settlements • Establishment of Field Offices • Quality Assurance • Redress and Complain Mechanism • Third Party Evaluation
- 8. HI OVERALL SCHEME BISP HQ SLIC HQ Hospitals Civil Societies, NGOs, VBOs Facilitate BISP Beneficiary Claims Premium Claims Partner- Agent Model E nrolm entD ata E xchange EnrolmentofBeneficiary & IssuanceofSmartcard Feedback Mechanism Visit Treatment Select Select Initial Phase: NADRA Rollout Phase: SLIC Zonal Offices
- 9. HI MAIN PROCESS BCC Campaign Preparation Signing of MoU between BISP and SLIC Pilot Test of in 4 Selected Districts Tehsil-wise Enrolment Plan & Process BBC Campaign to educate Beneficiaries about Waseela e Sehet and its usages MIS & M&E Systems Development (Enrolment, Transaction) Meetings to discuss the scheme & Implementation Methodology Initial Phase: NADRA to assist in Enrollment Process Rollout Phase: SLIC Zonal Offices will take-up Enrolment Procurement of Resources & Technology Trainings of MIS staff at all levels 2 3 11 7 8 Issuance of Smart Card with Brochure having details on usage & protection of Smart Card Approval of WS Operations Manual Advance BCC Campaign Launch Kickoff Meetings with SLIC & other Stakeholders 6 Empanelment of Hospitals 1 4 5 9
- 10. HI MAIN PROCESS … cont. Discharge of Beneficiary & debiting of The final amount from the smart card 12 13 Settlement of all Claims between Hospitals and SLIC Redress and Complain Mechanism 15 14 Data Transmission to BISP & SLIC Servers Updating of all Data and M&E Reports 10 11 Beneficiary Authentication Using Smart Card system Beneficiary Visit Hospital Doctor checkup beneficiary, and If required, Admission &Treatment will be carryout Blocking of the anticipated insurance amount using smart card system Medical bills claim by hospital from the SLIC
- 11. Enrolment Process Verification Configuration Verification of Beneficiary Family Head using CNIC Configuration of Household Data into family Unit Reception BISP Desk Community Rep Acquisition Family Photos, Fingerprints Personalization · Smart Card Activation & Handing Over · BISP/SLIC Info Leaflets Awareness BISP Desk Initial Verification of BISP Beneficiary NADRA NADRA Program Details & Service Utilization NADRA
- 12. Enrolment MIS Development Management Information Systems involve three primary resources: • People (BISP Beneficiary) • Information Technology (hardware, software) • Information: – data that would be printed and stored in the Smartcard. – M&E Reports
- 13. Enrolment Software 1. Beneficiary Data Management Module: This application will extract the data from existing BISP household data on the format decided among SLIC and BISP Waseela-e-Sehet teams. 2. Download / Upload Module: This application will download household data from BISP server to local server and will upload Beneficiary family data from local server to BISP server in case BISP server is available online. In case BISP server is offline then the local server should have the utility to send data in batch file as well as generate backup on removable media. 3. Family Configuration Module: This application will convert household data into family units. This application will have a full editing and search utilities. 4. Photo & Biometric Module: This application will take photographs & fingerprints of beneficiary and her family. And make the enrolled data available to the Smart Card Activation module. Waseela-e-Sehet (HI) 13
- 14. Enrolment Software cont… 5. Smart Card Activation and Printing Module: This application will write on the smart card the family data along with fingerprint of up to 6 individuals of the beneficiary family (maximum 2 fingerprints per individual) and photograph of the individuals. And also print the smart card. 6. Security Management System (SMS) Module: This application will provide the complete security features against illegal tempering or duplication. 7. Backend Data Management Module: This application will provide a robust mechanism of data exchange between the BISP Head office, Tehsil offices, the Insurance Companies and selected company. Waseela-e-Sehet (HI) 14
- 15. Beneficiary Personal Data: · Tagging of Basic Household Data · for linking children with parents · Grouping Data into Family Unit · Photograph · Fingerprints BISP Server Insurance Company Server Beneficiary received activated card after Verification Beneficiary Data imported to Enrolment Site Authentication Required to Login to BISP/NADRA Server to Import Data Enrolled Data and Smart Card specific data transferred BISP/NADRA & Insurance Co Servers. And Final Card delivered To beneficiary NADRA Server CNIC Verification Verification of Fingerprint WORKFLOW PROCESS AT THE ENROLMENT SITE
- 16. Enrolment MIS Project • Project Initiation Doc • Request For Proposal (RFP)
- 17. WHY SMART CARD? S.NO Characteristics PVC Card Smart Card 1. Internet Connectivity in hospital for Beneficiary verification 24 hrs Connectivity Required Connectivity not required all the time 2. Data security on card Low High 3. Biometrics feature Not available Available 4. Authentication on card No Authenticity or Identification available Authenticity & Match on Card is available 5. Can communicate with computer devices No Yes 6. Printing Requirement on Card for Identification Printing Required; cumber sum Process No printing Required, as all data stored on chip 7. Capable of performing encryption Not available Available 8. Unique serial number Available Available 9. Personalization/updating Not available Available 10. Capable of processing data from card Not available Available 11. Information and applications on a card can be updated without having to issue new cards No Yes 12. Cost-effective Less More
- 18. SMART CARD BENEFITS • Cashless/paperless transactions even in the remote areas despite of load-shedding. • Authentication of beneficiary in empanel hospitals due to Transaction Station self power system. • The amount of Rs 25000 must be stored on the card itself for maintaining transparency and quick service. • Tamper-resistant security device. • In case of damage/lost, card can be issued from local Tehsil office without delay.
- 19. NADRA Proposal Highlights Waseela-e-Sehet (HI) 19 Technical: • Complete SRS doc of Enrolment Application not included so as to freeze the requirements for signoff. • The detailed methodology given in the proposal is too brief; hence it is not possible to assess how NADRA would deliver against the work plan (not given). • System Architecture does not conform to prescribe standards as well as to Product Perspective given in RFP. • The Roles & Responsibilities mentioned under “Scope” need to be revisited for clarity.
- 20. NADRA Proposal Highlights … cont. • The original design of Enrolment process has been changed by NADRA. The major deviation is in the distribution of smart card to the beneficiaries. • In original design, the complete enrolment process i.e. from verification, identification of family, biometric, photographs and handing over the smart card to beneficiary would happen in one go that is during enrolment in the field. • Whereas, NADRA would first capture the data while going in the field, the enrolled data will be exported back to NADRA HQ for processing and personalization of smart card. The smart card will then be sent back to the enrolment sites again for distribution to the beneficiaries.
- 21. NADRA Presentation • Complete demo of Enrolment Software with all its functionalities; • Detailed methodology with Timelines of Enrolment Process; • Technical aspect of Enrolment Procedures; • Integration scope with Transaction System; • Dedicated Team (members & roles) for the Enrolment Project; • Effect/update on BISP core IT system; • Transition and Transfer of Technology Strategy.