Health Insurance SchemeEnrolment Process

& Enrolment MIS Development

Waseela-e-SehetBISP

Syed Anwar HussainMIS Expert (WS)

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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)

Presentation Objectives

• To present Overall Health Insurance (HI) Scheme

• To explain Enrolment MIS Project• To highlight NADRA’s Proposal

WASEELA-e-SEHET OBJECTIVE

• Improving access to health services and reducing income loss from catastrophic health shocks.

"Be Healthy – Be Productive”

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;

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.

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

HI OVERALL SCHEME

BISP HQ

SLIC HQ

Hospitals

Civil Societies, NGOs, VBOs

Facilitate

BISP Beneficiary

Claim

sPr

emiu

mCl

aims

Partner-Agent Model

Feedback Mechanism

Visit

Treatment

Select

Select

Initial Phase: NADRARollout Phase:

SLIC Zonal Offices

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 ProcessRollout Phase:SLIC Zonal Offices will take-up Enrolment

Procurement of Resources & Technology Trainings of MIS staff at all levels

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3

11

7

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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

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Empanelment of Hospitals

1

4

5

9

HI MAIN PROCESS … cont.

Discharge of Beneficiary & debiting of The final amount from the smart card

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13

Settlement of all Claims between Hospitals and SLIC

Redress and Complain Mechanism

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Data Transmission

to BISP & SLIC ServersUpdating of all Data and M&E

Reports

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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

Enrolment Process

Verification Configuration

Verification of Beneficiary Family Head using CNIC

Configuration of Household Data into family Unit

Reception

BISP DeskCommunity Rep

Acquisition

Family Photos, Fingerprints

Personalization

· Smart Card Activation & Handing Over

· BISP/SLIC Info Leaflets

Awareness

BISP Desk

Initial Verification of BISP Beneficiary

NADRANADRA

Program Details & Service Utilization

NADRA

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

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Enrolment Software1. 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)

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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)

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

NADRAServer

CNIC VerificationVerification of Fingerprint

WORKFLOW PROCESS AT THE ENROLMENT SITE

Enrolment MIS Project

• Project Initiation Doc• Request For Proposal (RFP)

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

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.

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NADRA Proposal Highlights

Waseela-e-Sehet (HI)

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.

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.

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.