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Biju Krushak Kalyan Yojana Detailed Guidelines Government of Odisha

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Biju Krushak Kalyan Yojana Detailed Guidelines Government of Odisha Biju Krushak Kalyan Yojana Detailed Guidelines Government of Odisha Directorate of Agriculture and Food Production, Department of Agriculture ___________ (as on 1 December 2013) 1 nd (2 Edition) 2 GOVERNMENT OF ODISHA BIJU KRUSHAK KALYAN YOJANA A number of studies have revealed that risk owing to low level of health security is endemic for Farmers and their family members, especially those in unorganized sector. The vulnerability of these Farmers and their family members increases when they have to pay out of pocket for their medical care with no subsidy or support. On the one hand, such a farm family does not have the financial resources to bear the cost of medical treatment; on the other, the public owned health infrastructure is unable to cope up with the demand. Large number of persons borrows money or sells assets to pay for treatment in hospitals. Thus, Health Insurance can be a way of overcoming financial handicaps, improving access to quality medical care and providing financial protection against high medical expenses. The “Biju Krushak Kalyan Yojana” announced by the Government of Odisha attempts to address such issues. For effective operation of the scheme, partnership is envisaged between the Insurance Company, public and the private sector hospitals and the State agencies. State Government/Nodal Agency will assist the Insurance Company in networking with the Government/Private hospitals, fixing of treatment protocol and costs, treatment authorization, so that the cost of administering the scheme is kept at the lowest, while making full use of the resources available in the Government/Private health systems. Public hospitals, including ESI hospitals and such private hospitals fulfilling minimum qualifications in terms of availability of inpatient medical beds, laboratory, equipments, operation theatres, smart card reader etc. and a track record in the treatment of the diseases can be enlisted for providing treatment to the identified families under the scheme. 3 Table of Contents GLOSSARY ................................................................................................................................................................ 7 BIJU KRUSHAK KALYAN YOJANA – DETAILED GUIDELINES ..................................................................... 14 1. NAME ..................................................................................................................................................... 14 2. OBJECTIVE ........................................................................................................................................... 14 3. IMPLEMENTING AGENCY ................................................................................................................. 14 4. BENEFICIARIES ................................................................................................................................... 14 5. ENROLMENT UNIT AND ITS DEFINITION .................................................................................... 14 5.1 Unit of Enrolment .............................................................................................................................. 14 5.2 Size of Farmer Family ....................................................................................................................... 14 5.3 Definition of Farmer Family ........................................................................................................... 14 6. BENEFITS ............................................................................................................................................. 15 6.1 Benefit Package.................................................................................................................................. 15 6.2 Package Rate ....................................................................................................................................... 16 7. ELIGIBLE HEALTH CARE PROVIDERS / CRITICAL CARE PROVIDERS .................................. 18 8. EMPANELMENT OF HEALTH CARE PROVIDERS ........................................................................ 18 8.1 Empanelment of Public Health Care Providers / Critical Care Providers ......................... 19 8.2 Empanelment of Private Health Care Providers ....................................................................... 19 8.3 IT Infrastructure for Empanelment in BKKY ............................................................................. 20 8.4 Additional Benefits to be provided by Health Care Providers .............................................. 20 8.5 Additional Responsibilities of the Health Care Providers ..................................................... 20 8.6 Process for Empanelment of Hospitals ....................................................................................... 21 8.7 Agreement with Empanelled Hospital......................................................................................... 22 8.8 Delisting of Hospitals ....................................................................................................................... 22 8.9 List of Empanelled Health Care Providers to be submitted................................................... 22 9. SERVICES BEYOND SERVICE AREA ................................................................................................ 23 10. DISTRICT KEY MNAGER AND FIELD KEY OFFICER ................................................................... 23 11. PAYMENT OF PREMIUM AND REGISTRATION FEE ................................................................... 24 12. REFUND ................................................................................................................................................ 25 13. PERIOD OF CONTRACT AND INSURANCE .................................................................................... 25 13.1 Term of the Contract ........................................................................................................................ 25 13.2 Issuance of Policy .............................................................................................................................. 26 13.3 Commencement of policy in districts .......................................................................................... 26 4 14. ENROLMENT OF BENEFICIARIES ................................................................................................... 28 15. CASHLESS ACCESS SERVICE ............................................................................................................. 30 16. REPUDIATION OF CLAIM ................................................................................................................. 30 17. DELIVERY OF SERVICES BY INTERMEDIARIES .......................................................................... 30 17.1 Third Party Administrators, Smart Card Service Providers or Similar Agencies ............ 31 17.2 Non-Government Organisations (NGOs) or other similar Agencies .................................... 31 18. PROJECT OFFICE AND DISTRICT OFFICE ..................................................................................... 31 19. MANAGEMENT INFORMATION SYSTEMS (MIS) SERVICE........................................................ 32 20. DISTRICT KIOSK................................................................................................................................. 32 21. CALL CENTER SERVICES ................................................................................................................... 33 22. PROCUREMENT, INSTALLATION AND MAINTENANCE OF SMART CARD RELATED HARDWARE AND SOFTWARE IN EMPANELLED HOSPITALS ............................................................... 34 22.1 Public Hospitals ................................................................................................................................. 34 22.2 Private Hospitals ............................................................................................................................... 35 23. GRIEVANCE REDRESSAL .................................................................................................................. 35 23.1 District Grievance Redressal Committee (DGRC) ..................................................................... 35 23.2 State Grievance Redressal Committee (SGRC) .......................................................................... 35 24. PENALTY CLAUSE AND TERMINATION ........................................................................................ 37 25. STANDARDIZATION OF FORMATS ................................................................................................ 38 26. IEC AND BCC INTERVENTIONS ....................................................................................................... 38 27. CAPACITY BUILDING INTERVENTIONS ........................................................................................ 38 28. AUDIT MECHANISM: ......................................................................................................................... 38 28.1 Medical Audit ...................................................................................................................................... 38 28.2 Beneficiary Audit ............................................................................................................................... 39 29. COMMITMENTS OF STATE GOVERNMENT .................................................................................
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