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Health Insurance

Scheme
Enrolment Process
&
Enrolment MIS
Development
Waseela-e-Sehet
BISP
Syed Anwar Hussain
MIS Expert (WS)

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 NADRAs 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 CSections;
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

HI MAIN PROCESS

HI MAIN PROCESS cont.

Enrolment Process

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

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

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

WORKFLOW PROCESS AT THE


ENROLMENT SITE

Enrolment MIS Project


Project Initiation Doc
Request For Proposal (RFP)

WHY SMART CARD?

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.

NADRA Proposal Highlights


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.
Waseela-e-Sehet
(HI)
19

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

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.