PANAJI
The government plans to implement the much-talked about insurance scheme -- Deen Dayal Swasthya Seva Yojana -- on August 15. The card which will be issued to the beneficiary itself will work as a medical smart card that will enable a family of three or less to use Rs 2.5 lakh per annum and a family of four and above a cover of Rs 4 lakh per annum.
Of the 447 medical ailments listed in the scheme, 278 will be treated at Goa Medical College.
The insured persons, however, can also avail treatment of these 278 ailments at empanelled private hospitals based on a rate decided under the scheme. The government will categorise the hospitals into Grade A, B and C based on infrastructure, doctor to patient ratio, the total number of beds among a list of other requirements.
Under the scheme, each family will be issued a 64 kb smart card with the biometrics of family members saved on the chip. The system works on a cashless form of payment.
Once the identity of the beneficiary or his family member is verified based on their fingerprint, the patient will be admitted to the hospital. Based on the medical treatment that is necessary, a pre-authorization from the insurer will be requested. The request will either be approved or rejected with valid reason within 12 hours of a normal case and three hours of an emergency/critical case.
On approval, the hospital will open a claim on the card, following which treatment will be given and the claim will be closed once the deductions are made. At the time of discharge, final entry will be made on the smart card after verification of patient's fingerprint records.
Biometric verification will also be used during renewal of the card for successive years till the insured year 2020. Annual renewals will be done by verifying beneficiary biometrics at a dedicated DDSSY Kendra that will contain a kiosk to handle services including modification, new registration, splitting registration and annual renewals of the card.
