Presentation by SKDRDP-Sampurna Suraksha - Sa-Dhan

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Presentation by SKDRDP-Sampurna Suraksha - Sa-Dhan
|| OM SHREE MANJUNATHAYA NAMAHA ||
SHREE MANJUNATHA SWAMY TEMPLE
THE TRUSTEES
Shri Kshethra Dharmasthala Rural Development Project popularly known as SKDRDP is a registered
charitable trust promoted by Dr. D. Veerendra Heggade. The SKDRDP is managed by Board of
Governors consisting of 7 members (At present four members).
Smt. Hemavathi V. Heggade
President
Jnana Vikasa Women Programme
Sri K.M. Udupa
Trustee
Sri D. Surendra Kumar
Trustee
Dr. D. Veerendra Heggade
President
Sri B.B.Shanubhogue
Trustee
Sri. R.V.Shasthri
Trustee
Sri Udaya Kumar
Trustee
Dharmasthala the abode of Dharma
Shri Kshethra Dharmasthala Rural Development
Project popularly known as SKDRDP is a registered
charitable trust promoted by Dr. D. Veerendra Heggade
the sole trustee of Shri Dharmasthala temple.
Dharmasthala is a famous Hindu religious shrine of South
India with about 700 years of History. The presiding deity of
Dharmasthala is Lord Manjunatha Swamy reincarnation
of Lord Shiva. Dharmasthala is known for religious
harmony yet with a lot of Bhakthi and religious fervor.
Although the deity is Shiva, the Priests are Vaishnavaites.
The trustee of the temple belongs to Jain community.
Many festivals in Dharmasthala attract tourists and
faithfulls, all over the country.
The festivals of Dharmasthala have a tinge of religion,
bhakthi, social value, cultural ethos, rituals.
Annadhana and Abhayadhana are two of the major
functions ordained to be performed by Dr. D. Veerendra
Heggade as the trustee of the temple.
Sarvadharma and Sahithya Sammelana are annual
features of Dharmasthala
Dharmasthala the abode of Dharma
Excellent facilities have been provided for visitors of Dharmasthala.
The massive
“Annapoorna” Dining hall provides lunch and dinner for all the visitors of Dharmasthala.
The quality of food and hygiene practiced in Annapoorna Kitchen is phenomenal.
Charity is supposed to be practiced by Dr. D. Veerendra Heggade in its purest form. No seeker
goes empty handed from Dharmasthala.
To
promote
the
philosophy
of
directed charity Dr. D. Veerendra
Heggade
has
Institutions
promoted
in
the
many
field
of
Education, Health, Promotion of
Indian
Medicine,
Naturopathy,
Yoga, Life Education, improving
the living environment.
|| OM SHRI MANJUNATHAYA NAMAHA ||
Welcome to an introduction of
SAMPOORNA SURAKSHA PROGRAMME
(A unique Health Care Model)
A product of
SHRI KSHETHRA DHARMASTHALA RURAL DEVELOPMENT PROJECT (R.)
(A secular, not for profit, non political, registered voluntary organisation)
For us
Progress with values is a passion
To reach the unreached is our vission
Grama
Kalyana
Hindu
Rudra
Bhoomi
Jnana
Deepa
Community
Development
SIRI
Jana Jagruthi
KUDCEMP
Agriculture
Programmes
Of
SKDRDP
Sampoorna
suraksha
Pragathi
Bandhu &
SHG
Micro
Finance
SGSY
131 Net work
Hospitals
5 Districts
17 Taluks
Insurance
company
4739Villages.
290000
Families
1084000
Members
COVERAGE AREA OF THE SCHEME
Shri Kshethra Dharmasthala
Rural Development Project is
functioning in 6 Districts of
Karnataka State of INDIA
SAMPOORNA SURAKSHA
HEALTH CARE PROGRAMME. *
The Scheme covering 2,94,151
families and 11,76,433 members .
OUR VISION
TO REACH THE UNREACHED IS OUR VISION
The greatest hurdle for the financial development of the SHG
members and their families have been the sudden incidence of disease,
accidents and hospitalization expenses which put them to the vicious cycle
of debts. Therefore our vision is to provide “Cashless” quality health care
to all the members of the family of the self-help groups.
OUR MISSION
The mission is to provide financial protections to the
poor in their emergencies cashless quality health
care treatment through net work hospitals at
affordable rate, Financial consolation at the time of
birth (delivery) Normal or Accidental death,
permanent physical disability, domiciliary treatment,
and damage to the dwelling house due to natural
fury.
Scheme Name:
SAMPOORNA SURAKSHA

Duration:
For 12 months commencing from 1st April to 31st
March of subsequent year –Renewal every year.

Eligibility:
S H G member and his / her family members
maximum 10 member with age 3 months to 80
years.

Family :
Husband, wife, sons, unmarried daughter, parents,
In-laws (in case of dependents,) brothers, and their
spouse and children, unmarried sisters, widow
sisters/daughters and their minor children.
SUBSCRIPTION AND FACILITIES
 Subscription Rs. 220 for the APL SHG member
and Rs.145 per member of his family
 Rs:200 for the BPL SHG member and Rs: 110 per
member of his Family
 Cashless Hospitalization facility is Rs.5000 per
member in multiples or Rs.5000 each member
of the family registered on floater basis.
 Additional Special benefits:- Delivery expenses
reimbursement, Death (Accident or Normal)
Consolation,
Domiciliary
treatment
Rest
allowance, Permanent disability compensation,
consolation on loss to dwelling House.
OUR INSURANCE PARTNERS
•
Oriental Insurance Company
•
New India Assurance Company Ltd.
•
National Insurance Company Ltd.
2. Special Benefits by Sampoorna Suraksha
(S.K.D.R.D.P.)

1st and 2nd delivery maternity benefit to the members.
Normal Delivery
– Rs. 2000/- maximum.
Caesarian Delivery
– Rs. 5000/- maximum.

Domiciliary treatment - rest allowance to the S H G member
(Stake holder) at Rs. 50/- per day maximum for 30 days.

S H G member’s (Stake holder’s) Natural death consolation to
nominee Rs. 5000/- with in 24 hours.

S H G member’s (Stake holder’s) death due to accident
consolation to nominee Rs. 25,000.
Full disability of
Stakeholder Rs. 25,000/-, partial disability is 12,500/-

Dwelling house damage due to nature’s fury Rs. 1000/consolation.
Service Delivery Mechanism

Registration & Subscription collection and delivery of Registration
card by S. K. D. R. D. P. Field staff.

Time of Registration during second week of February & march
every year.
1. Cashless Treatment benefit

Registration card to be produced in the network hospital to
avail cashless treatment facility.

Net-work hospital should seek Pre-authorization by Fax with
in 24 hours of the hospitalization .

Pre-authorisation is decided by Medical officer as per norms
and condition.

On Pre-Authorisation Net work hospital extends cashless
treatment to the member.

Suraksha Assistants in Taluk office visits the hospital and
Identifies the member.

Bills of the cashless treatment should be sent to suraksha office
on weekly basis

Bills will be verified on both accounting and medical angle in
suraksha office then to Insurer who will release the amount to
suraksha office.

Suraksha Office settles the bills to Hospitals.

Pre authorisation , Claim processing and accounting system in
suraksha office is computerized.
2. Special Benefits and paid treatment claims
 Paid treatment and Special benefits claims are
submitted to the concerned project office through the
village level field staff and forwarded to suraksha
office on weekly basis.
 These claims are processed in accounting and
medical angle.
 Paid
treatment
claims
reimbursed
by
insurance company, Special claims sanctioned by
SKDRDP.
 Settlement of these claims
by cheque through
concerned project office & village level field staff
SHG GROUPS
48 Net
work
131
Hospitals
Net work
Hospitals
SETTLEMENT
CLAIMS
P.A .REPLAY
P.A.REQUEST
SETTLEMENT
SUBSCRIPTION
SKDRDP
SAMPOORNA
SURAKSHA
PROCESSED CLAIMS
FACILITY FLOW CHART OF THE SCHEME
Insurance
company
List of Net -work Hospitals
Taluk
SL.
No
Belthangady
1
Fr. L. M. Pinto Health Centre Badyar
08256- 278245
2
Jyothi Hospital
08256-233939
3
Benaka Health Centre Ujire
08256-236742
4
Abhaya Hospital Guruvainakere
08256-232331
5
Shree Damodara Hospital , Belthangady
08256-233097
6
Shree Raghavendra Nursing Home
08256-232061
7
Somayaji Hospital B. C. Road
08255-232268
8
Saraswathi Nursing home Bantwala
08255-233247
9
Pushparaj Hospital Kalladka
08255-275213
Bantwala
Sullia
Hospital Name
Phone _ No
10 Dakshayini General Hospital BC Road
08255-232257
11 K. V. G. Hospital Sullia
08257-230316
12 Jyothi Hospital Sullia
08257-230411
13 Vivus Hospital Madikeri
08272-222658
Mangalore
14 Concetta hospital Kinnigoli
0824- 2297041
(Rural)
15 S. D. M. Eye Hospital
0824-2457988
Mangalore
16 Ju. K. S. Hegde Hospital Deralakatte
0824-2204471
17 Yenepoya Medical College Hospital Deralakatte
0824-2204669
18 Fr. Muller's Medical College Hospital
0824-2238134
19 S. D. M. Ayurveda Hospital Bijai
0824-2224884
20 A. J. Hospital Mangalore
0824-2229125
21 K M C Attavar
0824-2421771
22 Tejaswini Hospital Mangalore
0824-2225777
23 Mulki Nursing Home
9739082257
24 Fr. Patrao Hospital
08251-233183
25 Shri. Durga Nursing Home Kaniyur
08251-284274
26 Adarsha Hospital Puttur
08251-235142
27 Ashwini Hospital Nellyady
08251-254333
28 Shushrutha Ayurveda Hospital
08251-231516
Puttur
Udupi
Karkala
29
Pragathi Speciality Hospital
08251-231046
30
Chethana Hospital
08251-231902
31
Sathya Sai Annapoorna Nursing home Puttur
08251-230935
32
Mahaveera Hospital, Putturu
08251-234525
33
Bonanthaya Hospital Puttur
08251-234748
34
S. D. M. Ayurveda Hospital
0820-2533970
35
Adarsha Hospital Udupi
0820-2535289
36
Hitech Hospital Udupi
0820-2533331
37
Govt. Hospital Udupi
0820-2530333
38
Kasturba Manipal
0820-2571200
39
Dr T M A Pai Hospital Udupi
0820-2531363
40
City Hospital Udupi
0820-2521164
41
Mallya Nursing Home
08258-230807
42
Karkala Nursing Home
08258-230446
43
Alvas Health Centre Moodabidre
08258-238104
44
Raghavendra Nursing Home Hebri
08258-251828
45
Gurukripa General Hospital Bailoor
08258-275029
Kundapura
Sirsi
46
Spandana Hospital Karkala
08258-231627
47
City Nursing Home Karkala
08258-230356
48
Aroor's Clinic Nursing Home Bailoor
08258-275025
49
Geetha Clinic Beluvai
08258-266066
50
08258-235085
51
T M A Pai Rotary Hospital Karkala
Dr. N. R. Acharya Memorial Hospital
Koteshwara
52
Surgeons Hospital Koteshwara
08254-261087
53
Vinaya Hospital Kundapura
08254-230368
54
Chinmayi Hospital Kundapura
08254-232243
55
Shree Devi Nursing Home Kundapura
08254-230066
56
Manjunatha Hospital Kundapura
08254-230515
57
Adarsha Hospital Kundapura
08254-230580
58
Rotary Charitable Hospital
08384-226980
59
Kripa Nursing home
08384-235733
60
Totagar’s Seva Samiti,
08384-234843
08254-261550
61
Hegade Hospital Mundugodu
08301-22901
62
Kannis Nursing home Yallapura
08419-262380
63
Shree Marikamba Nursing Home Sirsi
08384-228132
64
Jyothi Health Centre Mundugodu
08301-521175
65
Mahalaxmi Memorial Hospital
08384-225341
Bhatkala &
66
R. N. Shetty Hospital Murdeshwara
08355-268039
Honnavara
67
Shri. Sharada Nursing Home Karki
08387-236625
68
Amitha Hospital Bhatkala
08385-227422
69
Shree Devi Hospital Honnavar
08387-220430
Kumata &
70
Achutha Pandith Hospital Kumata
08386-222031
Ankola
71
Arya Medical Centre Ankola
08388-230570
72
K. L. E. Society Dr. Kamala Hospital
08388-231473
73
Ramaleela Hospital Kumata
08386-222232
74
Gurukrupa(Arya) Nursing Home Karawar
08382-223100
75
Canara Nursing Home
08386-223580
Sidhapura
76
Shreyash Hospital Siddapura
08389-231447
77
Omkar Nursing Home
08389-230440
78
Dr.Hiremath's Maternity & Nursing Home dandeli
08284-231425
79
Pateel Nursing Home
08284-231636
80
Holy Cross Hospital
08262-220077
81
Joldal Nursing Home
Ashirvad Chikmangalore
08262-235683
9449282333
Dandeli
Chikkamagalore
82
Ashirvad Tarikere
83
08261- 222218
Shringeri
84
Sharada Dhanvanthari charitable hospital
8265-250168
N R Pura
85
Pushpa Hospital
08266-220152
Mudigere
86
K P Manjunatha Prabhu Memorial Hospital kalasa
08263-274431
Kaduru
87
Arekal Nursing Home Birur
08267-255697
88
Sathya Sai Hospital Kaduru
08267-221643
89
Vasudha Hospital
08261-222272
90
Raj Nursing home Tarikere
Tharikere
Bhadravathi
Shivamogga
Sagara
Theerthahalli
Hasan
91
Sharada Nursing Home
92
Bhadra Nursing Home Bhadravathi
93
Meena Nursing Home Bhadrawathi
94
Usha Nursing Home
08182-223355
95
Shri Basaveshwar Hospital
08182-220535
96
Priyanka Hospital
08182-225111
97
Subbaiaha Hospital
08182-224822
98
Spandana Hospital
08183-221566
99
Yelamali Nursing Home
08183-226378
100
Anuradha Nursing Home
08181-228238
101
Melige Hospital
Rajeeva Hospital Hassan
08181-229177
102
103
104
105
106
107
S S Hospital Arsikere
Nagesh Hospital Channarapatna
P G Hospital H.N. Pura
S S Memorial Hospital Hassan
Bharathi Hospital Channarayapatna
9845390631
08282-265505
08172-267550
944835029
08176-256088
08175-273635
08172-260436
08176-256245
Mandya
Mysore
108
Adichunchanagiri of Medical
08234-287011
109
Suraksha Nursing Home Mandya
9448589903
110
Manjunath Nursing Home
Sri. Srinivasa Hospital
9845116904
0821-2456114
Bahusar Nursing Home – Hunsur
08222-252076
Punya hospital Channapatna
7251600
Latha Nursing Home
08192-253320
Kadli Ningamma Hospital
9448115764
Bapuji Nursing Home Tumkur
0816-2271628
Kasturba Hospital Tumkur
08162-274489
111
112
Bangalore Rural
Davanagere
113
114
115
Tumkur
116
117
118
119
120
121
122
Balaji Nursing Home Gubbi
Balaji Hospital Tiptur
Kumar Hospital Tiptur
Raghu Hospital Sira
Vijaya Hospital Tiptur
08194-320021
Chitradurga
123
Krishna Nursing home - Chithraduraga
08193-227550
124
Basavaraj Hospital – Hiriyur
08194-222054
125
Hubli Dharawada
126
Basaveshwara Medical College
S.D M Hospital Sathur Dharwad
9880765111
127
Vatsalya Hospital
0831-2401456
Belgaum
128
Adhar Hospital Belgam
9343020009
129
Gadag Hospital Bailahongala
9448390240
Haveri
130
Shivakrupa Hospital – Ranibennur
Package List
This Package is inclusive of Bed, Doctor's Fees, Nursing, Service, Medicines, Surgery and
Pre Surgery medical expenses, medical consumables & relevent investigations etc., in
general ward. Package is Inclusive of Bed, Doctor's Fees, Nursing, Medicines, Pre Surgery medical
expenses medical consumables etc. in general ward.
OBG
Gastroenterology
S.
No
Name of the Surgery
1 Hysterectomy
2 Removal of Ovarian Tumor/Cyst
3 D & C (Therapitic)
4 Fibroid Myometomy
1
2
3
4
5
6
7
8
Gastrectomy
Cholecystectomy
Laproscopic Surgeries
Appendectomy
Intestine perforation
Hernia (Inguinal,Umbilical)
Colectomy
Biopsy
a) Excision GA/LA
b) Incission Biopsy L A
9 Sub Acute intestinal obstruction
Existing Revised Package for
Package
the year 2008-09
8000
9000
5000
6000
1500
1500
8000
9000
16000
16000
7000
10500
10000
10000
5500 6500 Including Biopsy
10000
10000
6000
7000( With Mesh)
10000
14000
500
500
2500
2000
500
2500
Genito-Urology
1 Renal
Calculi(flush therapy)
1000
1000
a. Ureteroscopic stone removal
10000
11000
b. Uretero-lithotomy
10000
11000
c.Lithotripsy
10000
11000
d. Extraction of Calculus
6000
11000
3 Prostate.(B.H.P)
10000
12000
4 Hydrocele, Vericocele, Orchidectomy
4500
5500
1 Septoplasty
3500
3500
2 Tympnoplasty
4500
4500
2 Ureter
ENT
Tympnoplasy with Mastoidectomy
7000
3 Tonsillectomy with Adenoidectomy
3000
4000
Eye
1 Cataract
2500
2500
General Surgery
1 Splenectomy.
9000
11000
2 Pancreatctomy
18000
18000
3 Lumpectomy LA/GA
3000
3500
4 Radical Mastectomy
8000
9000 Including Biopsy
5 Prolapse rectum
5000
6000
6 hemorrhoidectomy
6000
6000
7 Perianal abcess GA/SA
1500
3000
8 Phimosis or circumcision
2000
2000
9 Abcess drainage
1500
2000
10 Thyroideoctomy
7500
10000
11 Vericose Vein Surgery
8000
Medical
1PUO
1000
1500
Condtions
2GI related- Dysentry
1000
1000
3Respiratory,pneumonia
2500
2500
4Infection of the C N S (Meningitis)
3000
4000+CT Charges
5Urinary Tract Infections
1000
1000
6Viral Hepatitis
1200
1500
7Malaria
1500
1500
8Typhoid
1500
1500
9Viral fever
1200
1000
2200
12000
2500
14000 Including
Implants
Fracture-Humerus-Open reduction
7500
10000 Including
Implants
2 Fracture, Femur-Closed reduction
1500
1500
1200
1200
1200
1200
Fracture, Radius & Ulna open
4 Reduction
7500
10000 Including
Implants
5 Dislocations Closed Reduction
2500
Dislocations Open reduction
6500
10Asthama
Orthopaedics 1 Fracture,Femur- open reduction
Fracture,Humerus-Closed reduction
Fracture, Radius & Ulna.closed
3 reduction
6 Fracture neck of Femur
11000
2500
7500 Including
Implants
14000 Including
Implants
7 Fracture+POP+UE/LE
1200
1200
8 IVDP
2200
I V D P Surgery
20000
9 Collies fracture
750
750
# - met carpels or Phalanges-Closed
10 reduction
500
750
11 Fracture-Tibia Fibula Closed Reduction
1500
1500
12 Fracture- Calcaneum-closed reduction
1200
1200
13 Fracture-Tibia Fibula open Reduction
10000
12500 Including
Implants
14 Rib Fracture
1200
1200
15 Compression-Spinal Fracture
2000
2000
16 Implant Removal
6000
8000 Including
Implants
17 # Patella- Open Reduction
Neurology
2200+ MRI Charges
1 T.I.A (Transient Ischemic Attack)
1500
2000
2 C.V A (Cerebro Vascular Accident)
2500
3000+ CT Charges
No
PERFORMANCE CHART
Sl.
N
o
Description
1.
First Year
Second year
Third year
Forth Year
Forth Year
2004-05
2005-06
2006-07
2007-08
2008-09
Numbe
rs
Amount
Numb
ers
Amount
Numbe
rs
Amount
Number
s
Amount
Numb
ers
Amount
Hospitalization
treatment
7737
2,64,21,143
8587
2,49,89,658
16274
5, 11,08,434
27968
9,12,99,606
31567
12,35,16,46
2
Delivery
allowance
2593
70,17,268
2761
60,12,452
6045
1,33,72,367
10174
2,17,01,070
10970
2,28,89,483
3
Death
Consolation
227
11,35,000
208
11,75,000
308
18,39,500
521
31,22,000
4202
1,02,16,746
4
Domiciliary
treatment
Rest allowance
360
2,02,090
518
2,23,165
882
9,58,600
1643
11,68,509
2302
16,20,255.0
5
Consolation for
natural
calamities
893
6,48,061
1061
4,16,392
232
2,60,520
475
3,97,800
367
3,31,648.00
Total
11810
3,54,23,562
13135
3,28,16,667
23760
6,75,39,421
40,781
11,76,88,985
49408
15,85,74,59
FUTURE PLANS

Access to good diagnostics and OPD care for effective
disease management

Community education in health, nutrition and sanitation,

Training of village level workers on basic testing and
disease identification for early intervention

Introduction of standard treatment guidelines

Research on impact assessment to commence soon
Our exerience
Implmentation stage
Problems






Our inexperience in the insurance field
Group members education standard
Hesitation to pay hard earned money for unforeseen events /
ailment
Lack of pre plan, and necessary system development
High expectations of the members and misunderstanding that
scheme covers all hospitalisation expenses
Unnecessary admission , high billing, ineligible claims, caused
financial burden to both Insurance Company . To the
organisation






Insurance Co had no experience with similar product
for rural.
No Proper and adequate infrastructure for claim
management and guidelines by the Insurance Company.
No Control gate for admission in the hospitals
No Fixed billing tariff to the hospitals
Due to hurried implementation of the scheme without
prior knowledge, lack of trained staff and full
knowledge of the scheme.
Not fully succeed to create awareness, importance and
necessity of the scheme among the members.
Probable Cause







Heavy workload
Poor enrollment Rate
Dissatisfaction by the members
Delay in claim settlement
Pendency and rejection of claims
Heavy claim in flow leading to high claim Ratio
Hospital and Patient induced admission
Changes done on the basis of
I Year Experience
Changed the Insurance Company
Reduced the no. of network hospitals
Fixed tariff to the procedure and treatment
Pre – authorization system
Personal Identification system of the hospitalised member
gave human touch to the care of the members
Pre– planned – calendar of events of implementation such as.
Training the field staff










Creating awareness Among the members, by addressing in their
meetings and gathering
Systems and procedure - how to avail the facility ………
Accounting and medical servicing of claims before
submitting to Insurance company
To earn confidence of hospitals – advance payment by obtain
is that money from Insurance co.
RESULT





“ Trust “ Created among members
No of members increased
Claims are controlled – Unnecessary
admissions reduced to minimum
Because of trained field staff – members
doubts and grievances are solved to the
maximum extent
Members are increased every year
CHALLANGES
 100% enrollment not obtained We are unable to convince
100% members
 Unable to full fill members all health needs
 We are not succeeded in creating spirit of
among the
network hospitals.
 Still there high claim, therefore Insurance Co. is not
comfortable
 Because the tariff does not cover the cost of treatment
entirely – hospitals are not comfortable – hence collecting
money over & above the tariff.
 Members are not comfortable , because they are not getting
facility to all o their ailments
 Members financial condition is not fair to give higher
premium. So Loading the premium and increasing tariff is
difficult.
 Loading the premium and increasing the tariff
 Planning to Making use of Govt. hospitals for medical service
to minimise the treatment cost.
Thank you

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