|| 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