Ministry of Labour and Employment

Govt. of India

RSBY Guidelines for

Business Continuity Plan

Submitted by:
Sumita Chopra
World Bank Consultant

Version 1.0
Released: July 2009
 RSBY Business Continuity Plan

TABLE OF CONTENTS

GLOSSARY ..............................................................................................................................................3
1 OBJECTIVE ......................................................................................................................................3
2 POSSIBLE REASONS FOR INVOKING BCP .....................................................................................3
3 BUSINESS CONTINUITY PROCESS...................................................................................................3
4 RECORDING ELECTRONIC TRANSACTION....................................................................................3
5 STANDARD CODES .........................................................................................................................3

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 RSBY Business Continuity Plan

Glossary

BCP Business Continuity Plan

MoLE Ministry of Labor & Employment

KMS Key Management System

URN Unique Registration Number

FKO Field Key Officer

DKMA District Key Management Authority

HoF Head of Family

BPL Below Poverty Line

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1 Objective
It has been noticed that at times the Hospital is unable to record an electronic transaction.
This may be due to many reasons viz., non-working of card, non-verification of fingerprint,
Hardware devices not working, extension of insurance period or any other reasons. However
due to any of the reasons cited, the transaction system cannot record the transaction though
service may or may not be provided to the beneficiary. This would lead to a break in the
entire system due to the following reasons

a) The claim for such a transaction will not enter the electronic transaction system and
hence a paper based manual claim will have to be raised by the hospital. This would
increase the work load of both the hospital & the insurance company, at the same time
delaying the settlement process.

b) Since the transactions shall not be a part of the electronic system, the data being
compiled & consolidated will not show the correct picture.

c) The state nodal agencies are monitoring the performance of the Insurance company’s
in terms of usage. Since data for such transactions would not be a part of the
electronic data, this could affect the performance measuring mechanism.

d) Such a transaction will not be recorded in the beneficiary’s card and hence the cover
on the card may be more than the actual cover balance available to the beneficiary.

The Insurance company’s have been time & again requested for their Business continuity
plans (BCP), but it is felt that some kind of central guidelines may be necessary for having a
backup system to ensure that there is very little data loss for the transaction system. Towards
this the Insurance cos or their service providers will have to modify their software at the
district kiosk in order that the complete functionality is available and usable.

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2 Possible reasons for invoking BCP

Certain known cases for invoking BCP have been mentioned below and the next section in
the document will discuss the manner in which they can be handled.

However, these are only suggestions and the minimum required, the Insurance cos and their
service providers may decide to further enhance the functionality to provide a more effective
solution, in which case we request them to provide the details to us at MoLE for approval.

3.1. Case I - The Policy period has been extended for the beneficiaries due to any reason
by the Insurance co.
3.1.1. In such case, the Policy on the card would expire as defined at the time of
enrollment and the transaction system would not allow transaction using that
card.
3.1.2. The transaction system at the hospital (as per Transaction System specs ver 3
RSBY 08 – RSBY 10) would allow authentication of the beneficiary using
fingerprints. This option should be utilized to authenticate the patient or any of
his family members enrolled on the card.
3.1.3. In case fingerprint authentication cannot be carried out for any reason,
3.1.3.1. They should be verified using any other documents available at the
time.
3.1.3.2. Simultaneously the URN on the card should be communicated to the
District Kiosk thru phone, fax or/ and e-mail.1
3.1.3.3. Once acceptance or decline is received from the Insurance co
(Insurance co should ensure this is done within 60 minutes of receiving
request), the rest of the process should be followed.
3.1.4. In any case in an urgent situation, the patient should not be denied service
though the family may be cautioned that in case the eligibility cannot be
established or the insurance cover has already been fully utilized, they may need
to pay for the hospitalization.
3.1.5. The card should be retained by the hospital and along with necessary
documents sent to the District kiosk for authentication and manual entry. Any
member of the patient’s family may accompany the card, however it is not
necessary and it is the hospital’s responsibility to ensure that the card and details
reach the kiosk within 6 hours of admission/ visit.

3.2. Case II - The Hardware or software systems are not functioning

3.2.1. The patient or any other family member should be verified using any other
documents available at the time.
3.2.2. Simultaneously the URN on the card should be communicated to the District
Kiosk thru phone, fax or/ and e-mail.

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3.2.3. Once confirmation is received from the Insurance co (Insurance co should

ensure this is done within 60 minutes of receiving request), the rest of the
process should be followed.1
3.2.4. In any case in an urgent situation, the patient should not be denied service
though the family may be cautioned that in case the eligibility cannot be
established or the insurance cover has been utilized, they may need to pay for the
hospitalization.
3.2.5. The card should be retained by the hospital and along with necessary
documents sent to the District kiosk for authentication and manual entry. Any
member of the patient’s family may accompany the card, however it is not
necessary and it is the hospital’s responsibility to ensure that the card and details
reach the kiosk within 6 hours of admission/ visit.

3.3. Case III – Though the system is functioning and transactions are being made using
other RSBY cards, a particular card is not recognized by the system
3.3.1. The patient or any other family member should be verified using any other
documents available at the time.
3.3.2. Simultaneously the URN on the card should be communicated to the District
Kiosk thru phone, fax or/ and e-mail and confirmation sought on validity of card.
3.3.3. Once confirmation is received from the Insurance co (Insurance co should
ensure this is done within 60 minutes of receiving request), the rest of the
process should be followed.1
3.3.4. In any case in an urgent situation, the patient should not be denied service
though the family may be cautioned that in case the eligibility cannot be
established or the insurance cover has been utilized, they may need to pay for the
hospitalization.
3.3.5. The card should be retained by the hospital and along with necessary
documents sent to the District kiosk for authentication and manual entry. Any
member of the patient’s family may accompany the card, however it is not
necessary and it is the hospital’s responsibility to ensure that the card and details
reach the kiosk within 6 hours of admission/ visit.

3.4. Case IV – The fingerprints of the patient or accompanying family member is not
getting verified
3.4.1. The Policy validity and availability of cover can be checked from the system
(displayed prior to fingerprint verification as per Transaction system specs
version 3 – para RSBY 09)
3.4.2. The patient or any other family member may also be verified using any other
documents available at the time.
3.4.3. Simultaneously the URN on the card should be communicated to the District
Kiosk thru phone, fax or/ and e-mail.
3.4.4. Once confirmation is received from the Insurance co (Insurance co should
ensure this is done within 60 minutes of receiving request), the rest of the
process should be followed.1

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3.4.5. In any case in an urgent situation, the patient should not be denied service
though the family may be cautioned that in case the eligibility cannot be
established or the insurance cover has been utilized, they may need to pay for the
hospitalization.
3.4.6. The card should be retained by the hospital and along with necessary
documents sent to the District kiosk for authentication and manual entry. Any
member of the patient’s family may accompany the card, however it is not
necessary and it is the hospital’s responsibility to ensure that the card and details
reach the kiosk within 6 hours of admission/ visit.

Note:
1. In case the card has not been issued by the insurance co working in the district where
the patient is visiting,
• Confirmation shall be sought from the Issuing Insurance co (determined from the
District code in the URN)
• The rest of the transaction shall be conducted at the kiosk in the district where the
patient is visiting) and then transmitted to respective insurance co for
confirmation.
• Card shall be updated with the transaction and returned to the beneficiary only
after confirmation is received.
• It should be the responsibility of the Issuing Insurance Company to return the re-
issued card to the Hospital, in case the card was issued from another district / state
and within 48 hours if the card was issued in the same district where
hospitalization happens.
• It is the responsibility of the hospital to ensure that the card is returned to the
beneficiary within 24 hours of it reaching the hospital. In order to do this, Hospital
should ensure they have complete postal address of beneficiary at the time of
discharge, in case card cannot be handed over before discharge.

3 Business Continuity Process

Since it has been determined that electronic transaction is not possible at the hospital due to
any of the reasons discussed above, the onus is on the hospital to get the card authenticated
and the transaction entered into the electronic system as claims can only be raised and paid if
the transaction exists. However, the transaction can be done only at the District kiosk where
the hospitalization happens, though the card may have been issued in another district and by
the same or another Insurance company.

In case the card is issued by another insurance company or issued at another District,
• The onus is on the Insurance company working in the district where hospitalization
took place to
o Confirm authenticity from the responsible issuer

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o Create the transaction

o Send the card & electronic transaction to the issuer.
o A copy of this information should also be sent to DKMA of both the Issuing &
hospitalization district for information
• Thereafter the issuer company has to
o Revert with the duplicate card (if required)
o Confirmation on transaction or
o Information to both the hospital and district kiosk where transaction is
originated that card is not authenticated.

In case, card cannot be authenticated at kiosk and by technical experts or is found to be a

fake,
• DKMA of both the issuing & hospitalization district should be informed immediately
by respective insurance cos for further investigation and action.
• Hospital should be informed
• A new Unblock transaction created as per transaction system specifications.

Once the Card and the details reach the District kiosk, the technical staff would need to

3.1. Check the name of the Issuing insurance company (using the state and village code)
3.2. Confirm that (the Card Validation Software prepared by NIC may be used for this
purpose)
3.2.1. The contact chip is working
3.2.2. The card is a valid RSBY card
3.2.3. The card has been activated at the time of enrollment
3.2.4. Card layout and data is as per specifications
3.3. In case card is issued by another insurance company, immediate information should
be sent to them about non-functioning of card (in case that is the reason for invoking
BCP). The minimum information to be sent is
3.3.1. Printed on the card
3.3.1.1. URN number
3.3.1.2. Issuance Date
3.3.1.3. Name of Head of Family
3.3.2. Hospital Information
3.3.2.1. Name of Hospital
3.3.2.2. Code of Hospital
3.3.2.3. Date of Admission/ Visit
3.3.2.4. Reason for Admission/ Visit
3.3.2.5. Name of Contact Person at Hospital
3.3.2.6. Phone number of Hospital
3.3.2.7. Fax number of Hospital
3.3.3. Other Information
3.3.3.1. State Name
3.3.3.2. District Name
3.3.3.3. Serving Insurance Company

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3.3.3.4. Serving TPA (if any)

3.3.3.5. Name of District In-charge from the Insurance company/ TPA
3.3.3.6. Phone number of District In-charge from the Insurance company/ TPA
3.3.3.7. Fax number of District In-charge from the Insurance company/ TPA
3.3.3.8. Reason for Invoking BCP
3.3.3.9. Result after checking the card (if card had not been working)
3.4. In case any of these conditions are not fulfilled, appropriate action will have to be
taken
3.4.1. Chip is not working
3.4.1.1. A duplicate card will have to be issued to the family from district
where Original card was issued. For this the guidelines for Issuance of
Duplicate card (District Kiosk & Server_guidelines_ver1) need to be
followed.
3.4.2. In case the card is not a valid card,
3.4.2.1. Immediate information should be given to the DKMA and Nodal
officer
3.4.2.2. Enquiry should be initiated into the card issuance
3.4.2.3. Eligibility of the family should be checked against the BPL list and the
enrolled list
3.4.2.4. In case eligibility can be established, a new card should be issued with
support of district administration.
3.4.3. In case the card is not activated
3.4.3.1. Enquiry should be initiated into card issuance
3.4.3.2. Eligibility of the family should be checked against the BPL list and the
enrolled list
3.4.3.3. In case eligibility can be established, the card should be activated with
support of district administration.
3.4.4. In case the card layout is incorrect or data is written incorrectly
3.4.4.1. Enquiry should be initiated into card issuance
3.4.4.2. Eligibility of the family should be checked against the BPL list and the
enrolled list
3.4.4.3. In case eligibility can be established, a duplicate card should be issued
to the beneficiary family. For this the guidelines for Issuance of Duplicate
card (District Kiosk & Server_guidelines_ver1) need to be followed.
3.4.5. Policy was extended beyond expiry date on card
3.4.5.1. Transaction should be created in the Kiosk and card updated with the
details.

4 Recording Electronic Transaction

Once the reason for electronic transaction not being made is established, in case it was
due to non-functioning of the software or hardware, the same should be rectified at the

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earliest. In the meantime, the manual transactions would have to be transferred to the
electronic system for which the prerequisites are
i. A Hospital Card (MHC) would have to be issued in the name of the District
Kiosk. (Request for this should be given to DKMA and CKGA along with MKC
card)
ii. Transaction software should be installed at the District kiosk; however this would
need to have slight differences from the transaction system at the Hospital. The
differences are:
a. The system should have facility to select the Hospital name from a pre
populated list
b. It should record the reason for doing the transaction at the kiosk
c. It should allow transaction even without Fingerprint verification.
d. In case transaction is made without Fingerprint verification, the software
should record the manner in which verification was carried and the name
of the person who verified the patient
e. The transaction should be flagged as happened at kiosk (Hospital Code
issued should point this).
f. Transaction date may be prior to or same as current data but not beyond
current date
g. Transaction date beyong Policy expiry date may be allowed.
h. All these extra details should be stored in the database but the data in the
card should be written as per the transaction specs version 3

5 Standard Codes

Sl No. Data element Code assigned Description

1 BCP Reason
1 Fingerprint Device not
working
2 Card Readers not
working
3 Computer not working
4 Computer not installed
5 Fingerprint Device not
installed
6 Card Readers not
installed
7 Software not installed
8 Software not Working
9 Fingerprint not
authenticated
10 Card cannot be read
11 Card authentication
failure
12 Policy extended
13 Other

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