Grievance Redressal Mechanism

Rashtriya Swasthya Bima Yojana (RSBY)
New Complaint and Grievance Redressal Web Page
www.rsby.gov.in
22.12.2012
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Why this ? The success of any scheme depends on how it handles the complaints and grievances arisen under the scheme.
A good process for handling the grievances can enhance outcomes and give people satisfaction that their complaints have been heard, even if the outcome is less than optimal.
www.rsby.gov.in
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Grievance Redressal Mechanism under RSBY
For efficient, transparent services in RSBY and for beneficiary and Service provider satisfaction, a web based system on www.rsby.gov.in where anyone can send their complaint on the web window as well as track his/her complaint, has been designed.
www.rsby.gov.in
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Complaints may come from various Stakeholders such as Beneficiary/Hospital/IC/TPA/NGO or any other party. The complaints will be referred to the concerned agency for redressal within a prescribed time frame. If the redressal is done to the satisfaction of the complainant then it is resolved and issue is closed. However, if the response is not received within the time frame or comments/redressal is not satisfactory, the Complaint is transferred to Grievances category.
In addition to the above, Grievances can be directly registered also.
www.rsby.gov.in
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Classification of Grievances and level to which they would be referred

Aggrieved party Nature of Grievance Beneficiary Denied treatment Asked money for treatment Card retained by the Hospital Transport Allowance not paid Smart card not being distributed on spot All members not photographed Extra Registration fee charged Name not found in the BPL list Claim settlement Empanelment of Hospitals De-empanelment Hospital Transaction software MHC issues Smart card issues FKO not available in field as per plan DKM space not available BPL Data not updated since last round Delay in premium payment Grieved Against referred (Category) Level Hospital (Category-1) to
Level I,DKM
Smart Card Service Provider (Category-2) DKM (Category-3) Level II,SNA
Hospital
Insurance Company (Category-4)
Level II SNA
Insurance Company
Insurance company
DKM SNA (Category-5)

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Level III MoLE

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www.rsby.gov.in
Entered on the web page by any complainant on a prescribed format
Receipt of complaints/grievances at DKM/SNA/MoLE
Received in the form of Phone call/e-mail/ hard copy at DKM/SNA/MoLE
Generation of Automatic Unique Registration number

Acknowledgement sent to the complainant (mail/phone)
Decision taken whether it is a complaint or a Grievance
All complaints/grievances entered on the designed web page by the DKM/SNA/MoLE designated officer
Complaint www.rsby.gov.in
Grievance
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Automatic generation of the Type/location and category of complaint
Complaint
Grievance
Final Feed back to the complainant in the form of e-mail or in the form of a phone call and status updated on the web page by the DKM/SNA/ MoLE
An automatic email/letter sent to the concerned agency to seek comments in a time frame
Comments not received
Comments received
If satisfied with comments
a time frame Reminder to be sent www.rsby.gov.in
Not received or not satisfied

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Grievance
Automatic generation of the Type/location and category of o complaint done f t An automatic email /letter sent to the h concerned agency (DGRC/SGRC)to e seek comments in a time frame
District Grievance Redressal Committee
State Grievance Redressal Committee
Appealed(wi thin 30 days)

Settled and satisfied (within 30 days)
Settled and satisfied
Not satisfie d
Final Feed back to the complainant in the form of email or in the form of a phone call and status updated by the DKM/SNA/MoLE
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www.rsby.gov.in
The concerned Committee where the grievance is received will hear the parties and take a decision within 30 days. If at any point the decision of DGRC /SGRC/NGRC is contested by the complainant an appeal is made to the next level of Grievance Redressal Committee. The decision by the Appellate Body shall be taken within the next 30 days.
At each stage ,after a decision is taken on the Grievances, necessary entry will be made by the respective designated person and an intimation sent to the complainant /aggrieved party.
www.rsby.gov.in
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There would be a fixed date once a month for addressing these grievances in their respective committees (DGRC/SGRC/ NGRC).This would enable all grievances to be heard /settled within the set time frame of 30 days . It would be the duty of the DKM/SNA /MoLE to ensure that all relevant documents available/received at their end are pre sented in these committees in the form of forwarded mails/scanned copies/photo copies or original documents to facilitate the proceedings of the grievance redressal mechanism.
www.rsby.gov.in
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Snapshots of the Application
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Log in Access
Three Levels of Access
National Level State Level District Level
For all the levels Access will be with both Government and Insurance Companies This will be available within existing log in of RSBY website
www.rsby.gov.in
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Information Required
Complaints will automatically flow to the designated persons in each district and State Every SNA will need to provide details of Nodal person for each district and at the State level Every Insurance Company will need to provide details of Nodal person for each district, State and National level
www.rsby.gov.in
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Grievance Redressal Mechanism

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Grievance Redressal Mechanism

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Rashtriya Swasthya Bima Yojana (RSBY)

New Complaint and Grievance Redressal Web Page

Grievance Redressal Mechanism under RSBY

In addition to the above, Grievances can be directly registered also.

Classification of Grievances and level to which they would be referred

Insurance Company (Category-4)

DKM SNA (Category-5)

Level III MoLE

Entered on the web page by any complainant on a prescribed format

Receipt of complaints/grievances at DKM/SNA/MoLE

Received in the form of Phone call/e-mail/ hard copy at DKM/SNA/MoLE

Generation of Automatic Unique Registration number

Decision taken whether it is a complaint or a Grievance

Automatic generation of the Type/location and category of complaint

Comments not received

If satisfied with comments

a time frame Reminder to be sent www.rsby.gov.in

Not received or not satisfied

District Grievance Redressal Committee

State Grievance Redressal Committee

Appealed(wi thin 30 days)

Settled and satisfied

Snapshots of the Application

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