Page 15 - Life Insurance Today FEBRUARY 2016
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Bed charges limited to a fixed amount (as per com- service with adequate salary & TPA will have to
mon practice bed charges often determine the spread their services to the rural areas.
level of charges for other hospital costs as well);
Insurers will have to shape the products to ben-
Use of generic drugs only; efit the customer on real-time basis with assured
coverage which will not be plagued with failure
Consultation of specified/ named doctors only; clauses.
Use of local hospital and treatment at other hos- All services and payments to be agreed with vari-
pital by referral only; ous providers, so that the insured can be given
hassle free, cashless service.
Imposing sub-limits on various common treatment;
Status of Micro-insurance in India at
With regard to outpatient care, it could be encour- present:
aged on a controlled basis, as various benefits
could be derived. Preventive treatment in time can Micro-insurance schemes in demand in India (list has been
help to avoid expensive curative treatment. The prepared by ILO-2004): The inventory lists 51 schemes that
consumer also can obtain total healthcare. Loss of are operational in India:
earnings could be avoided if timely Out-patient N Most schemes are still young, having started their op-
treatment is availed. However, outpatient care is
possible only if local general practitioners (GPs) can erations during the last few years. Of the 39 schemes
be available to do service on monthly honorariums for which this information is available, around 24
depending on the number beneficiaries covered. schemes came up during the last 4 years, and about 7
Thus if 2,000 persons in a community are covered schemes have operated for more than a decade.
the doctor can be paid Rs.5,000/- per month and
the basic risk premium per person per annum N As regard to the beneficiaries, the 49 schemes for
would be Rs. 30/- only and more the group size is which the information is available cover 7.2 million
it will go down considerably. people.
3. Guaranteeing the benefits of the product: N Most insurance schemes (66%) are linked with micro
Since micro-health insurance is absolutely an essential finance services provided by specialized institutions (19
product, to make it popular it must be ensured that it schemes) or non-specialized organizations (17
delivers the promise. This can be achieved with the schemes). Twenty two percent of the schemes are
active participation of many players as explained be- implemented by community-based organizations and
low: 12% by health care providers.
The government public health system has to be
upgraded for quality & responsiveness. To enable N Life and health are the two most popular risks for which
them to do so they can charge user charges pay- insurance is demanded: 59% of schemes provide life in-
able by the insurer. This will enable them to have surance and 57% of them provide health insurance.
the necessary cash flow for day-to-day administra-
tion, continuous improvement and up gradation. In SEWA's experience health-cover tops the list of risks for
which the poor needs insurance.
Private & profit hospitals need to have beds for N Twenty-five out of 37 schemes received some external
the poor with low/transparent charges. Where
communities do not have affordable health facili- funds to initiate their schemes.
ties, the same should be started on assurance fu-
ture cash flow that could come by way of assured Twenty out of 32 schemes received external technical
insurance payments. assistance in the form of advisory services, technical
services, training, or even referral services for their
Willing doctors to be appointed for community schemes.
N In the majority of the schemes special staff had been
Open your eyes, look within. Are you satisfied with the life you're living?
Life Insurance Today February 2016 15
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