Details for Reform Option "Health Insurance Scheme for Women, Maharashtra"
The HALO Medical Foundation (HMF) trains and works with women to provide reproductive and child health (RCH) services to the rural population in Osmanabad district. Bharat Vaidyas (as these women are called) provide services for a nominal fee that she collects directly from the community.
One of the activities undertaken by these women is to form self help groups and women’s savings groups. Loans are given to members of the savings group from the funds collected. It was noticed that 25% of loans taken by the women was for medical treatment. Also there was a demand from the community that charges for medical treatments be taken once a year rather than every time they are treated. (For more on Bharat Vaidyas, see entry on ‘Training of community health workers, Maharashtra’.)
HMF then came up with the idea of a life and health insurance scheme for its self-help group members. HMF jointly with Life Insurance Corporation and United India Insurance Company Limited came up with a scheme specially designed for the ‘Bachat Sangh’ members.
The scheme covers members between 18-58 years for the following:
(i) Hospitalisation expenses inclusive of maternity extension for first two pregnancies (excluding standard exclusions under Mediclaim) up to INR 5000
(ii) Natural Death INR 20000
(iii) Partial Permanent Disability INR 25000
(iv) Total Permanent Disability INR 50000
(v) Death due to accident INR 50000
Additional benefits under the scheme include:
(i) Scholarship to children of insured women who are studying in classes IX to XII @ INR 1200 per year.
(ii) Annual health checkup camp at the village by two doctors (one a GP and the other a gynaecologist), with free routine blood and urine tests.
(iii) 50% concession on the investigation charges at Halo Medical Foundation Diagnostic Center, Anadur. (Ultrasound, X-Ray, all blood chemistry and urine tests)
Bharat Vaidyas are the key motivators for the scheme.
Seeing the good response to the scheme and with a demand from the community, a family health insurance scheme- “Rural women’s self help group policy” (one of the existing schemes of the United India Insurance Company) was introduced in January 2005 to cover the member, her husband and two children under the age of 18. The premium for a year is INR 375 and a cover of INR 5000 is available as a floater policy for four persons- husband, wife and two dependent children. Thus far 400 women have opted for this policy.
The first policy period expires in April 2005 and it is expected that the number will further increase.
Though the scheme only started in April 2004, the following indicators show a good response:
(i) Total No. of women insured: 891
(ii) No. of pregnant women: 39
(iii) Total delivered till December 2004: 20
(iv) Institutional deliveries (at Govt. institutions 5): 18
(v) LSCS (caesarians): 6
(vi) Home deliveries: 2
(vii) Claims submitted: 36
(viii) Claims settled: 33 (91.6%)
(ix) Delivery Claims: 13
Only one initial workshop for workers (the Bharat Vaidyas and their supervisors) was organised costing approximately INR 10,000.
Anandur, Tuljapur Taluka, District Osmanabad, Maharashtra initiated in April 2004.
Increases affordability: The community can now get services from better health facilities.
Increases health-seeking: Now they know they will get their money back, women stop neglecting their health.
Incentive for institutional deliveries: Most insurance schemes do not include maternity benefit.
Partial cover: Out Patient Department expenses not covered.
Restrictive: Stringent conditions levied by insurance companies.
Consultative workshop with district heads and local leaders; help from media in advertising scheme; identification of ethical medical practitioners and socially motivated insurance officers; an institution (such as HMF) to provide technical assistance (third party administrators).
Who needs to be consulted
Community, NGO staff, insurance companies, Government officials at State and district level.
Good provided the following are in place:
i) MOU between insurance companies, NGO (third part administrators), public service providers.
ii) Ensuring premium - claim ratio is maintained for the scheme to be viable.
iii) The set up of a scrutinising committee to avoid bogus claims.
iv) Accreditation of private hospitals.
Chances of Replication
The District Panchayat (Zilla Parishad) Osmanabad has now allocated INR 5 lakh which will pay 50% of the premium of all pregnant women in district.
Sara Joseph, Researcher, ECTA, New Delhi, February 2005.