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Seminar On Micro Insurance Presented by : APV Reddy CEO Family Health Plan Ltd. 15 th Oct 2005.

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Presentation on theme: "Seminar On Micro Insurance Presented by : APV Reddy CEO Family Health Plan Ltd. 15 th Oct 2005."— Presentation transcript:

1 Seminar On Micro Insurance Presented by : APV Reddy CEO Family Health Plan Ltd. 15 th Oct 2005

2 Healthcare Spending Source: Peter Berman 1996 75.2% 20.7% 1.4% 1.2% 0.5% 0.8% Over 75% out of pocket payment..…Indicator of potential for Health Insurance

3 2% of APL Indian fall into BPL every year due to Health care indebtedness - Express Healthcare Management 2004 Health care expenditure is the second cause for Rural Indebtedness - NCAER 24 % of Hospitalized Indian are pushed into indebtedness due to Healthcare expenditure - World Bank

4 Traditional Insurance (Mediclaim)1% ESIS & CGHS3% Railways1% Social /Mandatory Insurance4% NGO/CBHI (Self funded)1% Around 9% population is covered…… How does the Health Insurance Industry looks today

5 ESIS253Lakhs CGHS 43 Railways 80 Defence Employees 66 Ex Servicemen 75 Mining & Plantations 40 State Sponsored Schemes 5 Employer Reimbursement schemes140 Community Based H S 30 Health Segment of Life Inc 2 Health Ins PSU100 Health Ins Pvt Cos 30 TOTAL864

6 Market place Indian Population 70% APL 30% BPL Public Hospitals /Trust Low cost Hospitals 50% lower Middle class 40% Upper Middle class 10% Elite class Moderate cost, high tech High cost, high tech, Frills Economic levels are major drivers in the Health care industry

7 Rural -73 % Urban -27 % So far…… emphasis of organized health insurance has been in Urban areas for multiple reasons Indian Population – Rural Vs Urban

8 URBAN 270 mn Above Poverty Line COVERED Above Poverty Line UNCOVERED Source: Census India 90 mn lives Mediclaim CGHS ESIS PSUs State Govt. Defense BPL UNCOVERED 90 mn lives Self Employed Employed but not covered Urban Poor Urban India- Segmentation

9 RURAL 730 mn Above Poverty line 530 mn Below Poverty Line 200 mn Organized 360 mn Unorganized 170 mn Unorganized 70 mn Organized 130 mn Source: Census India 60% ( 430 mn) Farmers Rural India - Segmentation

10 Innovative Product Community based products Social Insurance Coverage for Out-patient Integration of Inpatient & Out-patient What India needs for a achieving a significant Health Insurance coverage

11 Photo ID Card Cashless Network Claims Management Call Centre Medical Pre-authorization TPA MIS What India needs for a achieving a significant Health Insurance coverage

12 Healthcare Spectrum Preventive care In-patient care Out-patient care Medical Surgical All the existing Models cater to the In-patient requirement only Vaccination Check-ups Heath camps Consultation Pharmacy Investigations

13 Suggested Plan Surgical treatment Relevant Medical treatment Govt has to play a role in social & preventive medicine Govt. hospitals capable of handling medical treatment Surgical treatments are expensive Lack of surgeons in Rural Hospitals Hence Health Insurance cover for…… MedicalSurgical Number of cases 58%42% Expenditure 23%77%

14 Co-operative Societies Banks/ NABARD Co-operative Banks Suggested medium 30% rural Indians avail Banking services ( 41.6 million families) Almost 100 % villages are covered under co-operative fold 67% of rural household are members of Co-operative institutions 7% of the Farmers have Kisan credit card Over 35,000 branches of 560 banks located in 563 districts in 30 states Source:NABARD.microfinance.2004

15 Provider of healthcare services Govt. Hospitals Private Hospitals Nursing Homes Network of hospitals - both private and government - across the country to facilitate delivery of treatment to the rural poor at their door step…… Public Private partnership

16 1600 Surgical procedures Free Outpatient Consultation Largely Discounted Lab Tests 100 % Cashless treatment In Top Quality Hospitals Standard rates at Private Hospitals Easy Access User friendly Yeshasvini - Features

17 Registered member of State Co-operative society for minimum 6 months Dependant family members Age limit- Upto 80 yrs Membership for

18 Product features Cost of Medicines & consumables during hospital stay Cost of Operation Theater,Anaesthesia, Surgeons fee Professional charge: Consultant fee, Nursing fee Accommodation

19 Entities involved Network Hospitals FHPL Implement Administer Govt. of Karnataka Dept. of Co-operative

20 Implementation of the Scheme Trust Family Health Plan Ltd (FHPL) Governing Body Fund maintenance & Disbursement Periodic review Administration Claim processing Services to member Reporting – MIS Periodic review Dept of Co-op Member identification Membership protocol- collection of Fee Feed Back

21 Provider of healthcare services Network hospitals Cashless treatment Special discounted tariff for medical treatment Preferential treatment Free Out-patient consultation Discounted Lab charges Exclusive front desk counter 2003-2004: -114 Hospitals 2004-2005:- 137 Hospitals Hospitals spread across 30 Location All hospitals follow single rate list for defined surgical procedure

22 STATISTICS Yeshasvini Co-operative Farmers Health Care Trust Jun 03 - May 04Jun 04 - May 05Total for 2 years NumbersValue Rs.NumbersValue Rs.NOsValue Rs. No of Mems Enrolled 1,601,152 2,021,661 Contribution collected 96,909,491 119,755,440 Govt Contribution 45,000,000 35,788,000 Interest 3,743,622 4,880,368 Cont frm CO OP soc 6,296,177 Contrbution from SBM 300,000 Total Amt Collected 145,653,113 167,019,985312,673,098 Claim Status Claims Settled 8,996105,385,417 13,632 162,317,166 Bills Pend for pyment 12 97,000 1,232 16,971,603 Total 9,008 105,482,417 14,864 179,288,76923,872 284,771,186 0.560.74 Free OPD Treatment 35,814 50,171 85,985

23 Facts & Figures Year 1Year 2Year 3 ( 4 months) Sensitization6 months News paper/ TV/ Radio Jingles 2 months News paper/ TV/ Radio Jingles 2 months News paper/ TV/ Radio Jingles Enrollment drive6 months2 months4 months ID cardsNot issuedPartly issued Number of hospitals114137 Group size16 lakh21 lakh14 lakh Membership fee Govt Rs.60/- PA ( 9.6Cr) Rs.30/- PA (4.5 Cr) Rs.60/- (11.9 Cr) (Total 4.56 Cr) Rs.3.45 Cr Govt. +48 L (interest) + 62.9L( Co-op) +3L ( SBM) Rs.120/- (16.9 Cr) Nil Total CorpusRs.14.19 CrRs.16.5 Cr16.9 Cr Renewal rateNot applicable35%43% Claims settled9008148641937 ( Pre-auth) Total claim payoutRs.10.53 Cr17.9 Cr3.39 Cr( Pre-auth value) Avg Claim value11689/-12042/- Incidence0.56%0.74% Free OPD35814501719356

24 Strong Govt. initiative & support Large identifiable groups Defined & extensive network of hospitals Largely discounted rates at Private hospitals Effective administration by TPA Success factor

25 Thank you

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