Views and Suggestions of Community Members on Micro Health Insurance MICROFINANCE COMMUNITY OF PRACTICE SOLUTION EXCHANGE,UNITED NATIONS, INDIA

Solution Exchange – an initiative of the UN Country Team in India Micro Insurance Scenario Supply Side Government Promoted /Private insurance Companies Central and State Governments IT Companies Supporting Health Insurance sector Insurance Consultants ( Companies and Individuals) Demand Side Disadvantaged People - Grouped / Individuals ; Rural Urban Intermediary Organizations/ Individuals NGOs - MFIs People’s Organizations- SHG Federations, Health Mutuals, Self- Reliant Cooperatives, Farmers’ Unions Panchayati Raj Institutions Individual Advisors/ Agents Other Organizations Regulatory Bodies- IRDA - Insurance Regulatory And Development Authority, NABARD, RBI Research Organizations – Micro-Insurance Academy and Management Institutes Service Providers-Hospitals, Clinics, Medical Development Professional

Solution Exchange – an initiative of the UN Country Team in India Gaps identified in the Value Chain of Micro Health Insurance Details of the Schemes not available in Local Languages Consider Higher end Premiums as Investment- Expect Returns Premium Payments in Trainings/ Meetings Enhances faith of the members ‘Commercial Approach’ – Need ‘Value Oriented Approach’ Lack of Faith on Claim Settlement Process- Need of SHGs/ People’s Organizations Felt Gaps - Products Offered by Insurance Companies and needs of Different Segments Problem of Information Asymmetry ‘Health Mutuals’ / Community Based Models Solution

Solution Exchange – an initiative of the UN Country Team in India SPECIFIC RECOMMENDATIONS Mapping of all the schemes and conducting a mass media campaign to build common understanding Training of Intermediaries and SHG leaders on Claims Handling Mechanism to Monitor different Activities of Micro-Health Insurance – Products, Delivery of services claims Administration Demystifying different types of services – Health insurance, Health Care, Hospitalization Enhancing networks of hospitals and clinics in rural areas/ Replicating Own Networks/ Tie-up arrangements, Cash Less Facilities experimented by some NGOs Enhancing Participation of Intermediary Organizations – NGOs, Mutuals, Cooperatives etc. as Key Facilitator Representing Supply as well as Demand Side Micro Health Insurance – Key Factor in Livelihood Security NGOs to create Formal/ Informal Networks- Deal with the companies Collectively

Solution Exchange – an initiative of the UN Country Team in India SPECIFIC RECOMMENDATIONS Link micro Health Insurance with Community Health Interventions ( Public Sanitation, water, Health Centers) Role of Community Based Models- for Enhancing Outreach Using Heterogeneity creatively ( Mixing Well-off and poor Clients Ex-West Bengal ) Profit Sharing Models for Intermediaries ‘Strategy of Exclusion’- Based on Risk, Age, Pricing discrimination to be stopped. Regulations required- Inclusive (Group) policies Not only Sustainable ‘health Insurance systems’ but ‘Social Security Systems’ NGO Networking – Common Platform to Pool Resources, Collective actions, Sharing Tools- pricing software, MIS etc. ( Maharashtra Example) ‘Intermediary Service Providers’ ( ISPs) function as a substitute for Third Party Administrators( TPAs) – Incentives to ISPs

Solution Exchange – an initiative of the UN Country Team in India International Examples Philippines- Mutual Benefit Associations – Nominal Regulatory Capital Req. (5 Million Pesos) Africa -Mutual Health Organizations( MHOs) Europe – Health Mutuals in France represent 85% of Complementary Health Insurance market IRDA – Guidelines required for – Non Partner Agent Model: Regulations for Community Owned Health Mutuals Need for Introducing the concept of Health Mutuals for Increasing outreach- Existing SHG Federations Create ‘Health Mutual fund’

Solution Exchange – an initiative of the UN Country Team in India Legal Entity Basic Characteristics of Mutuals – Voluntary and Open Membership Democratic Management Pooling of Resources One member one vote Mutual Help and Solidarity Equal Rights and Ownership Share Capital Profit / Surplus Creation and Distribution Tax Exemptions Benefits Not For Profit To Some ExtentNoNo Distribution Yes. Max. Mutual Benefit Compulsorily PresentYes To some extent For ProfitOnly Pooling of ResourcesYesYes (based on Share) No Comparative Analysis

Solution Exchange – an initiative of the UN Country Team in India Thanks