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

Micro Insurance Scenario Demand Side • Disadvantaged People - Grouped / Individuals ; Rural Micro Insurance Scenario 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 Supply Side Government Promoted /Private insurance Companies • Service Providers-Hospitals, Central and State Governments Clinics, Medical IT Companies Supporting Health Insurance sector Insurance Consultants ( Companies and Individuals) • Development Professional Solution Exchange – an initiative of the UN Country Team in India

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

SPECIFIC RECOMMENDATIONS Enhancing Participation of Intermediary Organizations – NGOs, Mutuals, Cooperatives etc. as Key SPECIFIC RECOMMENDATIONS Enhancing Participation of Intermediary Organizations – NGOs, Mutuals, Cooperatives etc. as Key Facilitator Representing Supply as well as Demand Side 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 Mapping of all the schemes and conducting a mass media campaign to build common understanding 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 NGO Networking – Common Platform to Pool Resources, Collective actions, Sharing Tools- SPECIFIC RECOMMENDATIONS NGO Networking – Common Platform to Pool Resources, Collective actions, Sharing Tools- pricing software, MIS etc. ( Maharashtra Example) 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’ Link micro Health Insurance with Community Health Interventions ( Public Sanitation, water, Health Centers) ‘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 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

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

Thanks www. solutionexchange-un. net. in Solution Exchange – an initiative of the UN Country Thanks www. solutionexchange-un. net. in Solution Exchange – an initiative of the UN Country Team in India