Seminar On Micro Insurance

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

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

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. How does the Health Insurance Industry looks today Around 9% population is covered……

5. How does the Health Insurance Industry looks today • ESIS 253 Lakhs • CGHS 43 • Railways 80 • Defence Employees 66 • Ex Servicemen 75 • Mining & Plantations 40 • State Sponsored Schemes 5 • Employer Reimbursement schemes 140 • Community Based H S 30 • Health Segment of Life Inc 2 • Health Ins PSU 100 • Health Ins Pvt Cos 30 • TOTAL 864

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

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

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

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

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

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

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

13. Suggested Plan • 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…… • Surgical treatment • Relevant Medical treatment

14. Suggested medium • Co-operative Societies • Banks/ NABARD • Co-operative Banks • 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 Public Private partnership Network of hospitals - both private and government - across the country to facilitate delivery of treatment to the rural poor at their door step……

16. Yeshasvini - Features 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

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

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

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

21. Provider of healthcare services Cashless treatment Special discounted tariff for medical treatment Preferential treatment Free Out-patient consultation Discounted Lab charges Exclusive front desk counter Network hospitals 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

23. Facts & Figures

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

25. Thank you