Kalaignar insurance scheme


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Kalaignar insurance scheme

  1. 1. KALAIGNAR INSURANCE SCHEME FOR LIFE SAVING TREATMENTS Abishek Roy Aparna Arun Prakash Shinde Deepak Surenderan Vidya Shankar Vishnu Varshan
  2. 2. <ul><li>“ Around 24% of all people hospitalized in India in a single year fall below the poverty line due to hospitalization ” </li></ul><ul><li>----(World Bank, 2002) </li></ul>
  3. 3. Tamilnadu <ul><li>Population: 6,70,12,000 (2010E) </li></ul><ul><li>BPL 22% => 1,47,42,640 </li></ul><ul><ul><li>Source: Department of Economics and Statistics </li></ul></ul><ul><li>As of 2004-2005, the poverty line in TN was set at Rs. 351.86/month for rural areas and Rs. 547.42/month for urban areas </li></ul><ul><ul><li>Source: Planning Commission, Government of India. </li></ul></ul><ul><li>For the same period, for India Rs. 356.3/month for rural and Rs. 538.6/month for urban </li></ul>
  4. 4. <ul><li>Target: More than 1 crore poor families </li></ul><ul><ul><li>Any family whose annual income is Rs.72,000 or less </li></ul></ul><ul><ul><li>All members of 27 welfare boards </li></ul></ul><ul><li>Cover of Rs. 1 lakh per family for 4 years </li></ul><ul><li>51 critical life saving treatments covered </li></ul><ul><li>No pre/post medical expenses paid </li></ul>
  5. 5. <ul><li>Smart Cards issued on eligible applications </li></ul><ul><li>Liaison Officer in each network hospital </li></ul><ul><li>Referral slips from Primary Health Centers/GH </li></ul><ul><li>Hospitals categorized as A/B/C </li></ul><ul><li>Emergency cases: Attended immediately & proof to be submitted within 48 hrs </li></ul>
  6. 6. Current Status <ul><li>Current enrolled: 1.43 crore families </li></ul><ul><li>30,508 people had been provided treatment under 'Kalaignar Insurance Scheme for Life Saving Treatments' at a cost of Rs 102.17 crore </li></ul><ul><ul><li>Source: ET, Jan 26, 2010 </li></ul></ul><ul><li>More treatments being added </li></ul><ul><li>Target: 1 lakh treatments by June, 2010 </li></ul><ul><li>Source: Mr. Murali Krishnan, Field Manager of KKT, Star Health, Trichy </li></ul>
  7. 7. KKT-Trichy <ul><li>5 lakh families (4 lakh smart cards issued+ 1 lakh under processing) </li></ul><ul><li>80 to 85% coverage reached </li></ul><ul><li>Around 2700 treatments at Rs. 6.27 crore </li></ul><ul><li>36 hospitals empanelled till now </li></ul><ul><li>Few cases cover extended to more than Rs. 1 lakh on case to case basis </li></ul><ul><li>Source: Mr. Murali Krishnan, Field Manager of KKT, Star Health, Trichy </li></ul>
  8. 8. Operational Issues <ul><li>Usage of medical terms leads to complications for users. </li></ul><ul><li>51 main categories and around 475 sub-categories of treatments only covered </li></ul><ul><li>Infrastructure issues in including GHs/Rural hospitals </li></ul><ul><li>Eligibility verification not proper </li></ul><ul><ul><li>Live cases found in BHEL/OFT here </li></ul></ul>
  9. 9. Avg Cost per Treatment Rs. 33,500 Target 1 lakh treatments Total Claims expected Rs. 335 crore Claims as % of Premium paid 71% Cut-off % as per agreement 65%
  10. 10. Rajiv Aarogyasri Community Health Insurance Scheme in A.P. <ul><li>Widely appreciated model since 2007 </li></ul><ul><li>Premium payout of Rs 330 per family. </li></ul><ul><li>Annual health cover of Rs 1.5 lakh </li></ul><ul><li>Phased roll out, 6.5 crore BPL families in 23 districts </li></ul><ul><li>367 private and public hospitals as service providers </li></ul>
  11. 11. Central Govt Scheme <ul><li>Rashtriya Swasthya Bima Yojana (RSBY) to provide health insurance for families below the poverty line. </li></ul><ul><li>The beneficiaries are entitled to hospitalisation coverage of up to Rs 30,000. </li></ul><ul><li>Only 30 lakh smart cards have been issued so far. </li></ul><ul><li>The Congress has promised to cover all poor families within the next three years. </li></ul>
  12. 14. Insurer Perspective <ul><li>Readily available pool </li></ul><ul><li>Profits capped at 35% of premium </li></ul><ul><li>Inability to revise premium & an uncertain risk profile </li></ul><ul><li>Review the premium based on the morbidity experience and the benefit structure. </li></ul><ul><li>Maintain satisfaction of Govt as well maintain profits. </li></ul><ul><li>Building & expanding relationships with Hospitals </li></ul>