COMPREHENSIVE ACCIDENT & HEALTH INSURANCE SCHEME
FOR BPL FAMILIES

LAUNCHED BY
GOVT. OF KERALA

KUDUMBASHREE

HEALTH INSURANCE – The Need
 
•    Achievements of the State in the Health sector comparable to Developed Nations
•    Low IMR / MMR, Improved Sex Ratio 1000:1059, Better Life expectancy rate – Male 74 & FM – 79, Universal Immunization etc,  unique features of the State
•    Increased awareness of people on Health care
•    Existence of good health care facilities in Public and Private sector
•    Laudable achievements under shadow due to increase in morbidity
 
 HEALTH INSURANCE – The Need
 
•    Increasing cost of Health Care
•    Technological & Scientific advancement in health sector not reaching the poor
•    Direct relation between Ill Health & Poverty
•    Ill health drag the poor further to destitution
•    Health Insurance - an innovative answer to protect the poor from  falling to a debt trap
 
HEALTH INSURANCE – The Scheme
•        Government appointed a Committee of 5 Government Secretaries to formulate the Scheme
•        Committee evaluated the ongoing schemes including Universal Health Insurance
•        The features  of the existing schemes are not meeting the actual requirements of the poor
•        Committee re designed the scope of Universal Health Insurance scheme by adding dire needs of poor
•        Extensive discussions with Insurance Companies – public sector and private sector.
•        Facilitated transparent bidding process.
•        Fetched lowest rate of Rs.399/- per family including Government of India subsidy of Rs. 300/-.
•        Financial committment of State Government only Rs.99/- per family.
 
 
BENEFITS OF SCHEME
PART 1 – ACCIDENT INSURANCE
 
•      DEATH OF HEAD OF FAMILY/EARNING MEMBER ( Rs 1.00 Lakh)
•      FULL DISABILITY OF HEAD OF FAMILY/EARNING MEMBER (Rs 1.00 Lakh)
•      PARTIAL DISABILITY OF HEAD OF FAMILY/EARNING MEMBER (Rs 50,000)
 

PART 2 – HEALTH INSURANCE
•      Medical Expenses up to Rs.30,000 for 5 member family per annum without individual limit
•      Covering members in the age group – 3 months to 80 years
•      Coverage in all Public/Private/Co-operative hospitals with 15 or more beds
•      Cashless treatment in all networked hospitals with Identity Card
•      Benefits from the next day of enrolment
•      Coverage for all Pre-existing illness
•      Mental Illness covered
•      Maternity benefits (Max. coverage of Rs 15000)
•      Domiciliary Hospitalization benefits.
    (Maximum amount of Rs 6000)
•      Subsistence and Bystander Allowances
    (Rs 50/-day for maximum of 7 days)
•      Pre & Post Hospitalisation treatment
•      Ayurvedic / Unani / Homeopathic Treatments
•      Transportation to hospital by Ambulance or by other means of conveyance
 

Exclusions:
•      Suicide attempts or any other self inflicted injury.
•      Injuries sustained due to usage of prohibited and/or unconventional drugs, consumption of alcohol and other banned substances.
•      Injuries arising out of and/or due to Acts of Terrorism.
•      Injuries resulted from acts committed by the insured person, which are a breach of law with or without criminal intent.
•      Maternity benefits during the first three months of the policy period.
 
COST SHARING PATTERN

COMPARISON OF UHIS & KUDUMBSHREE SCHEME
IDENTIFICATION OF POOR

 USING  9 POINT RISK INDEX
 
FAMILY
 
     1.    With No Land / Less than 5(U) / 10 cents of Land (R) 
     2.  With No house / Dilapidated House
     3.  With No Sanitary Latrine
     4.  With No access to safe drinking water within 150 meters
     5.  With No regularly employed person in the family
     6.  Women headed house hold / Presence of a widow,                     divorcee  / abandoned lady   / unwed mother
     7.  Belonging to Socially Disadvantaged Groups(SC/ST)
     8.  Presence of Mentally or physically challenged person /         Chronically  ill         member in the family
     9.  Without colour TV (U) / Having an illiterate adult         member ( R )
 
 
IDENTIFICATION OF POOR

 USING  9 POINT RISK INDEX
 
     ELIGIBLE FAMILIES

   With 4 or more indicators
•      3 indicators ( If one of the indicators is from 6, 7 or 8)
•      2 Indicators ( If both are from 6, 7, 8)
•      All ST families without Govt. Employment (Up to Class 4 Employee Exempted)
 
ENROLMENT OF BENEFICIARIES 

•    Insurance company print & supply 30 lakh forms & brochures
•    The District Missions of Kudumbashree to coordinate with CDS and LSGIs for distribution of Forms and Brochures
•    CDS to Collect back the completed forms along with beneficiary contribution of Rs.33/-
•    8,11,661 families enrolled as on 4th Feb 2006
•    Data entry and submission of data to be done by Kudumbashree IT units
•    Issuance of BPL Health Cards by ICICI Lombard
•    Distribution of BPL Health Cards to the families by CDS.
 
 
ADMINISTRATION OF SCHEME

  APPOINTMENT OF DISTRICT COORDINATORS
•   3 coordinators per district
•   2 coordinators to liaise with BPL Families
•   1 coordinator to liaise with the networked hospitals

    3 ZONAL OFICES
•   Thiruvanathapuram, Kochi and Kozhikkode
•   Oversee the coordinators/hospitals, ensure TAT( for preauthorization, customer care, etc.)
 
 SEPARATE COUNTERS/KIOSK AT MAJOR HOSPITALS