The Hindu Business Line : Novel health cover for the poor in Kerala

THE Kerala Government and ICICI Lombard General Insurance Company are poised to sign an agreement for a pioneering health insurance scheme that seeks to bring the State's poor under `cashless medical treatment' cover.

To be implemented by the State Government's Kudumbashree poverty eradication programme, the `Arogyashree' scheme also has an accident insurance component that entitles a beneficiary below-the-poverty-line (BPL) family with a compensation of Rs 1 lakh in case of death of/full disability to head/earning member. In case of partial disability, the entitlement will be Rs 50,000.

Terms of health insurance are even more attractive and offer a better match to the Universal Health Insurance Scheme (UHIS) of the Centre, based on whose model Arogyashree has been configured. The share of the total premium of Rs 99 shall be borne in the ratio of 1:1:1 by the State Government, the local self-government and the beneficiary respectively. The share of the beneficiary is just Rs 33 (Rs 182 under UHIS). Medical expenses of up to Rs 30,000 for a five-member family will be paid out per year without individual limits. A formal memorandum of understanding has yet to be signed, but the scheme has already elicited enthusiastic enquiries from other State Governments, said Mr T. K. Jose, Executive Director, Kudumbashree.

Arogyashree vs UHIS: A comparison reveals that Arogyashree bests the parent UHIS feature to feature. For instance, Arogyashree offers cover for pre-existing diseases, first-year exclusions, maternity benefits and mental illness - all of which do not pass muster under UHIS. Provisions for bystander allowance and reimbursement of domiciliary hospitalisation costs are other highlights.

Arogyashree also covers transportation to hospital by ambulance or by other means of conveyance. Ayurvedic, unani and homoeopathic treatments are allowed. Members in the age group of three months to 80 years will be covered.

Photo ID: ICICI Lombard will issue photo identity cards to all beneficiaries within a period of 30 days from the date of signing of the MoU. All public and private hospitals with 15 or more beds are eligible to be members of the network envisaged.

Significantly, the company has also agreed to implement the scheme for the remaining three months of the current financial year as well as for the next three years without any change in the rates of premium.

Accordingly, the vast network of Kudumbashree neighbourhood groups has already been geared up for grassroots-level implementation.

Earlier, the State Government had constituted a Committee of Secretaries with a mandate to draw up a scheme for `bringing quality health care to the poor.' Executive Director, Kudumbashree, was the convenor of the committee.

A draft proposal was put up before insurance companies in both the public and private sectors. The offer submitted by ICICI Lombard was found to be the lowest at Rs 99 per annum (excluding the Rs 300 subsidy receivable from the Centre under UHIS).

The company has since confirmed that it is agreeable to offering all benefits envisaged in the scheme formulated by the committee.