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Low income families face significant barriers to accessing quality healthcare. Only 2.6% of Pakistan’s GDP is allocated to health care provision, leading to significant service gaps in the public sector, leading to heavy reliance on private healthcare facilities. This is expensive, and poor households typically have to borrow money or sell assets to meet the costs. The NRSP Hospital and Accidental Death Insurance programme was designed to address these problems. The programme is now the largest in Pakistan’s private sector, covering clients and their spouses in 38 Districts.
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The programme, launched in November 2005 in partnership with the Adamjee Insurance Company, was designed for the Rural Support Programmes’ CO members. CO members give their insurance claims to NRSP staff and NRSP submitted them to Adamjee, which then processes the claims and made payments through NRSP. The ceiling for insurance compensation was Rs. 25,000 which includes in-patient hospitalization expenses incurred due to illness or accidental injury. The life insurance policy, which also has ceiling of Rs. 25,000,was applicable in case of death or permanent disablement resulting from accidental bodily injury. Each client paid an annual fee of Rs. 250 and the policy was limited to the individual policy holder.
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Revised Insurance Agreement: Linking hospitalization and accidental death insurance with the micro credit programme. Following our analysis of claims and dialogues with community members we revised the programme in 2006, when NRSP signed a direct agreement with the Adamjee Insurance Company. The analysis showed that the majority of claims were for less than Rs. 15,000. The premium was then reduced to Rs 100 and the coverage limit was to Rs. 15,000 and coverage expanded to include funeral expenses for death from natural causes.
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In July 2013 NRSP signed micro insurance agreement with Jubilee General Insurance Company. All the benefits, coverage limits and operational procedures were same as in the last year contract. Now coverage revised upto Rs. 20,000 for individual against the premium of Rs. 200 for both client and spouse. NRSP and Jubilee are working to arrange cashless claim facilities through the arrangement of panel hospitals initially at the district level and later on such panel hospitals will be arranged at Tehsil level for convenience of policy holders. The policies now cover the client and his or her spouse. All NRSP loan clients aged 18 to 65 are eligible. The premium is embedded in the credit processing fee. The agreement stipulates that the insurance policy is in force for a maximum of 12 months. Insurance cover starts from the date of the credit cheque.
The salient features of the current insurance scheme are: Target clients: All micro credit clients of NRSP and their spouse Coverage: “Hospitalization, Accidental Death, Disability of CO member" Covers pregnancy, pregnancy related diseases and delivery Additional cover of natural death/ funeral charges Maximum ceiling is of Rs 20,000 for each of the above coverage Keeping in view the significance of family planning services these are included in the product benefits. Under this coverage client can get reimbursement if birth control procedures has been done in panel hospitals/family planning centers. Premium: Rs. 200 for both client and spouse per annum
Part of regular Micro Finance activities carried out by NRSP therefore has a big reach Administration cost factored into the premium Wide range coverage of community organization in all programme areas. Health education workshops Claims processing co-ordinate by a NRSP facilitator and monitored by Medical officers MIS which helps in analyzing the claim data for product and programme innovations; Cashless health facilities through empanelled hospitals at the district and Tehsil level Speedy claims settlement (20 to 25 days) in case of reimbursement mode Regular feedback collected from the NRSP members regarding the product and its significance, during community organization meetings
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