Yeshasvini Trust, Karnataka India
CGAP Working Group on Microinsurance: Good and Bad Practices, Case Study No. 20, 2005
45 Pages Posted: 18 Oct 2007
The Yeshasvini Cooperative Farmers Health Scheme is a young but incredibly successful micro-insurance scheme in Karnataka. Having started in 2003 with 1.6 million insured right away, it covered 2.2 million lives in its second year of operation, but in the third year it dropped to 1.45 million members after doubling the premium. This (still) amazing success is possible through a tight partnership with the cooperative sector enabled through the Karnataka Department of Cooperation. The department used its influence to encourage cooperative societies to market the product actively. The marketing strategy applied by the societies' secretaries varies: while most convince their members to join, a few simply enrolled their members. Yeshasvini Trust decided to design a benefit package focusing on high cost / low frequency events. More than 1,600 surgeries are covered under the scheme. The maximum coverage provided for one person per year amounts to Rs. 200,000 ($4,545). The annual premium per client was recently increased from Rs. 60 ($1.40) to Rs. 120 ($2.70). A person can claim the benefits in one of 150 (mainly) private hospitals aligned with the insurance scheme. A rate for each surgery is fixed. Additionally, free outpatient department (OPD) treatment is provided. The patient does not need to handle money; the insurer pays the health care provider for pre-approved surgeries, so the service is cashless to the policyholder. Yeshasvini is a self-funded scheme and not linked to any insurance company. It outsources the administration of the scheme to a Third Party Administrator, a profit-oriented company. This company authorizes surgeries, processes claims and maintains a register of the members. The scheme received government subsidies in all years of operation. With the increased premium in the third year, the scheme is expected to get closer to financial viability. Although Yeshasvini can use the cooperative structures to channel information to clients, many policyholders are not well informed about the benefits and how to claim them.
Keywords: micro health insurance, social insurance, insurance for the poor, community based health insurance, health financing
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