Family Health Plan Insurance TPA Limited (FHPL) announces its support for the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) Scheme, in an effort to bring health coverage to an additional 50 crore India with no health coverage. PMJAY is an initiative that has substantially expanded health coverage in India to approximately 10.74 crore families.
The total covered population under all other schemes such as ESIS, CGHS, ECHS, Railways and private insurance including PMJAY, is approximately 80-85 crore. As per the IRDAI Annual report 2018-19, the number of people covered under private paid insurance policies through insurance companies was 11.50 crore (individuals/families/group covers). This still leaves approximately 50 crore Indians without any financial protection against health shocks, especially of the catastrophic kind, potentially pushing these people to poverty or to avoid seeking appropriate healthcare. The Covid-19 pandemic, along with high ‘out of pocket spend,’ has further increased the vulnerability of the uncovered population. This segment of the population is often referred to as the ‘missing middle,’ in the discussions on financial protection and Universal Health Coverage in India.
The missing middle comprises of varied sections of the non-poor population – informal sector workers, self-employed, professionals, employees in MSMEs, and others who spread across occupations, geography and income strata. Lack of penetration of overall health insurance for this segment in particular is due to many reasons such as lack of awareness, low affordability, difficulty in reach & distribution, complex products, high premium levels (due to high claim cost for insurers), and lack of incentive/mandate to purchase health insurance, to name a few.
To address the needs of the ‘missing middle’, The National Health Authority (NHA) floated an ‘Expression of Interest’ for insurance companies to participate in insurance pilots. The NHA will extend support as outlined in the PMJAY framework for insurance companies to rate the risk and determine actuarial premium levels. IT systems and anonymized actuarial data for the relevant State/territory will be curated for the insurance company that intends to carry out pilots. Under insurance pilots, it is proposed that the insurance company shall offer coverage to the uncovered population on a self-pay basis, having the liberty to innovate, to attract and service the needs and aspirations of the profile of customers in this segment.
Upasana Kamineni Konidela, MD, FHPL, says, “The idea of universal health coverage and affordable healthcare is close to becoming a reality thanks to the initiatives by the National Health Authority. This is a superb and timely move by the Government that we wholeheartedly support during these tough times. There is no one model that can be adopted; referrals to several existing models, upgradation of technology and innovation are crucial in order for a final product to evolve”.
Bharathi G, CEO, FHPL, asserts, “At FHPL, we are keen to pledge our support by partnering and working with insurance companies to develop a best suited model and continue our unmatched service delivery. This is combined with our ability to set up servicing offices in any part of the country, managed with ease under tight deadlines. Our vast network of medical services and expertise allows us to handle claims, frauds, excellence in hospital coordination and promises unmatched efficiency and speed to provide cashless and claims services”.
