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    Micro-Insurance Briefs: Tamil Nadu: Kadamalai Federation Health Insurance Scheme (DHAN Foundation)

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    KoolPal
    The Kadamalai Federation Health Insurance Scheme is a community-based health insurance program run by the DHAN Foundation in Tamil Nadu, India since 2000. [1] It is owned and managed by six self-help group federations representing over 15,000 individuals. [2] For an annual premium of 250 rupees per family or 200 rupees per individual, the program provides up to 10,000 rupees per family for hospitalization costs and access to primary healthcare services. [3] The scheme has expanded healthcare access, seen high renewal rates, and plans to continue growing coverage through partnerships with government health systems.

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    Micro-Insurance Briefs: Tamil Nadu: Kadamalai Federation Health Insurance Scheme (DHAN Foundation)

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    KoolPal
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    The Kadamalai Federation Health Insurance Scheme is a community-based health insurance program run by the DHAN Foundation in Tamil Nadu, India since 2000. [1] It is owned and managed by six self-help group federations representing over 15,000 individuals. [2] For an annual premium of 250 rupees per family or 200 rupees per individual, the program provides up to 10,000 rupees per family for hospitalization costs and access to primary healthcare services. [3] The scheme has expanded healthcare access, seen high renewal rates, and plans to continue growing coverage through partnerships with government health systems.

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    The Kadamalai Federation Health Insurance Scheme is a community-based health insurance program run by the DHAN Foundation in Tamil Nadu, India since 2000. [1] It is owned and managed by six self-help group federations representing over 15,000 individuals. [2] For an annual premium of 250 rupees per family or 200 rupees per individual, the program provides up to 10,000 rupees per family for hospitalization costs and access to primary healthcare services. [3] The scheme has expanded healthcare access, seen high renewal rates, and plans to continue growing coverage through partnerships with government health systems.

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    25 views2 pages

    Micro-Insurance Briefs: Tamil Nadu: Kadamalai Federation Health Insurance Scheme (DHAN Foundation)

    Uploaded by

    KoolPal
    The Kadamalai Federation Health Insurance Scheme is a community-based health insurance program run by the DHAN Foundation in Tamil Nadu, India since 2000. [1] It is owned and managed by six self-help group federations representing over 15,000 individuals. [2] For an annual premium of 250 rupees per family or 200 rupees per individual, the program provides up to 10,000 rupees per family for hospitalization costs and access to primary healthcare services. [3] The scheme has expanded healthcare access, seen high renewal rates, and plans to continue growing coverage through partnerships with government health systems.

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    MICRO-INSURANCE BRIEFS

    Tamil Nadu: Kadamalai Federation Health Insurance Scheme (DHAN Foundation)

    Scheme Design General Overview


    Since 1997-98 the Development of Humane Action (DHAN) Starting date: April 2000
    Foundation has carried out innovative rural development Ownership profile: Federation of SHGs
    work and has up scaled these to many parts of the country. Target group: SHG members and
    At present it operates in Andhra Pradesh, Tamil Nadu, their families
    Karnataka, Orissa, Madya Pradesh, Rajasthan, Kerala, Outreach: Six SHG federations
    Maharastra and Union Territory Pondicherry with an outreach in Theni Dt, TN
    to 6 lakh poor households. DHAN Foundation believes that Intervention area: Rural
    poverty and resource degradation are best addressed by Risks covered: Health care
    linking communities with mainstream sectors like banks, Premium Insured/Y: Rs 250/family of 5 or
    insurance companies and government agencies as the poor Rs 200/person
    have a legitimate right over resources available. Co-contribution: No
    The Kalanjiam Community Banking Programme was evolved Total premium: Rs 250
    by DHAN as an alternative banking system managed by poor No of insured: 15725
    women. People institutions are promoted at three levels – Operational Mechanisms
    self-help groups (SHGs) at village level, cluster development Type of scheme: In-House
    associations at the level of groups of villages and federation Insurance company: NA
    of SHGs at block level. Tank fed Agriculture Programme, Insurance plan year: July - June
    Rainfed Farming Development, Working with Panchayats, Insured unit: Family of 5
    Post Tsunami Programme, Information and Communication Type of enrolment: Voluntary
    Technology for Poor and Tata-DHAN Academy are the other One-time enrolm.fee: None
    development activities of DHAN Foundation. Premium payment: Upfront
    Insurance, one of the programme components safeguards Easy payment mech: Special savings in
    the poor from risks and vulnerabilities. It is offered through SHG’s
    community programmes or in collaboration with insurance Waiting period: None
    companies. Over 4.5 lakh poor access insurance, of which Indirect subsidy: Admin costs covered
    60000 are covered under community based insurance by MF activities
    schemes of life, health and crop. Scope of Health benefits
    Community based health insurance was first offered by the Tertiary health care:
    Kadamailaikundu federation at Theni District in April 2000. A Hospitalization:
    well designed scheme it includes features such as ownership
    of hospital, widespread community health support through Deliveries:
    local village health workers and an efficient monitoring
    system. It has evolved into a mutual insurance programme Access to medicines:
    model, fully owned and managed by the community. By July Primary Health Care:
    2007, the programme was replicated in five additional
    federations in Theni District. A 24 hours Community Hospital Level of Health benefits
    – SUHAM (Sustainable Healthcare Advancement) Hospital Hospitalization: Up to Rs 10,000 per
    has been established at Theni with surgical facilities and Medicines: family
    pharmacy. Primary health care
    Service Delivery
    Eligibility Conditions Prior H. check-up: No
    Tie-ups with HP: Yes
    The scheme is open to all member of the Kadamalai Kalajia Type of agreement: Formal
    Vattara Sangam federation of Women SHG’s promoted by No of Assoc. HP: 9
    DHAN Foundation Access to HC serv: free access + referral
    Co-payment: PHC & secondary
    Exclusions level hospitals - 25%;
    None at SUHAM
    No exclusions. Secondary care entitlement only upto 55 HC service payment: Cashless
    years, those above this age get benefits at Kalanjiam TPA intervention: No
    Hospital only. Addit. financial ben.: Wage compensation
    Addit. non-fin. ben.: Mobile clinics

    Micro-insurance briefs: Kadamalai Federation Health Insurance scheme (DHAN FOUNDATION) 1


    Plan Benefits Activity Indicators

    • 75% of total hospitalisation expenses upto maximum of


    Num ber of Insured
    Rs 10,000 per family 20000
    • Primary Health care at community hospital 15725
    • Wage loss compensation of Rs 75.day to a maximum of 15000 12845 12407
    15 days if hospitalised at a government hospital 11495
    10000
    Premium
    5000

    The annual premium to cover a family of five is Rs 250. For


    0
    an individual with no dependants/family it is Rs 200 per year 2004-05 2005-06 2006-07 2007-08

    Insurance Plan Key Features

    The insurance plan has the following main features:


    Wom ens' participation
    • A community owned and managed mutual health
    scheme Men
    • Mutual model – promoted by federations, spreads risk 44%
    across mutual members and backed up by a
    Women
    reinsurance mechanism presently provided by Eureka
    56%
    Re (Netherlands)
    • Scheme has its own hospital that takes care of primary
    health at federation and one 24 hour hospital at district Women Men
    HQ providing secondary health care
    • Also ties up with 9 referral hospitals for the secondary
    level care
    • Has mobile clinic services reaching the villages through
    a van

    Main Achievements

    • Steady membership with high renewal rate


    • Scheme has been expanded to 4 more federations
    • 24 hour community hospitals with surgical facilities and
    pharmacy established at District HQ

    Remaining Challenges

    • Extending coverage to all members of the federation

    Development Plans
    Development Plan
    • Working with government health care system through 2011 100000
    public private partnership

    2008 15725

    Micro-insurance briefs: Kadamalai Federation Health Insurance scheme (DHAN FOUNDATION) 2

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