Uplift Mutuals People Led Social Protection Kumar Shailabh

Why Mutuals Unorganized Sector’s Need Affordable product Access to quality care services Rationalization of costs(only) Transparent procedures Impact on Health Value for money Profit Sharing Risks in PA Health Insurance Numerous Exclusions Moral Hazard No people’s participation in Health -Risk Management Wrath of Claim rejection(affecting other business lines) Risk of premium increase due to high claim ratio Increase in cost of Care Risk of product inefficiency if very low claim ratio Profit sharing ?

Why we do not believe that they can… Community based models cannot be up scaled It is not insurance! Risk management should be done by professionals – insurers and re insurers (who can manage big losses) Though nascent MI got regulations and a clear delivery model(PA) No conclusive community based risk management business model in sight So what…can people really manage their own risk/insurance ?

21 Mutuals covering over lives in Maharashtra decide their premium, benefits, exclusions and claims and share and manage their health risks today. They saved their 31 lakh of rupees in 2008 in form of discounts negotiated with a shared network of health care providers While they paid 100 Rs/person/year the return on investment was 143Rs/person average only on amount saved- Claims paid were separate. They not only get timely access to quality care (a real time 24X7 helpline) but dedicated preventive services through discounted OPDs, Health Camps and Health Talks. Yes, people have been sharing risk and its growing!

This works through the Mutuals Model of risk sharing - that is a value chain of families, communities, their organized structures who come together to form Uplift –Risk is managed at multiple levels OK ! How does it work? Costs Frequency Many Colds, Flues, Gastros Some fractures, pneumonia, Respiratory diseases, Caesareans Rare ablations, Operations with Local Anaesthesia Rarest Severe operations under GA (Heart by pass… )

6 Costs Frequency UPLIFT Mutuals    Re -Insurance  Re -Insurance  MIU 2  MIU 2  Local Branch n.n  Local Branch n.1  MIU 1  MIU 1  Local Branch n.n  Local Branch n.1

Uplift’s Business Model Shared Resource Uplift Actuarial Support Systems Setup (TPA, MIS and Business Processes ) Risk Management Risk Sharing (Reinsurance) Capacity Building including Governance) CBOs Enbloc affiliation (distribution) Community Ownership Democratic decision making Due diligence in processes and finances Readiness to share Mutuals having representation on Uplift Board Community Relevant Shared and owned by Communities Social enterprise Technically sound

Uplift Mutuals…four defining values Inclusive Risk pooling Community Owned -Shared Health/Services need focused Technically Sound 8

INCLUSIVE,RISK POOLING AND MANAGEMENT 9

MUTUALS COMMUNITY OWNED SHARED 10

TECHNICALLY SOUND 11

HEALTH SERVICES -NEED FOCUSSED 12

Mutuals Performance as on Dec /3/2016 Performance Indicators Micro Health Insurance units Ongoing Members 62,804 Contribution Collected INR 6 MILLION Approx Amount disbursed INR 1.1 MILLION Reimbursement Ratio 53% Reimbursement Rejection Ratio 9% Reimbursement Frequency.2% Renewal Ratio 55% Reserves INR 1,640,585

Services Report for Mutuals /3/2016 Services Indicators Performance Data No of IPD referrals given 6210 % of positive referrals 78% Health Camps 70 Attendance4,093 Health Talks 337 Attendance4718 No. of OPD referrals 4302 Amount saved of members (fund)thanks to all services INR 3 MILLION(30 Lakhs)

Portfolio Growth /3/2016

Claims experience and frequency /3/2016

Health Services /3/2016

Savings thanks to services 2/3/2016