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WELCOME TO NATIONAL LEVEL MEETING OF PROJECT DIRECTORS OF RURAL DEVELOPMENT. ANDHRA PRADESH. PRESENTATION ON Community Managed Health & Life Insurance Total Financial Inclusion Food Security. SANJEEVANI “Community Managed Health Insurance”. SANJEEVANI.

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Community Managed Health & Life Insurance

Total Financial Inclusion

Food Security


“Community Managed

Health Insurance”


  • Sanjeevani is a Community based and Communitymanaged Health Welfare Scheme, promoted by Zilla Samakhya, Vishakhapatnam.

  • This is an initiative to make Healthcare Services accessible to rural Self Help groups ( SHGs) and to promote preventive Healthcare.

  • Good health is a pre-requisite to human productivity and the development process. A healthy community is the infrastructure upon which an economically viable society can be built.

Need for the Scheme

  • Existing schemes are not pro-poor

  • Cumbersome Procedure

  • Uncertainty of coverage of financial shock from health care expenses

  • Expulsion of pre-existing deceases (Rural poor won’t go for regular check-up of deceases

Need for the Scheme

  • Uniqueness of existing schemes – Insurer, Insured, TPA and Service Providers are un-happy

  • Existing health care facilities from Govt. institutions not accessed adequately

Scope of the Scheme

  • Hospitalization Cover for Surgeries and Medical Conditions

  • Free Outpatient Consultations.

  • Fixed discounts on

  • - Medicines

  • - Investigations

  • Consultation by a lady doctor on specified days.

Administration of the Scheme

  • The scheme will be implemented and administered by Zilla Samakhya, in coordination with the Mandal Samkhaya, and Village Samakhyas.

The Role of Zilla Samakhaya

  • The ZS is responsible for the day-to-day operation of the Scheme and will ensure service standards at provider Network for hospitalization and Diagnostics.

  • The duties will include,

  • Maintaining member database

  • Issuing Photo ID cards to the families covered under the scheme

  • Creating a network of hospitals to facilitate Cashless treatment to the beneficiaries of the scheme

  • Facilitating the authorization process with the Network Hospitals

  • Claims Processing and settlement.

Coverage and Premium

  • Period of operation from 1st May 2007 to 30th April 2008

  • Maximum amount payable Per Family Rs. 30,000/- for surgeries ( List provided ).

  • Maximum amount payable is Rs 5000/- for medical conditions other than surgeries under the Family Package 5.

  • 10% of Co-Payment by the patient on the final bill.

  • Premium payable is Rs. 260 per year for a family of 5.

  • Age Limit: 0-60

Features of the Scheme

  • Out Patient Consultation

  • PHC level: consultation with lady doctors once in a week free of cost

  • Network Hospital (NWH): consultation free of cost

  • Diagnostics:

  • Basic diagnostics will be done at PHC free of cost

  • Diagnostics at NWH will be done at a fixed discounted rate.

  • Quality Medicine

  • Free of cost at PHC level

  • 2.  10% Discount rate at NWH

  • 3. Grossly discount at Drug depots of IKP (Sanjeevani Pharmacy)

Features of the Scheme

  • Contd…

  • 4. Hospitalization cover:

  • Cover- Inpatient treatment requiring hospitalization for more than 24 hours.

  • Cover would include consultation, investigation and room charges, medicines and consumables.

    • 5. Medical and Secondary and Tertiary Surgical Care

    • Treatment provided through Referral Network Hospitals only with 100% Cashless facility

    • 6. Pre existing diseases are covered

    • 7. Treatment in General ward only

Surgeries Covered

  • The scheme covers more than 1500 surgeries, including all categories of complex and common surgeries, such as

    • OBG – includes normal delivery, LSCS and Hysterectomy

    • General Surgery

    • Gastroenterology

    • Orthopaedics – includes fracture surgeries

    • Genito-Urology

    • Endocrinology

    • ENT

The Team

  • Case Manager – Role and Responsibilities

  • Coordinate the referral system of the patient

  • Regularly visit the Network Hospitals, at least once a week, and ensure that the terms and benefits of the scheme are being properly followed.

  • Regularly interact with the beneficiaries of the scheme undergoing treatment for feedback.

  • Inform the Implementing Agency (ZS) about any non-conformance, if any, and follow-up on action taken.

  • Collate data and statistics from network hospitals on the scheme every week end and Submit it to the ZS

The Team

  • Case Manager – Role and Responsibilities

  • Randomly verify the operated cases for authenticity of the members.

  • Verify the authenticity of every case received for pre-authorization and submit report to ZS.

  • Medical Officer – Role and Responsibilities

  • Approval of Preauthorization based on necessity of treatment

  • Liaison with NWH

  • Quality monitoring of service providers

Beneficiary approaches VO Representative

VO rep explains scheme

Beneficiary goes Network hospital with ID Card, Receipt

Medical treatment

Admission for Surgery

Intimation to TPA/ZS by NWH

Patient pays 10% of the bill

Pre-Authorization- from TPA/ZS

CASHLESS Hospitalization

Member signs on the Claim Form


Free OPD Consultation


Special rates

Process of Availing Treatment

Receipt of claims

From NWH

Document verification


Communication To Hospital


Claim ID Generation

Medical Scrutiny and Claims Processing

Claim pending for supporting


Approved Claims

Submitted To Trust (Weekly)

Communication To Hospital

Letter Of Settlement To he Bank By ZS

Collection of DD

Dispatch o hospital


Claims Flowchart


  • Total House Holds Covered sofar: 32,840

  • Annual Premium per Family: Rs.260/-

  • No. of Net working Hospitals: 17

  • 4.No. of PHCs & CHCs: 27

  • 5. Claims Received (May to December): 650

  • 6. Claims Settled (May to November): 650

  • 7. Claims amount Settled: Rs. 23.50 Lakhs.

    • Health Cards issued to all families covered under the scheme

    • 29 Case Managers trained & Positioned in all Mandals&KGH

    • One Medical Officer trained and positioned.


  • Free OP: No. of Patients benefited

    • In Primary Health Centres: 11,325

    • In Networking Hospitals: 4,460.

  • Diagnostic Tests

    • 20% discount on diagnostic tests

    • Amount benefited: Rs.1,51,860

  • Drugs

    • 10% discount on drugs

    • Amount benefited: Rs.98,329

  • Impact

    • Medical Cases treated

      • Physical:373

      • Amount:Rs. 9,12,465

    • Surgical Cases treated

      • Physical:277

      • Amount:Rs. 14,37,664

    Expenditure (From May to December 2007)

    • Medical Cases

    Medical Cases Treated

    Medical Cases Treated

    Expenditure (From May to December 2007)

    • Surgical Cases

    Surgical Cases Treated

    Surgical Cases Treated

    Community Managed Life Insurance Scheme

    Community Based life Insurance Scheme

    • Objective

    • Need

    • Evolution

    • Implementation

    • Claim Settlement Process

    • Impact




    • Scheme seeks to offer a risk mitigation measure for

      the rural poor against sudden death & disability .

    • The CBO - SHG and their federations VO Mandal

      Samakhyas and ZS play key role in evolution,

      implementation of the scheme




    • Rural poor household having no access to formal Insurance

      services to cover risks.

    • Very limited awareness about insurance related risk

      mitigation options amongst the poor.

    • High premium coupled with tedious & time consuming claim

      settlement process.

    • Participatory community based insurance delivery

      mechanism meets the needs of the poor more effectively

      than the provider managed insurance delivery.




    • Initiated dialogue with community on need for community

      based life & General insurance and risks to be covered.

    • Dialoging with insurance providers by CBO with facilitation

      support extended by functionaries.

    • Finalizing service providers with clear cut MOU between the

      insurance providers and Zilla Samakhya.



    A.P. Level Achievement 2007-08

    • Total Members covered:26,15,540

    • Premium Amount collected:Rs.26.68 Crores

    • Premium Amount paid to

    • Insurance Company:Rs.21.71 Crores

    • No. of Claims Received sofar:7215

    • Natural Deaths : 6459

    • Accidental Deaths: 756

    • Claims settled sofar:6133

    • Natural Deaths : 5515

    • Accidental Deaths: 618

    • Claim amount settled:Rs.15.73 Crores



    District-wise Achievement 2007-08



    District-wise Achievement 2007-08



    • Amount collected by CBO” per member Rs. 105/-

      • TATA – AIG life insurance premium Rs. 61/-

      • New India Assurance premium Rs. 12/-

      • Corpus available per member at ZS Rs 32/-

    • Total 1,00,681 Members covered

      • Rs. 105.71 Lakhs Amount collected by Zillah Samakhya.

      • Rs. 61.41 Lakhs Amount paid to TATA-AIG towards life

      • Insurance

      • Rs. 12.08 Lakhs Amount paid to New India Assurance

      • towards general insurance.

      • Rs. 32.21 Lakhs with ZS.

    Implementationin Visakhapatnam 2006-07



    Implementation in Visakhapatnam 2007-08

    • Amount collected by CBO” per member Rs. 80/-

      • Life Insurance CorporationRs. 50/-

      • National Insurance Rs. 18/-

      • Corpus available per member at ZS Rs 12/-

    • Members covered so far as against proposed target of

      83,266 members.

    • Rs. 66.61Lakhs Amount collected by Zillah Samakhya.

    • Rs. 41.63 Lakhs Amount paid to Life Insurance towards

    • life insurance.

    • Rs. 14.98 Lakhs Amount paid to National Insurance

      towards general insurance.

    • Rs. 9.99 Lakhs with ZS.



    Claim settlement process

    • Information from affected family to ‘VO’ from SHG.

    • Verification and Certification by ‘VO’.

    • Claim submission to Zilla Samakhya through Mandal


    • Verification by ‘ZS’ monitoring committee.

    • Claim submission by ZS to insurance company.

    • Claim settlement by ZS within ‘7’ days of receipt of the claim

      by ZS pending release of money by insurance company is ZS.

    • Claim shall reach ZS within ’90’ days of occurrence of the





    • Affordable premium

    • Immediate claim settlement by Zillah Samakhya.

    • 357 Claims settled so far against 390 claims


    • Rs. 89.10 Lakhs Amount distributed towards claim



    • 193 Claims settled so far against 235 claims


    • Rs. 73.69 Lakhs Amount distributed towards claim


    Impact in Visakhapatnam District



    ‘Total Financial Inclusion’

    General definition of financial inclusion

    • Accessing to banking services at affordable cost

      - Opening of ‘no frills account’

      - Issue of ‘General Purpose Credit Card’


    • To address all the financial needs of all households

    Should we focus on all or should we focus on poor ?

    The ‘Spread’ of Financial Inclusion

    Whether urban or rural, the spread is ‘wide’ in non-poor vis-à-vis poor

    Analysis of financial needs of the poor

    The Expenditure Portfolio of the Poor

    • House construction / repairs

    • farm activities

    • Working capital

    • non-farm activities

    • major

    • Health problems minor

    • school education

    • Children education –

    • higher education

    • Marriage purposes

    • Income generation Activities

    • Long term investment on land

    Scale of exp on these items

    • House repairs/construction-5,000 to 20,000

    • Marriage purpose - 20,000 to 50,000

    • Health needs - 5,000 to 15,000

    • Children higher education - 5000 to 10,000

    • Income Generating Assets – 10,000 to 15,000

    • Working Capital - 5,000 to 10,000

    • Long term investment on land – 30,000 to 50,000

    Own funds vis-à-vis debt

    Coping mechanism by the rural poor family

    • Debt

    • For smaller needs it is from banks

    • For larger needs it is from money lenders/mfi


    Money lenders/friends & relatives

    Which approach is better to reach the poor?

    Opening of ‘no frills’ account

    Issue of general purpose

    credit card

    Deepening the credit

    through SHGs


    Why SHG model for Financial Inclusion?

    • The ‘exclusion’ is more wide spread and deeper in poorer sections and priority is given to the poorest of the poor and the poor. The poor are in SHGs

    • SHG is proved to be an effective financial intermediary

    • ‘Financial inclusion’ does mean

    • (1)credit disbursement,

    • (2)credit utility and

    • (3)repayment

      – possible through SHG model

    Financial inclusion of Poor in Andhra Pradesh through SHG-Bank linkage

    Financial inclusion of the poor in Andhra Pradesh through SHG-Bank linkage

    • In AP, 90-95% of the poor are in SHGs and hence, ‘inclusion’ is wider (number covered) in the poor.

    • But inclusion is NOT deeper (when compared to financial needs)

    Financial inclusion – not deeper - empirical evidence

    Financial inclusion – not deeper - empirical evidence

    • In CC Palli village the total debt of 201 families was Rs. 29 lakh

    • Bank share was 11% (mainly for small needs)

    • Money lenders’ share was 87% (mainly for big needs)

    • Others’ share was 2%

    The Result ….

    Bank linkage per district (average): 150 crores

    Interest amount paid by all SHGs in the district: 230 crores


    Piloting the model

    • Take up this model in two villages in each service area of each bank-branch during 2007-08.

    Identification of village

    • Having good track record in SHG-Bank Linkage

    • Having SHGs which are following best practices

    • Having good book keeping practices in SHGs

    • Having SHGs with Poorest of the Poor and SCs and STs

    • Identification shall be done in consultation with CBRM/Mandal Samakhya


    • Facilitating the SHGs to enable them to be good SHGs - at least THREE months preparatory work has to be done in the village

    • All the members of each SHG shall be educated on financial inclusion

    • Book-keeping shall be strengthened

    • Good Monitoring mechanism shall be positioned

    Pre-conditions- intervention by IKP

    • CRP team consisting of four members-IB, TFI, BK and Activist, will be positioned

    • The team will work for 3 months in each village with 6 to 7 SHGs

    • The team will develop best practices in those SHGs

      -weekly meetings,

      -weekly savings

      -weekly internal lending of small debts,

      -weekly recovery of small debts,

      -book keeping – for every 4 SHGs, ONE book keeper

      -need based lending,

      -awareness among all members,

      -self-preparation of MCP by the SHG

    • Positioning of ‘anchor’ person for the branch

    Assessing the needs of each member of SHG

    • MCP shall be SHG-driven

    • The MCP includes the following:

    • Outstanding debt of the member to money lender or to mfi (the outstanding loan to Bank will be added at the end)

    • Income Generation

      • Requirement for investment in income generating asset

      • Working capital for agricultural purposes and for existing economic activities.

  • Social needs like health, education, food security, house repairs/construction, marriage purpose etc.,

  • Repayment by members to SHG

    • The installment shall comprise both principal and interest

    • It shall be monthly installment

    • It shall not be short term repayment – minimum 60 months

    • The members’ repayment is as per their capacity to re-pay

    • The members’ repayment schedule may vary-below 60 months-may be 40 to 48 months

    • There shall be surplus in SHG in every month


    Correlated with income of the poor

    Irrespective of income of the poor

    Repayment Plan of Members to SHG &

    Repayment Plan of SHG to Bank

    Why surplus in SHG?

    How to pay on monthly basis by the member ?

    High Cost ‘i’ paid to money lender is enough…to liquidate bank loan

    Monthly payments…..

    • Stabilising the monthly income

    • Multiple livelihoods

    • Access to Employment Guarantee Scheme

    If a big loan is again required …….

    Increase in the corpus of SHG

    • Surplus in SHG every month-the difference between members’ repayment to SHG and SHG’s repayment to bank

    • Increase in savings by the member in SHG

    Increase in the corpus of VO

    • Increase in savings by the SHG to VO

    • Introduction of ‘APADA NIDHI’-Rs.10 per each member with VO

    • Converting the CIF into ‘emergency fund’

    Financial Inclusion and other products

    • To members

    • To Village Organisation

    Other Products to members of SHG

    • savings product – RD for their children

    • insurance product-covering life, health, and assets

    • educational loan product through SHGs

    Cash Credit Limit to VO

    • Food Security initiative

    • Milk collection centers

    • Marketing activities

      The limit may be provided to the VO as per the guidelines approved by SLBC.

    Interventions in ‘key activities’ by the project

    • Identification of those ‘key’ activities, where huge investments are made by the members

    • Providing backward and forward linkages to increase production and marketing access


    Self-monitoring by SHG and VO

    • ‘Vetting’ of the plan by the SHG itself and later by the VO

    • Disbursement of loan to the members as per MCP

    • Utilization of loan by the member in the presence of the SHG or it’s committee

    • Submission of UC by the SHG to the bank and to the VO

    • Verification of assets purchased by SHG in a periodical manner by SHG itself and by VO

    Monitoring – intervention by IKP …

    • Community Based Recovery Mechanism (CBRM)

    • Participation of Branch Manager/Field Officer in VO’s scheduled meeting

    • Computerisation of transactions

    • One Anchor Person for each bank-branch

    Community Based Recovery Mechanism (CBRM)

    • Two members from each VO

    • All the rep from all VOs in a service area will form into CBRM

    • They will meet once in a month on a fixed date in the premisis of the branch

    • Each VO committee will maintain DCB of the linkage for that VO and bring it to the meeting

    • The OD & NPA will be discussed and corrective action will be taken by the committee before the next meeting and ensures 100% recovery

    • The utility of the loans will also be monitored by the committee and discussed in the meeting

    Bank – Linkage amount taken under T.F.Iin Maharajpeta (V) Consisting of Maharajpet, Gopuralam & Dontanapalli Hamplets of Rangareddy Dist

    Loan Amount Taken Under TFI in Gopularam H/o Maharajpet (V) of Rangareddy District

    Relief in interest burden per annumin Gopularam H/o Maharajpet(V) of Rangareddy District

    Building up of Assets of the poor in T.F.I. Village : Gopularam

    Increase in Annual Income of the poorin Gopularam H/o Maharajpet (V) of Rangareddy District

    Before TFI

    After TFI


    Bank Linkage

    Additional income

    Bank Linkage

    Additional income

    Bank Linkage

    Additional income

    Bank Linkage

    Additional income

    Achievement done sofar


    Total Villages covered:320

    Total SHGs covered:5218

    Total Financial Assistance extended:Rs.173.43 Crores


    Total Villages covered:1356

    Total SHGs covered:24456

    Total Financial Assistance extended:Rs.717.48 Crores


    The reason

    • The availability of rice under PDS is on an average 15 kg/month per family

    • The requirement of rice for an average size family in rural area is 50 kg/month

    • The gap is on average 35 kg/month

    • The 35 kg/month is used to be procured from open market

    • 2/3rd of the food security of the poor becomes vulnerable and subject to market fluctuations

    The coping mechanism

    • The stream of income of the poor is not regular-it is fluctuating on day basis

    • The expenditure for food for each day is more or less the same

    • The negative gap is being met by the poor either through borrowing or obtaining the food grains on credit basis or adjusted with low intake

    • The sufferers in the family are women and children


    • To attempt to minimise the “Food Gap” in POP and the Poor

    • To facilitate for the emergence of ‘Total FoodSecurity’ to the target poor at household level

    • To minimize the rate of exploitation in consumption expenditure made by the poor.

    • To provide access to good quality and accurate quantity of rice by the target poor through cheaper rates

    • TO correlate the nutritional improvement in the pregnant women and children with food security initiative

    Rice Credit Line-Reduction in Food Gap

    • Identifying the gap between the actual requirement of rice per month for each house-hold and therice availability from FP shop

    • Consolidating the requirement at VO level

    • Provision of funds from the CIF @ 90 % of the required funds – 10% being the beneficiary contribution

    The Cyclical Process in Rice Credit Line

    • Procurement of required rice on monthly basis by the VO from open market

    • Distribute it to SHG members through SHGs

    • Recovery of money through 3 or 4 installments by the VO from SHGs in the same month with little profit margin

    The Process

    • Sitting with the members of each SHG

    • Analyse the consumption pattern

    • Arriving at the rate of losses in respect of purchase of each commodity

    • Find out of the requirement of each member

    • Implementation in few VOs in each Mandal.

    The facilitation support

    • Training the VO Executive Committee

    • Training the CC and Activists in pilot villages

    • Facilitating the emergence of purchase committee, monitoring committee and recovering committee in each VO.

    • Introduction of Books of Accounts.

    Initially, requirement of each member in each SHG will be collected.

    Requirements of the VO will be arrived.

    Proposal will be sanctioned and the VO will be SPIA.

    The purchase committee procures the rice by conducting market survey in respect of quality and the price of the commodity.

    Implementation process-the collection of indent

    Implementation process-the distribution

    • The distribution committee will distribute to SHG leaders.

    • The SHG leaders will distribute to each member on the same day.

    • At every stage of distribution, the acknowledgements will be collected.

    Time line

    • First of every month SHG requirement is collected,

    • 2nd to 4th of every month VO level requirement is collected,

    • 5th to 10th of every month, distribution of rice from the mill to the VO, VO to SHG, SHG to members.

    Time line (contd..)

    • 10th every month, last date for distribution to the last member and collection of 1st installment.

    • 17th- 2nd installment,

    • 24th , 3rd installment ,

    • 30th / 31st final installment.

    Only rice will be included

    Recycling will be for every month or for every six months

    One month-procurement from open market or by procuring the paddy

    Six months- procurement of paddy, mill it in local rice mill and distribute to SHGs for every six months

    The basic model-rice centered

    The Comprehensive model

    • The commodity basket includes five commodities- rice, red gram, tamarind, edible oil and red chillies

    • It will be either one month model or three month model or six month model

    • In chenchu and other tribal areas the Food Security Basket will comprise 25-30 commodities-all house hold requirements

    If rice or paddy, it is at VO level

    In respect of red gram, tamarind, edible oil and red chillies it will be at VO level or at MS level or at Area level

    At VO level and MS level procurement committees are positioned out of the VO-EC or MS-EC as the case may be

    At AREA level the procurement committee is constituted with two members from each MS within that MS


    If it is monthly recycling, the recovery will be completed from the members within 3 weeks

    If it is 3 month/6 month model, recovery will be completed within 5 months

    In monthly model, the instalments will be on weekly basis

    In 6 monthly model the instalments will be on monthly basis



    • The corpus of the SHG

    • The CIF from the VO/MS

    • The cash credit limit by the bank to the VO

    Within the SHG, the food security plan is prepared by the SHG taking each member’s requirement , particularly the POP- both quality and quantity and the nature of food grains

    The repayment instalments will be fixed as per the convenience of the members

    The small loan provision is available in the SHG to the member in case she is not able to repay that instalment

    A poor women in Dondapadu Village of Thulluru Mandal Cooking Rice

    Inclusive approach

    The progress

    • Total no of VOs – 27,000

    • No of VOs covered – 6827

    • No of SHGs covered –1,83,241

    • No. of house-holds covered – 19,67,437

    • Quantity of rice – 68,860 MT/month

      -- 816,323 MT/year

    • Total turnover per year -- 898 crores

    • Total cost of the project – Rs.68 crores

    Reduction in “Food Gap” and increase in food intake by the poor

    Reduction in price

    Increase in real income

    Increase in quality

    Ensuring “Total Food Security”

    Caring for the aged, destitute and pregnant women

    Capital formation in VOs and MSs

    The Impact


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