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PWDS STUDY ON NEERA’S MICRO HEALTH INSURANCE PROGRAM: PRELIMINARY FINDINGS Presented at the Multi stake holder workshop organized by DATA, at Madurai on 15 th Oct 2007. Dr.N.JEYASEELAN , CONSULTANT, MADURAI. firstname.lastname@example.org Mobile: 09344108120. ACRONYMS.
PWDS STUDY ON NEERA’S MICRO HEALTH INSURANCE PROGRAM:PRELIMINARY FINDINGS Presented at the Multi stake holder workshop organized by DATA, at Madurai on 15th Oct 2007.
UHI- Universal Health Insurance product (A govt. sponsored product) is from United India Insurance company. UHI is implemented only by NJT.
NEERA MHI (A customized product) product is from New India Assurance company & implemented by all the remaining 9 partner NGOs.
As NEERA has not made the product compulsory, penetration is lower.
Penetration rate is the indicator for the marketing efficiency of NGO / insurer.
DESIRABLE LEVEL: ABOVE 80%
Desired Benchmark: 75%
MHI product in NEERA program is a profitable proposition for insurers.
Overall % of claim settled to total claim lodged comes to 40.3%, which indicate that the insurer is more rigid in claim processing.
Generally assumed benchmark for claim occurrence: 3% /year
Figures in Brackets indicate the claim occurrence / year
Overall claim pending at 9.7%, is not a serious cause of concern.
Figures in brackets indicate the percentage to the total. Around 72% of claims are pending for more than 3 months, on which insurers should focus their immediate attention.
More of partial claim settlements indicate that the product features are not properly understood by clients & insurer’s processes need a revision.
As per IRDA norms, a claim has to be paid or disputed by the insurer giving relevant reasons within 30 days of receiving all relevant documents. Insurer has taken more than 3 months in 41.3% of the cases. Claims processing needs to be revisited. Figures in brackets indicate the percentage to the total.
When the claim rejection rate is more than 5%, it indicates that the product has too much of restrictive clauses with coverage policy.
Renewal rate is the best indicator for the customer’s satisfaction on the product.
Besides, settling claims, HR (Human relations) needs to be focused
DESIRABLE RENEWAL RATE IS ABOVE 80%
UHI – Universal Health Insurance product (Govt. sponsored insurance product)
NMHI- NEERA’s Micro Health Insurance product (A customized insurance product)
DO –Divisional Office as Delivery unit (AIRD & RCPED NGOs are under the DO fold)
BO - Branch Offices as Delivery units (The remaining NGOs are under the BO fold)
I thank PWDS, DATA team, NEERA partners, SHGs, CBOs (Federations of SHGs), Doctors & Insurers for their cooperation.I welcome your feedback / comments / Suggestions.Thank you. Dr.N.Jeyaseelan, Madurai.