Hyderabad: There are 50 crore Indians without any financial protection against health shocks, especially of the catastrophic kind, potentially pushing these people to poverty. 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.
Upasana Kamineni Konidela, MD, Family Health Plan Insurance TPA Limited (FHPL), “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.”
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.
FHPL is one of the TPAs managing PMJAY in the entire state of Assam, 11 districts in Punjab, 15 districts in Gujarat, the entire state of Uttarakhand and 5 districts in West Bengal’s state-run scheme, Swastya Sathi. In the past it has been an integral part of Arogya Bhagya- Karnataka police 2002-2008, Yeshaswini 2003-2010, Maharashtra police 2005-2014, Vajpayee Arogya Shree in Karnataka from 2009 to 2014.
Says Bharathi G, CEO of FHPL, “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.”