Group health insurance scheme for PLHIV (people living with HIV)

[Guest guest]

GROUP HEALTH INSURANCE SCHEME FOR PLHIV (PEOPLE LIVING WITH HIV)

Health insurance is a critical issue for people living with HIV/AIDS,

but health insurance companies all around the world commonly deny

medical coverage for HIV positive individuals because they believe that such

insurance policies are not financially viable. India is no

exception. A health insurance cover for PLHIV is a concept, yet atypical in the

country.

PSI Connect has taken the initiative by identifying the problems faced

by PLHIV and the need of Health Insurance coverage for PLHIV. Star

Health and Allied Insurance Co. Ltd, a private health insurance company

headquartered in Chennai developed an insurance product aimed at PLHIV in July

2007.

However, the policy had no 'takers' six months after its

launch. PSI Connect approached Star Health to better understand the

product and to explore what role it could play in support of this

initiative. PSI and KNP+ undertook a social mobilization campaign with

district level PLHIV networks to generate interest and motivate

enrolment.

THE PRODUCT

On the basis of the assessments, PSI assisted Star Health to fine tune

the product as follows: a) Inclusion of coverage of hospitalization

expenses before the AIDS stage; Consideration of the medical status

of PLHIV in addition to CD4 count levels as criteria for enrollment.

PSI negotiated with the Insurance Company to bring down the price (by about 40%)

to an affordable level and further provided 50% voucher to the initial enrollees

from the project.

PLACE AND PROMOTION

The partnership mobilized the enrollment of around 300 PLHIV from six

districts in Karnataka through a social mobilization campaign in

partnership with Star Health and KNP+.

PRODUCT DESCRIPTION

There are many benefits. The policy covers only HIV infected individuals

irrespective of the person being on ART or not on ART.

There is no age limit for the applicant. The Period of Insurance is for one year

like any other mediclaim Policy. The sum insured is for Rs 30,000/-,Rs 40,000/-

and Rs 60000/-. 50% of the sum insured is covered for hospitalization and 50%

on reaching AIDS Stage. No CD4 count test need be done at the time of renewal

provided there is no break in insurance

PREMIUM DETAILS:

Premium: Rs 1511 Rs: Sum Insured: Rs 30000

Premium: Rs 1919 Rs: Sum Insured: Rs 40000

Premium: Rs 2545 Rs: Sum Insured: Rs 60000

ELIGIBILITY CRITERIA

The HIV Care Policy is issued to a group of persons infected with HIV.

This policy is available only on a group basis and not on individual

basis- the government or any NGO/CBO can take this policy for their

members. The Group size has to be of 200 and above. Pre Insurance

screening is mandatory for all applicants (CD4 cell count of 300 and

above).

COVERAGE

The HIV Care Policy covers, i) Inpatient Services/Hospitalization, ii)

Includes Room, Boarding expenses, iii) Covers Nursing Expenses, iv)

Surgeons fee , Consultant or Specialists fees are also covered during

the hospitalization, v) Pre Hospitalization expenses for 30 days, vi)

Post hospitalization expenses for Rs 5000, vii) CD4 count of 100 and

below for claiming the AIDS stage benefit

EXCLUSIONS UNDER THE POLICY

All diseases/injuries which are Pre-Existing will be covered only after a

continuous renewal of four years. Any disease contracted by the Insured person

during the first 30 days of the policy except for

accidents. Hospitalization less than 24 hours or charges incurred for

Diagnostic or lab examinations. Waiting period of 90 days for claiming

the AIDS stage benefit. ART, Tuberculosis and gastroenteritis are not

covered in the policy (ART is being covered by Govt & TB is also covered by

RNTCP).

PSI has already mobilized 2000 PLHIV till date in the states of

Karnataka, Tamil Nadu, Andhra Pradesh and Maharashtra. Mobilized efforts are

still on in increasing enrollments in these states. Over 70 claims are

registered in the Star Net plus policy.

FOR FURTHER INFORMATION CONTACT:

Ravi Subbiah, Director - Systems Strengthening, PSI, 1st floor, 116, 8th Cross,

Railway Parallel Road, Kumarapark West, Bangalore-560020, Tel: 91-80-40855600,

Fax: 91-80-23341406, email: ravi@....

(Source: PLHIV Health Insurance Brief, November 2009, PSI)

Santosh Padhy

e-mail: <santosh.padhy@...>