Thakchoe is an elderly Tibetan man living in the Indian state of Karnataka. He lives with his family in a Tibetan settlement which is home to about 3000 people. Like most in the settlement, Thakchoe’s family is very poor and has limited access to adequate healthcare. At 86, most insurance companies will not cover him with medical insurance or, if they do, the premiums are too high for his family to pay.
In April 2012, Thakchoe slipped and broke his hip. He was rushed to a local hospital, where he spent 3 days receiving care. On the fourth day, he was discharged and billed over 94,000 INR (about 1,100 Euro) for his hospitalisation. In a country where the average annual income per person is about 2500 Euro, the cost of medical care can quickly bankrupt a family. Thakchoe’s family was forced to borrow money to pay his medical costs.
Thakchoe and his family are enrolled in the Tibetan Medicare System (TMS), an insurance scheme operated by the Central Tibetan Administration (CTA). MIA designed the scheme, and has led the implementation and management of the scheme. The TMS launched in April 2012, just a day before Thakchoe was injured. With the guidance of the Executive Secretary, Thakchoe’s family filed a claim by sending the hospital bill to the TMS head office. Three weeks later, Thakchoe’s family was reimbursed for the hospitalisation.
The TMS continues to cover thousands of Tibetans living within India. For Thakchoe’s family, the TMS provided a reimbursement at their time of need, and kept the family from falling deeper into poverty due to his injury.
Kiran Devi and her family are members of India’s Scheduled Caste – one of the most economically deprived and socially discriminated groups in the country. Kiran works as a day labourer and lives on government land provided to Scheduled Caste communities. She has been a member of a local Self Help Group (SHG) called Ambedkar SHG, Gambhirpur, Lachhipur for 15 years, and has benefited from the saving and loan activities offered by the group. However, she has previously had a loan requested denied by the SHG, due to insufficient funds – even when the money was needed to cover an emergency health costs.
Recognizing her family’s need, Kiran enrolled the four members of her family in the Sanjiwani community-based health insurance scheme – operated by MIA – three years ago. She now has health insurance coverage for herself, her husband, her 13 year old daughter and her 10 year old son.
A year ago, Kiran’s village was attacked by a group of locals who felt the government had wrongly taken their land and given it to the Scheduled Caste community. During the attack, her husband was beat with sticks, and he had to be hospitalised for 5 days. The scheme’s Claims Committee reviewed her husband’s case and reimbursed the family for the medical costs, a value of 4500 INR (53 Euro).
Her husband was later hospitalised for Acute Gastro Enteristis. Again, the medical costs were covered by the scheme. Within 15-20 days, Kiran’s family received 3551 INR (42 Euro) as a reimbursement.
Kiran says, “I am very happy to be part of the Sanjiwani scheme and would continue to be part of it in future as well.”
Urmila Devi lives in a village in the Vaishali District of Bihar, India. Like many women in her village, Urmila’s husband works away from the home. With moderate income and few assets, Urmila often had to rely on money lenders – often charging interest of 5% or more on a loan – when the family needed extra money, like to cover a health related cost.
A representative of a local NGO called Ninad approached Urmila’s community and suggested a solution to their money problems. The NGO guided the local women in setting up and managing their own Self Help Group (SHG), called Komal Mahila Mandal. Ten women joined the group and began pooling their money. The women could each take a loan from the SHG at an interest rate of 2%.
Recognizing the benefits of the SHG, Urmila and the women in her community were immediately interested when MIA, working with the local NGO Ninad, approached the group to discuss micro insurance. The women recognized two perks to the scheme: the insurance was available to all members of the community regardless of age or health status and the insured members could choose their own benefit package and corresponding premium price. The women decided to form their own health insurance scheme called Swasthya Kamal, and selected a package costing 197 INR (2,33 Euro) per family member a year. The package covers testing up to 200 INR (2,36 Euro), imaging up to 300 INR (3,55 Euro), a full year check up by the Rural Medical Practitioner (RMP) and wage loss incurred due to hospitalisation. Within three days, all the women in the SHG had enroled their families in the scheme.
The benefits were immediate. The insured were able to get checked by the local RMP when they had a cold, fever or diarrhea. When Urmila’s daughter fell ill, the family received 500 INR (5,91 Euro) to cover the medical costs. The family also received 1000 INR (11,82 Euro) to cover hospitalisation and an ultrasound for Urmila’s pregnant daughter-in-law. Urmila says of this financial assistance through the scheme, “Our ecstasy was inexpressible for we would have been succumbed to a very pathetic situation without the pecuniary help from Swasthya Kamal.”
Urmila’s family was not the only one to see the benefits from the scheme. Three other members filed claims and received reimbursement from Swasthya Kamal. She says, “Those of us who did not claim were also happy for they felt safe now that if they fall sick, they won’t have to suffer on account of low or no money. And if they didn’t claim this year, who knows, they might fall sick the next year and might feel the need of the insurance.
“All the members have realized that Swasthya Kamal is an awesome scheme with innumerable benefits. That is the only reason why we have renewed the scheme for our whole family in the second year and we all trust the scheme from our bottom of heart. After two years of our scheme coverage we understand the essence of mutuality and how we actually help together on the basis of degree of trust that this scheme gives us.”