NIRAPOTTA (Safety net)

Since its inception, the microinsurance product has gone through many changes. One of the major developments is that the health insurance program has managed to increase coverage to almost 100% of SAJIDA members and widen the scope of health services to include health awareness, prevention, basic and secondary curative care. SAJIDA Foundation is the first organization in Bangladesh that provides full quantum of health care – promotive, preventive, curative including secondary care under a micro health insurance scheme.

Recent developments of the microinsurance program include a change in the name from HELP to NIRAPOTTA (meaning safety) in order to avoid confusion between HELP and Health Card, which its hospital operate as part of prepayment system.. After having conducted an actuarial pricing review, the premium was increased to Tk 300 and the additional member fee was reduced to Tk 40. This premium now varies by loan term and is not same for all loans. The annual premium that covers up to 5 family members are:

- Tk 300 for 12-month loans with Tk 40 per additional member

- Tk 150 for 3-9 month agriculture loans with Tk 20 per additional member

- Tk 450 for 18-24 month microenterprise loans with Tk 60 per additional member

Various other changes were made that are discussed throughout this section.

NIRAPOTTA Components

NIRAPOTTA has 5 components: Health, Education, Life/Loan, Legal and Man- made Disaster.

Health Insurance:

Health insurance is a major component of the microinsurance program.

- It provides predetermined monetary support (according to health table) to the insurance holder for most of the major hospital services.

- The insured members get discounted rates if they go to SAJIDA hospitals.

- Members can get free Normal Delivery and Cataract operations done at SAJIDA hospitals.

- General Physicians are available for free consultation at SAJIDA hospitals.

- Community Health Program provides healthcare at the community level through health workers called SAJIDA Bondhu(s) (friends of SAJIDA) who visit members’ households.

Life and Loan:

Life insurance provides financial support to members’ families in the event of an adult’s death in the family and waives (SAJIDA) loans (if any).

- Tk 4,000 cash benefit upon death of policy holder or spouse (in most cases).

- Remaining SAJIDA loan balance waiver, upto a maximum of Tk 39,000.

Education/Scholarship Program:

The aim is to groom talented children as future leaders.

- One child from each family is eligible for up to Tk 500 per month given that the child meets the eligibility criterion and maintains satisfactory progress.  For higher studies, all academic expenses are covered for scholarship holders.

Man-made Disaster Insurance:

Tk 10,000 is paid to cover damages / destruction of home or work place/tools caused by fire.

Legal Program:

A lawyer is available at least once a month at all branches to provide consultation and guidance on legal issues. No financial support is provided.

Community Health Program

SAJIDA initiated Community Health with the aim of providing promotive, preventive, basic diagnostic and curative care and referral services through SAJIDA Bondhu(s) (SB(s)) at community level through domiciliary visits. This program expands health coverage and increases health awareness. Claims costs and health claim incidence rates are expected to reduce as a result of promotive and preventive care making this a high-impact and effective program.

SAJIDA Bondhu’s role

- Create health awareness in the community and manage common illnesses

- Refer emergency cases and chronic illness to reliable and cost-effective health providers

- Identify pregnant mothers and children at risk and timely refer them for essential treatment

- Participate in SAJIDA’s Health program

- Make members aware of their microinsurance coverage and benefits

- Promote other activities of SAJIDA Foundation

SAJIDA Bondhu training

SAJIDA Bondhu training is designed to increase SB(s) knowledge about health, with special emphasis on safe motherhood, neonate and child care, reduction of common diseases, and referral of complicated medical cases. The SB(s) can then aware members of the community as well as basic diagnostic test for basic health conditions. Once the initial training is completed, refreshers training sessions are provided to SB(s) every 2 months and through on-the job training during supervisory visits of the trainer to keep their knowledge up-to-date.

Recent research and experience have shown that due to various reasons (relationship with husband, children and other family members, neighbors, workplace etc.) beneficiaries suffer from stress, anxiety, tension and other psychological pressures, which affect their quality of life and also in many occasions drain the economic benefit of microfinance program. In addition these reasons often lead to the members defaulting on loans. Therefore supporting its beneficiaries to better cope and handle the psychological pressures will not only support beneficiaries in improving their quality of life but also protect economic benefit and can also be beneficial for the viability of the microfinance program. Through carefully targeted counseling services SAJIDA aims to improve the wellbeing of its members as well as reduce the default rates for the microfinance program. Therefore SAJIDA initiated a 4-month psycho-social counseling program whereby SB(s) are to be trained by SAJIDA’s Psycho-Social Counseling Center’s counselors. SB(s) are currently conducting group sessions on the field. At the end of the pilot phase, an impact study will be done to evaluate if this program is effective and viable.

SAJIDA recognized the need for ANC and PNC check-ups at members’ houses for ensuring safemotherhood, as many pregnant members were not going for these check-ups despite having access to fixed cash amount through the health insurance component. Therefore a pilot program to provide ANCs and PNCs was initiated by training 10 SB(s) at SAJIDA Institute of Health Science and  Hospital. These SB(s) are conducting these check-ups on the field and at the end of the pilot phase, an impact study will be done before rolling out this training to all SB(s).

PACE tool

SAJIDA started using the PACE (product, access, cost, experience) tool in 2012, which is a tool developed by the ILO’s Microinsurance Facility to analyze and improve microinsurance products from a client-value perspective. NIRAPOTTA had already undergone various stages of improvement with the aim of providing better value to customers that fit the PACE model. SAJIDA now continues to refine NIRAPOTTA in accordance with the PACE tool.

The changes brought about in 2012 are shown below within each PACE category.

Product

• Actual cover adequacy was surveyed briefly by comparing fixed claim benefit amount to sample cost of claims from experience and from cost of treatment in popular hospitals.
• A few healthcare cash benefits were increased to be consistent with increase in healthcare costs incurred. Also the most commonly used health benefit amounts were increased to improve adequacy of the coverage.
• New health care conditions (e.g. additional ophthalmic conditions - Pterygium, Chalazion) were introduced as clients were found to suffer from these conditions.
• Some health categories have been simplified e.g. General Accidents have been included instead of just “Road Traffic Accidents”. Similarly percentage criteria for burn claims has been removed. All burn claims are paid out now provided the claimant had required hospitalization for the burn claim. “72 hour” hospitalization criteria has been replaced with “hospitalization of at least 3 dates”, which makes it easier for clients to understand eligibility for this claim and makes it easy to process these claims too, thus reducing claims settlement delay.
• Fixed cash benefits are now paid out for health claims, instead of benefits up to a maximum limit, for more straightforward health claim settlement.
• Free Normal Delivery and Free Cataract operations are now offered to members at SAJIDA hospitals.
• Fewer documents are now required for claims settlement.
• Fire cover was increased by more than 3 times (from Tk 3,000 to Tk 10,000) as fires have a large impact on clients. The cash benefit that was previously being paid was not sufficient to cover losses.
• Newborn children included within insurance and it has been made compulsory that newborn children are insured as soon as a birth is reported.
• Micro-credit is now being offered to ultra-poor and they are also microinsured.
• Cattle, life and health (C-section and Normal Delivery) insurance is being introduced for ultra-poor in rural region called Jamalpur.
• Providing more value added services for the livestock insurance in rural area Jamalpur, including vitamin supplements, de-worming and vaccination. Also helping in linking livestock sales to major customers in the market to protect farmers from volatility of the market prices of the livestock.
• Providing additional community health services in this rural region through paramedics.
• Community health workers’ have been trained to provide ANC and PNC services. They have also been trained to provide psycho-social counseling support. These value-added services are currently being piloted in 20 branches.
• Education counseling is being provided for students in order to emphasize on technical education rather than just conventional education for improved return of education investment.

Access

• Visual marketing materials (leaflets and posters) have been developed and distributed for increasing client education. Microinsurance ID card is being developed that will also contain visual display of microinsurance benefits for client’s better understanding of product.

Cost

• Flat premium of Tk. 250 now varies by Tk 150, Tk 300 and Tk 450. The premium varies by the loan term and type (e.g. core loan product for 12 months, agricultural loans for 3-9 months, and micro-enterprise loans for 18-24 months).
• Funding structure has been revised to make product more affordable (cross subsidizing certain non-insurance value adding services from microfinance surplus), for e.g. community health program, salary of lawyers providing legal advice are funded via microfinance.

Experience

• A claims settlement tool has been developed and is being used to settle claims at branches. The tool was recently made online for easy access and monitoring. This new decentralized claims settlement process is simpler (requiring fewer documents from clients) and quicker as claims can be approved or rejected at the branch level and only complex claims are being referred to the SAJIDA’s in-house medical doctor.
• A process map has been created to ensure claims settlement within 7 days, which will be implemented by November 2012.
• Microinsurance software has been developed and implemented that has enabled electronic databases.
• Community health program and enhanced education services will give an increased sense of tangibility to clients.
• New separate microinsurance ID card has been designed and will be printed and distributed soon.
• A monitoring process has been outlined to better monitor each step of claims settlement, and community health program.

NIRAPOTTA Challenges

- Ensuring basic health conditions in communities, who lives in slums.

- Lack of insurance education amongst staff and members.

- Lack of actuarially calculated reserve funds, although, funds are being are being slowly accumulated to build this reserve.

- Dependency of NIRAPOTTA on microfinance program (microinsurance is only available and mandatory on microfinance borrowers).

- If  NIRAPOTTA has its own operational staff then the current low premium will not cover the operational costs.

NIRAPOTTA Future Direction

- Strengthen partnership with ILO for capacity building assistance.

- Create automated MIS from new software for microinsurance program.

- Separate microinsurance from the microfinance program.

- Offer microinsurance on a voluntary basis to microfinance members as well as other non members.

- Explore ways to separate SAJIDA’s microinsurance program by establishing itself as an insurance company.