Svatantra (Felicitator)

Insurance Companies

Trusts / Charitable Influencers - Banls/ NGOs

Institutes / Corporates / / Agent / Telecom /
GOI Hostpitals / Doctors
 Svatantra (Felicitator)

Influencers - Banks /
Trusts / Charitable
NGOs / Agent /
Insurance Companies Institutes /
Telecom / Hostpitals /
Corporates / GOI
Doctors

Introduction

Indias health-related out-of-pocket expenditure, which pushes families into indebtedness and
deeper poverty is a major issue to address. It is the need of hour to create rural healthcare
product to ensure sustained financial health and maximize the social impact in rural
households. Svantantra, believes that a healthcare insurance product for the needy is an
attractive product in this market and hence we as a team have come up with our business model
to help Svantantra suggest a target group, design the insurance product with an execution
strategy, and highlight the areas of impact for stakeholders.

Objective

Research

Through our primary and secondary research, we have found out following pain points, and
we would be proposing our solution to address them:
Low enrolment, inadequate insurance cover and the lack of coverage for outpatient
costs are reasons for poor still paying huge amount for healthcare expenses despite the
enrolment in RSBY.

Methodology
Target Group

Target Market
Key Factors for adoption: Trust, Awareness, Affordability,
Geography
Phase 1: Target the places where Svantantra currently operates in states of Maharashtra,
Madhya Pradesh, Uttar Pradesh, Chhattisgarh, Rajasthan and Orissa. This is to leverage trust
factor which is critical for adoption and also for partnering with other institutions and parties.
Phase 2: Expand within these states to villages where there are no operations by leveraging
on partnerships made in phase 1. Then explore into other states in a phased manner.
Target: BPL families with BPL card and low income families with monthly income upto Rs.
5000/-.
Target Groups - SHG groups, Auto drivers associations, Labour workers association etc
Target families who have members in SHG groups to begin with and then move on to other
families. The SHG members will help to spread awareness amongst other members, groups
and also to other people in the community.
Demographics: 20-50 year olds who are sole bread owners of the family, SHG members,
Implementation Strategy

11 other defined categories of unorganized workers namely building and other construction workers, licensed
railway porters, street vendors, MGNREGA workers (who have worked for more than fifteen days during
preceding financial year) amongst ot

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Insurance Product

Since Svantantra is not into the insurance business currently, we have to tie up with an
insurance company to provide the health insurance. To allow free competition and best
possible product features at the affordable prices, we will follow the Competitive Bidding
Process with the below criteria. We will float the criteria and allow the quotes from the
insurance company pan India. The companies can bid for coverage PAN India or for select
states only, leaving the other states open to the next bidder.

Product Name: Swastya Parivar

Product Type: Family Floater health insurance covering family of up to 5 members

Sum Insured Amount Rs 1,00,000

Entry Age:

2 members from: Proposer/ Spouse/ Parents/ Sister/ Brother/ Father in law/ Mother in law/
Aunt/ Uncle 18 years to 35 years
3 members from: Dependent Children/ Grandchildren 3 months 30 years

Policy Period 1 year

Premium Amount For the entire family family plan,

Premium Paying term Since, we understand that it is difficult for rural insurer to pay the
amount at one time, we can offer the partial premium collection to be done 2 times in a year,
to ease the burden on the family.

Covers existing diseases at earliest: Maximum waiting period of 2 years for existing diseases.
Top Ups: Separate Top up plan available for senior citizens in family so as to allow the sum
insurance limit to increase for them.

Minimum number of sub limits in the policy with maximum clarity.

Diseases Coverage: Along with the other diseases, these top health related issues prevalent in
rural India such as Cataract, maternity, appendix. dengue fever, hepatitis,
tuberculosis, malaria and pneumonia should be in cover with a sub limit set in accordance
with the disease type.

Hospital Network Require cashless hospital network, larger the network of agreed or
preferred hospitals, the better, with a good coverage in rural areas.

In-patient Hospitalisation Include expenses for a minimum of 24 hours covering room rent,
boarding and nursing upto 1% of sum insured per day.

Out-patient Hospitalisation Include Surgeon's fees, Consultant's fees, Anaesthetist's fees

Pre- Hospitalisation Medical expenses incurred during the 60 days immediately before the
insurer is hospitalised, provided that such expenses were incurred for the same illness for
which hospitalisation was required.

Post- Hospitalisation Medical expenses incurred during the 90 days immediately after the
insurer is hospitalised, provided that such expenses were incurred for the same illness for
which hospitalisation was required.

Benefits for Insurance Company Svantantras present company reach and its marketing
campaign will help provide a group insurance guarantee where the insurance company can
benefit from higher number of enrollments.

STAR ADVANTAGE
No Third Party Administrator; direct in-house claims settlement.
Faster & hassle-free claim settlement.
24x7 Toll- free Helpline
Free expert medical consultation over phone 24 x 7 Toll Free Helpline.
Free storage facility for storing medical records in electronic form.

Hospitalisation cover:
In-patient hospitalisation expenses for a minimum of 24 hours. Includes room rent,
boarding and nursing expenses with maximum limit of Rs.150/- per day subject to
Rs.5000/- per hospitalisation
Surgeon's fees, Consultant's fees, Anaesthetist's fees upto a maximum of Rs.4500/- per
hospitalisation
Cost of blood, oxygen, diagnostic expenses, pace-makers, artificial limbs, medicines and
drugs, etc subject to a maximum of Rs.4500/- per hospitalisation
Ambulance charges for emergency transportation to hospital upto the specified limits
Total expenses payable under all heads are limited to Rs.15,000/- per hospitalisation and
to Rs.30,000/- per policy period
 Premium Rate INCLUDING TAX @ 18%
Sum Insured Rs. 5 yrs - 25 yrs 26 - 35 yrs 36 - 45 yrs 46 - 50 yrs
30000 325 413 502 590
Execution Strategy

Before we outline the execution strategy, below are the major stakeholders with whom we are
going to collaborate in our business model.

Key Field Officer (Agent)

The insurance company might not have the bandwidth to reach the product to all rural areas,
(a major challenge of today is rural accessibility). Hence, to address this, we propose to build
our own agent, a local representative of the village. The agent will be given training to sell
health insurance products jointly by Svantantra and the insurance company.

The key characteristic we are looking for in our agent are:

Job responsibility of Agent
Willing to work full/ part time for additional income 15% commission to be borne
by insurance company and added incentives payout based on performance.
Pitch the health insurance product to rural households and get maximum enrollments.
Be the interface for the insured household to know any details of the policy.
Settle the claims as processed by the insurance company with the insurance owner.
Help to solicit any feedback from the rural households for policy details.
Report to District Key Manager of insurance company and to Svantantra officials.

Criteria for selection

No prior work experience in insurance agency is mandatory
Must have good networking skills, communication skills and negotiation skills
Any existing client of Svantantra Microfinance will be given preference in selection.

Trusts/ Charitable Institutes

In India, there are a lot of trusts ran individually or as an organization by billionaires, other
high influential people, communities, corporations and CSR fund. For example, Azim Premji
Foundation, Tata Trusts, Shree Siddhivinayak trust, etc. A lot of companies also spend 2% of
their net profits as CSR fund into trusts who look after the noble cause of community.
These trusts potentially look for the best corruption free place to invest so as to maximize the
well-being of individuals in society. Normally, the trust operates in a select geographical
region and hence we would have to look at multiple trusts or charitable institutes interested in
providing healthcare services to poor and underprivileged people in rural areas of India.

The objective to partner with trusts is to get the partial sponsorship for the insurance
premium amount to be borne by the insurer and thereby reduce the rural family load to
pay the premium. Our study points out that the reduced premiums will considerably help in
increasing the number of rural household availing the insurance.

We are looking for trusts to sponsor atleast Rs 2000 per annual premiums. This will then
bring down the original premium cost of Rs 5000 to only Rs 3000, a range we perceive to be
commercially viable for the household to spend on the health insurance product.

Other Influencers/ CSR Department of Companies/ SHG/ NGOs

In order to reach the nook and the corner of the rural areas, it is important to adopt best
localized way of distribution channels. Svantantra has to reach the "local Paanwala, Local
Chai wala or Kirana Shop owners" to succeed. These stakeholders will play an important
role and act as an influencer the first touch point and convincer for the rural target
audience. They will help to promote the awareness and importance of health insurance and
connect the interested member to the Field Key Officer we will refer to as Agent for proper
information on health insurance policy. They will also help to collect any stories or
testimonials which can be shared with others in the locality of who has purchased the
insurance and the benefit of it. Cash rewards and other incentives will be shared with these
influencers on successful conversion of member referred by them.

In India, there are many villages in rural areas which are known after famous industrial
factories such as chemicals, steel, automobile, etc being set up there. This is a major source
of livelihood for many in that area, but not all people in that village will be employees for
that firm. Svantantra can work together with CSR department of those firms to jointly
organize events to promote awareness of health insurance and introduce their offerings to
the entire village or district.

We can also tie up with NGOs in the area who work with the community, Self Help Groups
(SHGs) and enlist further influencers from within SHG groups. We can Promote the policy in
Labour association forums for better reach and awareness.

We have divided the entire execution into phase approach.

Phase 0 Ground Work Time (Time: Today till we launch our offering)
Initial customers - We can leverage the presence of Svantantras presence in MIF industry
and pitch the health insurance product to existing customers (loan takers) and reach out to
their family to know their readiness to buy and feedback.

Insurance Provider Selection At this stage, we also need to select the health insurance
provider by following the competitive bidding process. Key criteria will be its distribution
reach, pricing and customer service.

Key Field Officer (Agent) Selection We have to divide the rural state geography into
various territories and assign one KFO to represent territory covering either a big village/
district or multiple small villages together.

Trusts/ Charitable Institution Selection The partner trusts will then play an important
role in the insurance provider selection process and help in sponsoring the premium amount
and hence subsidizing the health insurance premium for the actual user in rural area.

Apart from this, a proper marketing research plan will help us to understand the most
efficient ways to pitch our product, educate the masses and leverage the synergies with all the
stakeholders.
Phase 1 Launch Stage - Focus on Awareness and Initial Customer Enrollment

Banks/ Telecom Operators - Svantantra can collaborate with banks and telecom operators
(retail stores) having maximum outlet reach in the rural areas to also keep a kiosk in their
branch and help in enrollment of new members to the insurance plan.

Health Camps To educate the masses about importance of healthcare in India, Svantantra
can jointly organize the health camps in association with Ministry of Healthcare, GOI. This
will provide free health checkups for rural masses and reinstate in them the importance of
health insurance to protect them in times of need.
This can also act as launch event where the early enrollments can be done. Testimonials can
also be shared of people have benefitted from insurance scheme before as well the marketing
campaign will run around the theme of emergency fund, secured future and overcoming the
increased medical cost.
The partner hospitals will also benefit from this as they will have an increased brand recall
and people will come to know of various services available in the hospital. The doctors can
further help to educate the patients about our new health insurance product.

Focus in this stage is to get the early enrollment and create the buzz in market. This will help
to create the word of mouth marketing and increase the trust and creditability factor to help
the organization get more enrollments as a Halo effect.

Phase 2 Expand - Focus on Effectiveness and Efficiency in process

We would probably need to increase more agents in our network. Also we can start to reward
the agents by selecting the best agent and calling them as a CHAMPION agent in that state.
This agent will then receive the accolades from not only us, but also from community and
Government and be felicitated in front of his community for his efforts. This will help in
keeping the agent motivated in their job and also increasing the awareness levels in the
society.

Technology upgrades we need to ensure that the rural customer is given guidance to operate
the app and receive timely and important updates. Additionally, the operation process flow
involving various stakeholders needs to be integrated technically to ensure transparency in
the process.

We also have to increase our presence beyond the existing states to reach Pan India.
Additionally, importance is to be given to policy renewal so that households once registered
should continually avail the insurance in the next years as well.
 Use of technology to integrate all stakeholders to align the claims process

Filing an insurance claim to cover the medical can be an

emotional time for a policyholder. For some customers, filing a
claim is the only time they interact with an insurance company
and the rural people are more sensitive with respect to the
economic benefits they get and also the out of pocket expenses
they have to incur.

We suggest using technology in combination with the regular

human intervention to expedite the claims settlement process and
to generate a trust factor for Svatantra among the rural
policyholders. Our objective would be to minimize the use of
third party and to directly incentivise the customers, in line with
the Governments Digital India initiative.

Cloud enabled Platform - For health insurance to be truly

cashless, its important that hospitals and insurers talk to each
other in real time. We suggest a cloud-based platform that aims
to simplify the back-end of cashless claims by connecting
hospitals to the insurers.

Our cloud-based platform will communicate to the hospital information system (HIS) on the
hospital side and to the insurers system on the payer side. So, the data that is entered by the
hospital directly flows into the payer system, and not as scanned images over emails, as is the
practice now.

There are two models in which we integrate with the hospitals as shown below:
Model 1
The first is that we integrate
with their HIS. In this, the
hospital would enter the data the
way it does now, and we convert
that into a standard machine-
readable format, and send it
directly to the insurers system.
Model Architecture
Model 2
In the second model, the hospital logs in to our portal and
enters the information there by choosing from the drop
down menu on various billing items like room type,
ailment, line of treatment and pharmacy. We then convert
this into a standardised billing format, as prescribed by
the insurance regulator, and send the bill to the insurer in
a machine readable format.

Use of Smart Cards We suggest use of technology to facilitate smart card operation for
paperless transaction at network hospitals located in moffusils,
villages, towns and districts across country. A hospital under our
network is required to install a finger print reader, a smart card
reader device, transaction software and internet connection. Once
a hospital agrees to be part of our network, a unique id and
hospital authority card (HAC) is issued by Ministry of Labour to
the hospital, activation of the same is essential before a single
transaction is permitted at hospital end.
Thus the entire process of cashless claim is completed through use of smart card, smart card
reader, bio metric reader, transaction software and internet;