Making inclusive insurance work series

Health Part 2:

Health insurance for the emerging

consumer

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The UNEP PSI and ILO webinar series

Making inclusive insurance work - A webinar series by the International Labour Organization’s Impact Insurance Facility and UN Environment’s

Principles for Sustainable Insurance (PSI) Initiative

As part of the global agenda of insuring for sustainable development, the Impact Insurance Facility (www.impactinsurance.org) and the PSI Initiative (www.unepfi.org/psi) are organizing a seven-part webinar series with the

theme, “Making inclusive insurance work”.

Today’s session will focus on “Health insurance for the emerging consumer”

Evolution so far… and promise of PPP models

Private or community-based health insurer (CBHI)

SubstituteHMI services a population that is a) ineligible for public coverage or b) does not receive effective public coverage

Reform designs underway

No reform in place

Maturity (e.g. time, political commitment, management capacity, infrastructure, resources)

Government

Pro

vid

er o

f co

vera

ge

GOAL:Universal Health Coverage

FoundationCBHI is at the origin of health social protection; government decides to scale and exerts regulatory authority over CBHIs

PartnershipGovernment outsources specific pieces of the insurance value chain to private partners (insurer, bank, MNO and other organized groups)

SupplementHMI provides products covering additional benefits to public scheme (e.g. telemedicine, outpatient benefits, lost wages, travel, etc.)

Prim

ary

Pro

vid

er

Seco

nd

ary

Pro

vid

er

Making inclusive insurance work:

Health insurance for the emerging

consumer

Presenter:Sanjay Pande

Finsall Networks

Presenter:Walter Bacareza

PhilHealth

Facilitator:Lisa Morgan

Impact Insurance Facility

6

Presenter:Lorenzo ChanPioneer Group

Health insurance for the

emerging consumer

Product

Development

Flexibility &

Outstanding Service

to MFIs

Lorenzo O. Chan, Jr.

Pioneer group of insurance companies,

Philippines

Source: psa.gov.ph

US$158 – US$316 monthly

Mostly daily wage earners

US$5.30- US$10.50 a day

US$316 monthly – US$631

Mostly daily, weekly wage earners

with some bi-monthly salaried

US$10.50 – US$21 a day

Source: psa.gov.ph

2015

relevant

BENEFIT

DESCRIPTION

AMOUNT

Personal Accident 5,000

Daily Sickness

Hospital Benefit

(DSHB) /

Daily Accident Hospital

Benefit (DAHB)

200/day

Maximum of 15 days per year of

combined DSHB and DAHB

CARD CARE

Affordability

Simplicity

Accessibility

To Buy & To Claim

The $5 CARD Care could

be loaned

$7 MediCash applicable

for Salary Deduction

Cash assistance

P200/day or US$4/day for

CARD Care (max 15 days)

income assistance while

hospitalised

P10,000 or US$200 medical

cash assistance for MediCash

To Buy To ClaimAffordability

Affordability

Medical cash assistance,

P3,000 or US$60, 3 months

cover

$1 - $2 versions were

also created – shorter

cover period but matches

their wallet

same concept as shampoo sachets

To Buy To Claim

Relevant

Easy to graspSimplicity

To Buy To Claim

Simple triggers, forms and

requirements

PRODUCT COMPARISON – CLAIMS REQUIREMENTS

BRAND X

Hospital Admission &

Discharge

Philhealth Deduction

Hospital O.R.

Doctor’s Diagnosis- Dengue

Hemorrhagic Fever

Laboratory Results as basis

for diagnosis

Doctor’s Diagnosis- All strains

(CSMR)

Laboratory Results as basis

for diagnosis

Accessibility

CARD network, moms

Malls

TelCo redemption

Clinics

Speedy Payouts through

Banks

Pawnshops

CARD offices

To Buy To Claim

Affordability

Simplicity

Accessibility

To Buy & To Claim

Thank you

Lorenzo O. Chan, Jr.

Pioneer group of insurance companies,

Philippines

Finsall.

medical insurance. products, riders, add-ons,

conveniences, enablers that

low-income households

in India

have worked well for

Finsall.

22

an overviewIndia is still a low-density, low-penetration scenario

$262

GLOBAL NON-LIFE INSURANCE SECTOR

Insurance density

0.72%

Insurance penetration

INDIAN NON-LIFE INSURANCE SECTOR

$3

Insurance density

0.22%Medical Insurance penetration

INDIAN MEDICAL INSURANCE

Medical Insurance density

2.8%

Insurance penetration

$12

2015-16 data

Finsall.

2015-16 data

23

medical insuranceit is micro-insurance all the way

TOTAL POPULATION

1.27Bn

INSURED POPULATION

Out of 0.36 Bn, 76% lives are insured under

Mass segment(Mass : low –ticket, no-frills medical insurances ,

fully or partly subsidized by the governments)

0.36Bn

Mass segment accounts for 10% of total

Medical Insurance premium of US$ 3.7 Bn

Finsall.

24

typical product for low-income

Individuals / HouseholdsCORE

ADD-

ONs

In-patient cover

Pre & Post hospitalization

Maternity cover

Day-care procedures

Medex following accidents

low sums-insured, policy sub-limits, limited family-size, predominantly for medical-management, caters only to low-end surgical procedures

Eye treatment

Dental treatment

Neo-natal cover

Domiciliary treatment

Emergency ambulance

Travel expenses

Premium

subsidy

Finsall.

25

new initiatives to supplement the core

Outpatient

Cover

Top-up

Cover

Long-tail

Cover

Mostly in mass policies

Limited availability, otherwise

Extremely popular among low-income : IR 71% vs. 4%

Recognizes alternative branches of medicine

Acknowledges inadequacy of the underlying insurance

Addresses higher-end surgeries

Cheaper premiums as underlying sum insured acts as deductible

Requiring outpatient treatment over longer duration

e.g., Diabetes / Renal problems

products / riders / add-ons / conveniences / enablers that have worked well

Finsall.

26

new initiatives to supplement the core

Senior

Citizens

Cover

Medical

Wallet

Premium

Financing

*

Covers those who were otherwise excluded

(Annual +) period of insurance

Age > 60 and < 80. If uninterrupted, renewable up to 90 years

Health check-up

Second opinion from doctors in an insurer’s panel

Allows limited carry-forward of un-utilized sum insured

In addition to NCB

Financial enablement to buy or buy adequately

No collateral security or surety

Insurer & intermediary neutral

Low interest rate , minimal documentation

Targets economically marginalized

products / riders / add-ons / conveniences / enablers that have worked well

* Still a low-key initiative. A major initiative by Finsall in the pipeline

Finsall.

27

new initiatives to supplement the core

Extended

Family

Cover

Wellness

Linkages

HIV- AIDS

Typically, policies limit coverage to self + spouse + children + parents

About 19 relationships are covered

Affords a floater facility over larger family at lower costs

Insured member can draw from a bigger family pool

Health check-ups at intervals

Simple mobile Apps to monitor lifestyles

Measureable lifestyle-linked premium and T&Cs

Covers those who were otherwise universally excluded

Laudable, though limited, initiative by some insurers

Supplements free ART & paediatric ART by the Government

OIs and adverse effect of ART are covered

products / riders / add-ons / conveniences / enablers that have worked well

Finsall.

28

new initiatives to supplement the core

Medical

Insurance

Mutuals

village medical depots

Managed by trained Village Health Volunteers

Dispenses basic OTC medicines for routine ailments

Under supervision of Mobile Health Post

mobile health posts

Scheduled visits by qualified doctors to assigned villages

Basic investigations , medication and recommends tests

Connected to telemedicine personnel

Referrals to city OPDs for serious problems

referral OPD

A network of private clinics, specialists and investigation facilities

Cashless treatment for the members of a Mutual

products / riders / add-ons / conveniences / enablers that have worked well

thank you.

Sanjay H. Pande

sanjay.pande@finsall.com

mob: + 91 99581 14206

www.finsall.com

Finsall.

29

MAXIMIZINGYOUR PHILHEALTH BENEFITS

THROUGH SUSTAINABLE

PARTNERSHIP

WALTER R. BACAREZA

VICE-PRESIDENT, PRO III

last line of

Hospitals operations

first line of

PCB – Primary Care Benefit – P500 MCP – Birthing Facilities – P8,000 NCP – New Born Care/New Born Screening – P1,750

TBDOTS – TB Directly Observed Treatment - P4,000

Animal Bite Treatment – P3,000

Malaria Treatment – P600 Family Planning

IUD – P2,000

Implants – P3,000 *

can work for you?

How to work on

so

War against

PRO III COMBAT

PLAN

POVERTY

BDRUHC/KP

MDR

Phil. Health

Agenda

All Senior Citizens are now covered

POC : Point of Care Enrollment

(Gov’t hospital only as of this time)

POS :

POINT OF SERVICE

SIN TAX:

Enrolled 15M families nationwide

All pregnant women eligible for

enrollmentMembership War is Over

2013; in mi

llions)

RegionNo. of Accredited

Collecting LGUS%

VIII 99 49.75%

XII 28 14.07%

IV-A 16 8.04%

IV-B 14 7.04%

II 12 6.03%

X 9 4.52%

VI 8 4.02%

CARAGA 4 2.01%

CAR 3 1.51%

III 2 1.01%

V 2 1.01%

XI 2 1.01%

I 0 0.00%

VII 0 0.00%

NO. OF ACCREDITED COLLECTING LGUS 2016

0

10

20

30

40

50

60

70

80

90

100

CAR I II III IV - A IV - B V VI VII VIII X XI XII

No of Accredited Collecting Agents LGUS 2016

CAR I II III IV - A IV - B V VI VII VIII X XI XII

4.52%4.02

1.51% 1.01 1.01%1.01%0% 0%

49.75%

14.07%

8.04%7.04%6.03%

NO. OF ACCREDITED COLLECTING LGUS 2016

1. Partnership as a local collecting agent –Promote your Province as Collecting Partner by putting up billboards

PROVINCE-PHILHEALTH PARTNERSHIP IN PROMOTING UNIVERSAL HEALTH

COVERAGE

LGU’s WITH PCB PER PRO: CY2013 – 2016*

Note*: PRO III data is 2017, all other data remained constant

PRO W/ PCB % PRO W/ PCB % PRO W/ PCB % PRO W/ PCB %

VIII 143 100% CARAGA 70 96% VIII 143 100% VIII 143 100%

VI 133 100% VIII 136 95% III 126 97% III 126 97%CARAGA 72 99% III 124 95% CARAGA 70 96% CARAGA 70 96%

I 122 98% I 118 94% I 118 94% I 118 94%

IX 69 97% VI 124 93% VI 124 93% VI 124 93%

X 90 97% II 86 92% II 86 92% II 86 92%

II 89 96% XII 44 88% XII 44 88% XII 44 88%

IVB 102 95% CAR 66 86% CAR 66 86% CAR 66 86%

XII 47 94% VII 108 82% VII 108 82% VII 108 82%

XI 46 94% X 73 78% X 73 78% X 73 78%

V 107 94% IVA 73 78% IVA 73 78% IVA 73 78%

VII 122 92% ARMM 91 76% ARMM 91 76% ARMM 91 76%

IVA 86 91% XI 36 73% XI 36 73% XI 36 73%

III 117 90% IVB 70 65% IVB 70 65% IVB 70 65%

ARMM 98 82% V 74 65% V 74 65% V 74 65%

CAR 63 82% IX 38 54% IX 38 54% IX 38 54%

NCR 25 81% NCR 14 45% NCR 14 45% NCR 14 45%

TOTAL 1531 94% TOTAL 1345 82% TOTAL 1354 83% TOTAL 1354 83%

CY 2016*CY 2013 CY 2014 CY 2015

LGU’s WITH MCP PER PRO: CY2013 – 2016*

Note*: PRO III data is 2017, all other data remained constant

PRO W/ MCP % PRO W/ MCP % PRO W/ MCP % PRO W/ MCP %

VIII 132 92% VIII 134 94% VIII 155 108% VIII 155 108%

NCR 28 90% IX 63 89% IX 63 89% III 121 93%IX 58 82% II 68 73% II 68 73% IX 63 89%

V 85 75% VI 94 71% VI 94 71% II 68 73%

VI 88 66% V 79 69% V 79 69% VI 94 71%

X 58 62% IVA 64 68% IVA 64 68% V 79 69%

II 57 61% III 87 67% III 87 67% IVA 64 68%

XI 29 59% XI 32 65% XI 32 65% XI 32 65%

IVA 55 59% CAR 49 64% CAR 49 64% CAR 49 64%

III 76 58% XII 31 62% XII 31 62% XII 31 62%

ARMM 65 55% CARAGA 44 60% CARAGA 44 60% CARAGA 44 60%

XII 27 54% X 55 59% X 55 59% X 55 59%

CAR 38 49% IVB 57 53% IVB 57 53% IVB 57 53%

IVB 49 46% ARMM 62 52% ARMM 62 52% ARMM 62 52%

CARAGA 32 44% NCR 16 52% NCR 16 52% NCR 16 52%

I 54 43% I 56 45% I 56 45% I 56 45%

VII 50 38% VII 58 44% VII 58 44% VII 58 44%

TOTAL 981 60% TOTAL 1049 64% TOTAL 1070 66% TOTAL 1104 68%

CY 2013 CY 2014 CY 2015 CY 2016*

LGU’s WITH TB DOTS PER PRO: CY2013 - 2016

PRO

W/

TBDOTS % PRO

W/

TBDOTS

%

PRO

W/

TBDOTS

%

PRO

W/

TBDOTS

%

VI 133 100% VI 126 95% VIII 143 100% VIII 143 100%

VIII 118 83% VIII 132 92% VI 126 95% VI 126 95%

II 77 83% IX 62 87% IX 62 87% IX 62 87%

XII 41 82% II 77 83% II 77 83% II 77 83%

X 69 74% XII 41 82% XII 41 82% XII 41 82%

I 89 71% IVA 76 81% IVA 76 81% IVA 76 81%

IX 50 70% I 90 72% I 90 72% III 103 79%IVA 66 70% CAR 55 71% CAR 55 71% I 90 72%

CAR 54 70% VII 93 70% VII 93 70% CAR 55 71%VII 85 64% CARAGA 48 66% III 88 68% VII 93 70%

ARMM 75 63% V 72 63% CARAGA 48 66% CARAGA 48 66%

V 70 61% X 58 62% V 72 63% V 72 63%

XI 27 55% XI 30 61% X 58 62% X 58 62%

NCR 17 55% III 74 60% XI 30 61% XI 30 61%

CARAGA 34 47% ARMM 66 55% ARMM 66 55% ARMM 66 55%

III 49 38% NCR 16 52% NCR 16 52% NCR 16 52%

IVB 40 37% IVB 51 48% IVB 51 48% IVB 51 48%

TOTAL 1094 67% TOTAL 1167 71% TOTAL 1192 73% TOTAL 1207 74%

CY 2016*CY 2013 CY 2014 CY 2015

Note*: PRO III data is 2017, all other data remained constant

TOP PERFORMING (GOVT) MCP FACILITIES IN REGION 3

No.MUNICIPALITY /

PROVINCEFACILITY NAME

2016 BenefitPayment

1 SAN FERNANDO, PAMPANGA BIRTHING STATION 3 - SAN JOSE 3,848,650.00

2 SAN FERNANDO, PAMPANGASAN NICOLAS BIRTHING STATION NO. 4 3,686,300.00

3 SAN FERNANDO, PAMPANGA BIRTHING STATION NO. 1 3,093,150.00

4 TALAVERA, NUEVA ECIJA RHU I TALAVERA 1,857,850.00

5 STO. TOMAS, PAMPANGASTO. TOMAS MATERNAL AND CHILD HEALTH CLINIC/BS 1,782,900.00

6 MABALACAT, PAMPANGAMAYOR MIGUEL P. MORALES MD, MEM. BIRTHING STATION 1,364,050.00

7 TALAVERA, NUEVA ECIJA RHU III SAN PASCUAL TALAVERA 1,112,050.00

8 ANGELES, PAMPANGAJUANITA L. NEPOMUCENO BIRTHING CENTER 1,102,400.00

9 MINALIN, PAMPANGA MINALIN RHU & LYING-IN CLINIC 1,038,550.00

10 PILAR, BATAAN PILAR RURAL HEALTH UNIT 1,036,000.00

11 SAN JOSE, NUEVA ECIJA CHO PANGANAKAN NG SAN JOSE 1,011,350.00

BILLBOARDS, FLYERS, ETC.

MCAP

BILLBOARDS, FLYERS, ETC.

2013; in mi

llions)

Accredited Health Care Institutions2014 2015 2016

ABCBENEFIT

PAYMENT/ABCBENEFIT

PAYMENT/ABCBENEFIT

PAYMENT/ABC

DR. EMIGDIO C. CRUZ SR. MEMORIAL HOSPITAL 25 1,056,439.52 1,807,696.00 2,340,498.40

RICARDO P. RODRIGUEZ MEMORIAL HOSPITAL 25 1,014,213.52 2,421,796.32 2,324,723.20

ESCOLASTICA ROMERO DISTRICT HOSPITAL 50 962,122.92 1,703,529.32 2,033,059.36

MABALACAT DISTRICT HOSPITAL 25 982,806.96 1,693,311.20 2,004,157.68

DOMINGO B. FLORES DISTRICT HOSPITAL 25 592,401.28 1,515,876.32 1,910,275.36

DR. ANDRES J. LUCIANO DISTRICT HOSPITAL 25 1,246,846.88 2,191,913.04 1,895,632.72

DIOSDADO P. MACAPAGAL MEMORIAL HOSPITAL 75 720,491.15 1,493,164.13 1,852,593.52

ROMANA PANGAN DISTRICT HOSPITAL 50 775,755.88 1,761,752.36 1,852,134.12

JOSE SONGCO LAPID DISTRICT HOSPITAL 25 688,737.68 1,622,530.48 1,769,494.72

SAN LUIS DISTRICT HOSPITAL 25 877,166.40 1,584,390.80 1,411,726.80 RICARDO P. RODRIGUEZ MEMORIAL HOSPITAL (ANNEX SPECIALTY HOSPITAL) 25 407,112.48 868,350.16 1,015,157.12

BENEFIT PAYMENT (DISTRICT HOSPITALS IN PAMPANGA/ ABC)

2013; in mi

llions)

District Hospitals POC ENROLMENT UTILIZATION

PAID 2016 2016

BULACAN MEDICAL CENTER 14,032,800.00 79,481,024.00

BALIUAG DISTRICT HOSPITAL 6,033,600.00 27,721,860.00

OSPITAL NG LUNGSOD NG SAN JOSE DEL MONTE 3,888,000.00 11,610,170.00

EMILIO G. PEREZ MEMORIAL HOSPITAL 3,316,800.00 12,730,280.00

CALUMPIT DISTRICT HOSPITAL 3,300,000.00 7,965,650.00

ROGACIANO M. MERCADO MEMORIAL HOSPITAL 2,966,400.00 14,450,544.00

SAN MIGUEL DISTRICT HOSPITAL 2,844,000.00 10,481,090.00

GREGORIO DEL PILAR DISTRICT HOSPITAL 1,569,600.00 5,993,430.00

NORZAGARAY MUNICIPAL HOSPITAL 1,176,000.00 3,334,450.00

OSPITAL NG GUIGUINTO 508,800.00 2,416,620.00

BUSTOS COMMUNITY HOSPITAL 2,400.00 10,500.00

Total39,638,400.00 176,195,618.00

444.51 %

POC ENROLMENT 2016/ UTILIZATION 2016 BULACAN

TAT of Good Claims

16

6

109

3

13

18

8

20

45

2

7

11

19

17

12

1415

0

5

10

15

20

25

TAT of Good Claims Ranking per PRO*2016

0

10

20

30

40

50

60

70

80

90

TAT Claims for February 1-28, 2017 per PRO

ARMM

CAR

CARAGA

I

II

III B

IIIA

IVA

IVB

IX

NCR NORTH

NCR SOUTH

V

VI

VII

VIII

X

XI

• Accredit More :

ACP : Accredit Collecting Partner 1M/year

MCP : Maternity Care Package

TBDOTS

ABTC :Animal Bite Treatment Center

OMP: Outpatient Malaria Package

FAMILY PLANNING : IUD/ Implants

PNEUMONIA : Elderly

• PROMOTEOplan Billboard

• SERVEOplan Ipad

• CLAIM1M / Bed

2013; in mi

llions)

End of Presentation

Making inclusive insurance work:

Health insurance for the emerging

consumer

Presenter:Sanjay Pande

Finsall Networks

Presenter:Walter Bacareza

PhilHealth

Facilitator:Lisa Morgan

Impact Insurance Facility

56

Presenter:Lorenzo ChanPioneer Group

Q&A

Our next webinar

Making inclusive insurance work - A webinar series by the International Labour Organization’s Impact Insurance Facility and UN Environment’s

Principles for Sustainable Insurance (PSI) Initiative

The next webinar in the series on “Making inclusive insurance work” will focus on:

Insurance regulation – date to be announced soon!