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Government-Sponsored Health Insurance in India
throughout this book, a systematic examination of these schemes was beyond the scope of this work. 5. As discussed in the next section, precisely estimating coverage for these state schemes is difficult because all holders of state below-poverty-line (BPL) cards were automatically enrolled. Initially, many were unaware of their newly-acquired enrolment status. 6. Since at least two states are already planning their own schemes, the estimates presented in table 3.1 should be considered conservative. 7. The employer-based group insurance market remains static, and much of the recent growth in private health insurance originates from the retail clientele of individuals and families. 8. Employees earning up to Rs 15,000 per month are now included under the ambit of ESIS. Previous to the May 2010 revision, the ceiling was Rs 10,000 per month. 9. Retiring civil employees can opt for life-time coverage under CGHS by making a one-time contribution equal to 10 years (120 months) of the applicable monthly contribution. This one-time amount can range from Rs. 1,800 (roughly equivalent to US$40) to Rs. 60,000 (US$1,300) at current rates, but requires no future contributions. The contribution is inflation-proof, and provides unlimited coverage for life to the retiring employees and their dependents. 10. For most schemes, insurers usually outsource enrolment to third-party administrators (TPAs) and other agencies. 11. For distributing ID cards, TN used the BPL biometric data that the state had already collected and compiled for the BPL cards. Thus, while TN also issued smart (storage-enabled) ID cards, they did not specifically enroll beneficiaries in the field as in the case of RSBY. Instead, TN undertook an effort to distribute the cards to beneficiaries through state officials and local political leaders. 12. Of these households, 100 were enrolled. 13. This is understandable given that the scheme is heavily subsidized and provides beneficiaries cashless access to private providers for which there is considerable demand. 14. Sun reports that although the average village in his sample had 145 BPL families, the range spanned from 1 to over 10,000. 15. Contrarily, insurers have an incentive to enroll villagers in remote areas because experience shows that they tend to have lower levels of utilization (due to distance to empaneled hospitals), which could justify higher enrolment costs. However, it is unlikely that the enrolment agencies face this incentive in a flat-fee environment. 16. Since insurers are paid a flat-rate premium per card—irrespective of the number of family members enrolled—they have no incentive to ensure that the