Engaging Insurance Sector

in India for
Mainstreaming HIV and AIDS
Programme Brief: Insurance, Project Connect
Population Services International

Supported By: Connect Partner Technical Partners

Engaging insurance sector in India for mainstreaming HIV and AIDS
India is home to an estimated 2.4 million People Living with HIV (PLHIV). Out of pocket expenses for accessing quality healthcare
services have been a challenge for PLHIV in India who also bear the brunt of stigma and discrimination from healthcare providers.
Countries such as South Africa with high adult HIV prevalence of over 15 per cent have taken measures to mainstream HIV
through commercial insurance cover. However, with a low prevalence of 0.31 per cent in the country, the insurance sector in
India is yet to take major steps. The National AIDS Control Programme envisages mobilising private sector insurance companies
to define their role and contribution in the programme. Project Connect, led by Population Services International (PSI) aims to
build value added models of public private partnerships to mitigate HIV and AIDS in India. Connect is funded by the United States
Agency for International Development (USAID) under the President’s Emergency Plan for AIDS Relief (PEPFAR). One of the key
strategies of Connect is to engage the insurance sector in India for insurance solutions sensitive to PLHIV. The project has been
advocating the mainstreaming of HIV in insurance since 2007.

Facilitating India’s first group health insurance product for PLHIV

Leveraging PSI’s expertise in social marketing, Connect partnered with Karnataka
Network for People Living with HIV (KNP+) to provide technical assistance to
Star Health and Allied Insurance, India, in refining an existing health insurance
product which the company had launched in 2007. This product however had
little or no demand. Based on the health requirements of PLHIV, appropriate
changes were made in the product. The premium for the product was reduced
by nearly half the earlier price and in-patient treatment cover was introduced as
part of the policy benefits. Further and as part of an effort to create demand for
the product and to increase uptake of the policy, insurance literacy campaigns
were organized across Karnataka. This revised product was launched in March
2008 with a pilot group of 258 PLHIV from Karnataka enrolling under the policy.

Advocating insurance among PLHIV

Connect partnered with Indian Network for People Living with HIV/AIDS (INP+) to strengthen the systems of the network and
the state affiliates in Karnataka, Andhra Pradesh, Tamil Nadu and Maharashtra. The Kerala affiliate of INP+ was also provided
technical support. These efforts resulted in insurance becoming a part of the national agenda of INP+. Subsequently, INP+ held
multiple meetings with its state level affiliate networks and organized a national consultation on insurance for PLHIV in June
2009 to discuss the need for insurance and healthcare financing for PLHIV. Consensus emerged from this consultation that
advocacy efforts need to be taken up with insurance companies for more products sensitive to the needs of PLHIV. It was also
felt that for the below poverty line (BPL) PLHIV, there is a need to explore premium payment options such as subsidy through
mobilising resources, promoting savings in PLHIV groups and appropriate mechanisms that would allow PLHIV to pay premium
in instalments with a view to reduce the economic burden on affected households.

Expanding coverage in high HIV prevalent States in India

Various partnerships such as those mentioned subsequently in this
document coupled with sustained demand creation efforts helped in
insuring many more PLHIV across various states. Currently more than 6500
PLHIV are covered under Star Netplus, the group health insurance policy
exclusively for PLHIV. Four out of every five people who were insured in
2009-2010 renewed their policy in April 2010 for another year.

Partnerships for Scaling up Insurance

Karnataka Network for People Living with HIV (KNP+)
KNP+ has been a key partner to Connect in facilitating India’s first group health insurance policy for PLHIV. The network leads the
insurance advocacy and mobilisation efforts in Karnataka and nearly 1500 PLHIV were insured in Karnataka as of October 2010.
Connect provides technical assistance to build capacity of KNP+ and affiliated district level Networks to mobilise, manage and
monitor health insurance for PLHIV. As a result of this technical assistance and capacity building efforts, KNP+ now mobilizes
PLHIV for insurance independently. It manages most of the operations such
as claims management, cashless hospitalization, hospital empanelment and
reimbursements. The network also actively inputs in periodically refining the
product benefits. To inculcate the habit of savings so as to take care of premium
for renewals, KNP+ has formed nearly 50 Self-help groups (SHG) among the
insured PLHIV. To support children and widows who are not in a position to pay
the annual premium, KNP+ is mobilising resources from local donors. The network
also plays an active role in advocacy with insurance companies for additional
insurance products for PLHIV.
Greater Visakhapatnam Municipal Corporation, Andhra Pradesh
In 2009, Greater Visakhapatnam Municipal Corporation (GVMC) came forward to become
the proposer of the first insured group in Andhra Pradesh by paying 50 per cent of the
premium amount for 200 PLHIV. This group policy, which was the first in Andhra Pradesh,
was launched with support from Visakhapatnam AIDS Control Society (VACS) and Andhra
Pradesh State AIDS Control Society (APSACS) in June 2009. GVMC continues to remain the
proposer of the group in 2010 as well. Subsequently Plan India, an organisation working for
child rights also came forward to cover over 600 PLHIV in Andhra Pradesh.

Petraalthaan Pillai-ya? Tamil Nadu

Connect, in partnership with renowned actor Padmashri Dr. Kamal Haasan and Radio Hello FM, Tamil Nadu’s
leading and largest radio network launched “Petraalthaan Pillai-ya?”, a campaign in Tamil Nadu to cover
children living with HIV (CLHIV) in the state. This campaign, launched on World AIDS Day 2009, succeeded
in raising enough resources to provide health insurance cover to more than 2500 children in Tamil Nadu.
A sizable number of these children are orphan or with single parent. The second phase of the campaign
has been launched in November 2010 with more celebrities like Madhavan and Trisha lending their voice
for the cause. To build sustainability and ensure continued support for CLHIV in Tamil Nadu, the campaign
will now be run by Tamil Nadu State AIDS Control Society (TANSACS) which is mobilising resources for
orphan and vulnerable children (OVC) in the state under The Tamil Nadu Trust for Children Affected by HIV/
AIDS(TNTCAA) instituted by the Government of Tamil Nadu.

Network of Maharashtra by People Living with HIV/AIDS (NMP+)

Connect initiated the partnership with the Network of Maharashtra by People Living with
HIV/AIDS (NMP+) in 2008. Since then, more than 1300 PLHIV were insured till October 2010
in the state by NMP+. With sustained capacity building efforts initiated by Connect, the
network completely manages the insurance operations. NMP+ has also been working with
experts from National AIDS Research Institute (NARI) for advocating insurance for PLHIV. The
network is also leading the efforts for a tax waiver on the insurance policy for PLHIV with the
finance ministry, Government of India.

Consultation with Insurance Sector, India

In the absence of sufficient evidence on the viability of insurance products for PLHIV,
insurance companies perceive HIV to be beyond the scope of insurance and continue to
retain the condition as an exclusion in generic insurance products. In order to understand
the concerns of the sector and to explore opportunities for mainstreaming HIV in
insurance, Connect, in association with Federation of Indian Chambers of Commerce and
Industry (FICCI) organised a national consultation with private and public sector insurance
companies in December 2009. The consultation revealed that insurance companies
perceive that HIV is a non-insurable risk and that there is a need to disseminate more
evidence on morbidity and mortality due to HIV. This is required in order to demonstrate
that HIV, like Cancer or Diabetes, is a manageable chronic condition.
Technical Support to Insurance Companies in India
The Connect team is actively engaged in providing strategic support to various insurance companies in India in designing products
covering HIV. ICICI Lombard, Bharti AXA, Bajaj Allianz, National Insurance Company, Oriental Insurance Company, etc are some of the
insurance companies in India who have shown interest in covering PLHIV. Connect has been closely working with these insurance
companies and is providing inputs on product design, evidence on scope for mainstreaming HIV and facilitating consultations with
experts.

Piloting Mainstreamed Insurance Model

Connect in partnership with DHAN Foundation is piloting a mainstreamed insurance
model in the high HIV prevalent Salem district in Tamil Nadu. Under this model, life and
health risk of more than 70,000 individuals in Salem district will be covered irrespective
of their HIV status. There is no exclusion of any condition in this product and HIV has
been mainstreamed in consultation with senior micro-finance and actuarial experts in
the country.
Gathering Strategic Evidence for Advocacy
Under the guidance of experts from renowned academic institutions such as Institute of Economic Growth (IEG), National Institute
of Mental Health and Neurosciences (NIMHANS), National AIDS Research Institute (NARI) and Y.R. Gaitonde Centre for AIDS Research
and Education (YRG CARE) the project is exploring strategic evidence in the Indian context to mainstream HIV in insurance. A
testimonial documentary ‘My New Immunity’, a policy brief titled ‘Towards Mainstreaming HIV and AIDS: Role of Insurance Sector in
India’, a booklet documenting life stories of some of the beneficiaries of PLHIV insurance titled ‘The Positive Story’, and a pamphlet
designed to create awareness about the insurance product ‘India’s First Group Health Insurance for People Living with HIV: A Social
Marketing Innovation’, etc are some of the Connect ‘s contributions for advocating PLHIV insurance.

International Conference on Mainstreaming HIV and AIDS: Role of Insurance Sector

Connect has partnered with Health Systems 20/20, another USAID funded project which works in over 30 countries worldwide,
to address health systems weaknesses. Under this partnership and in order to gather and disseminate global experience on
mainstreaming PLHIV insurance, an international conference is being organised under the aegis of National AIDS Control Organisation
in February 2011. This conference will also serve to facilitate informed deliberations on mainstreaming HIV in insurance in India.

For further information, contact:

Atul Kapoor, Program Director • Email: atul@psi.org.in

Population Services International

52/2, First Floor, 8th Main, 16th Cross, Malleswaram, Bangalore-560 055. INDIA
• Tel: +91 80 40855600 • www.psi.org.in/connect • Email: connect@psi.org.in

Population Services International (PSI) is a global not for profit organisation working in partnership within the public and private sectors, and harnessing
the power of the markets. PSI has partnered with Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) for implementing project Connect.
International Labour Organization and Revised National Tuberculosis Control Programme (RNTCP) are technical partners to Connect.