As of December 2012

The savings-linked product

Legal status as a cooperative or self-help group is needed in order to take savings in India. UpLift had been unable to register as a cooperative, so it decided to form partnerships with cooperative organizations to distribute its savings-linked product. The following criteria were used for selection:

• Legal status to collect and handle savings and strong financial transaction experience
• Standard and formalized front-end and back-end procedures with strong accounting skills
• Strong community governance
• Readiness to focus on health services
• Interest of the organization in providing the product

UpLift partnered with PEDO, in rural Rajasthan, and with Prem Seva Cooperative Mumbai. The feasibility study on the partnership with Prem Seva was delayed, due to mistakes in the first round of data collection. As a result, an external surveyor had to be used for a second round of data collection.

Within PEDO, there are 3 participating federations – MADA, Genji and Jhontri – with separate membership. The same product is offered to all, though buying behaviours have varied between the federations.

UpLift designed the products and finalized them with both organizations and provided training on them. This took longer than anticipated. Although senior managers in the organization fully supported the project, it was more difficult to secure the buy in of the field staff who were focused on credit operations and had no experience of either health or insurance operations.

Before designing and launching the products, surveys were carried out to check the members’ interest in saving for their health needs. The results were positive and encouraged Uplift to work with these organizations for the product and process development.

The final products are outlined below:

UpLift designed a standard set of standard procedures to introduce the products into the field, including client education, enrolment, premium collection, receipts, and so on. However, training staff on these took considerable time as the existing microcredit teams were used, and they had little knowledge on health care.  In addition, the client education tools were revised and changed several times, causing delays in the field.

The enrolment process was further delayed as PEDO did not finalize the salaries of the field staff for this extra work. The federation staff therefore did not start enrolments, and UpLift had to intervene and ask PEDO to confirm the salary.  Further problems were created by a delay in appointing an operations manager to monitor the field staff and provide support and guidance.

An intense two-month client education programme was carried out before the product launch in both partner organizations. This was carried out through the partners’ networks of community representatives.

UpLift also supported PEDO in organizing four promotional health camps before the product launch. A total of 482 members benefitted from these camps.

UpLift established a network of healthcare providers in the area by interviewing staff of the partner organizations to find out which hospitals their members prefer. Ten healthcare signed a formal memorandum of understanding with UpLift and became part of the network.

At this point 2,425 policies had been issued, exceeding the target of 2,000 policies for the pilot.

As of March 2014

Uplift continued to work with the federations and the organizations in aligning processes to customers’ requirements, explaining details of the product, and networking relevant hospitals. As time for renewals drew near, it decided to conduct a focused renewals campaign, using demonstration cases of people who had received claims, featuring network hospitals and the advantages of going to them, and providing explanations of how the savings over the year can be used to pay the premiums. Information was shared with all members, even those who had not subscribed in the first year, to help build confidence in the product among all members.

The customer education plan was modified for use by the local community members, which also helped to build trust. Furthermore, health care visits and promotions were linked with self-help group meetings, allowing better communication with all members in one location.

Local federations’ involvement was enhanced by standardizing claims procedures and on-the-ground processes, supported by information brochures. This enabled local federations to carry out initial claims verifications and reduced the need for clients to repeatedly go to the hospitals to collect documentation.

The ability to pay the premium from the savings account, in combination with all the process modifications and continuing consumer education efforts, resulted in healthy renewals and new members enrolling in the programme.   

The additional services offered as a part of the project and their utilization is given below:

Updated services data till June 2014

Continuing with the work in the subsequent year, Uplift observed that the additional services offered, in addition to the claims paid out during the year proved to be a major attraction for new enrolments as well as people wanting to continue their insurance cover into the next year. Enrolments in PEDO grew from 2,075 to 3,445 and in the next year to 4,200, while Premseva policies doubled from 1,075 in the first year to 2,147 now. Renewals in both areas have been encouraging, with renewal rates in excess of 70% overall, and 96% in one federation.

Development of the management information system (MIS)

Potential vendors were reviewed, and UpLift decided to work with Tieto, a Finnish IT company with offices in India. Tieto agreed to develop a web-based MIS with UpLift, which will be called UpLift Tieto Total Automation for Mutuals (UTTAM). It was important to develop a customized MIS, as pre-designed software does not have the flexibility to cope with the different needs of the potential variety of future partners. Design and development of the MIS begun, but some parts of the work were delayed. Specifications for an improved claims process were developed and coded in the system.

UpLift and Tieto developed a simple excel format for enrolment data, in which the members’ information can be easily encoded .This tool is then used to import the data in the software and create the policies.

Trials were carried out, and policies and ID cards were successfully made with the new software. UpLift printed and submitted 1,349 ID cards to PEDO federations. These ID cards have the member information, policy information, helpline information, space to record the health facilities used, and details of the health care provider.

These ID cards are used by members when they use the services and health care facilities of the network heath care providers.

UpLift also worked on making its helpline more widely used. It improved its technical capacity to handle calls, and encouraged greater use among its members, particularly for claims. One partner (Prem Seva) even made calls to the helpline mandatory for claims payout. Stickers were also distributed to remind members of the helpline number. UpLift is monitoring the helpline to see whether there is any change in the pattern of calls.

As of March 2014

Uplift and TIETO continued to work towards further testing and debugging of UTTAM for the automation features. UTTAM was introduced in a few partner locations along with UpLift’s current MIS to check data accuracy. User manuals and a training plan for UTTAM users were developed and field executives were trained in the systems features and requirements.

As of October 2014

Uplift continued with field trials of the UTTAM and training of on field personnel to improve implementation and turnaround times. Some of the process changes and the results achieved are:

• Claim declaration and opening through the software can now be done from the field.
• The courier process has now been bypassed as the claim documents can be uploaded directly in the software from the field office itself.
• Once a claim is opened in Uttam, the auto adjudication system completes the primary checking of the policy status, including policy ongoing or not, number of renewal, claimant covered or not, balance sum insured, claimant history, pre-existing illness, previous claim, and so on, before the claim is passed on to the claim validator for the next stage. This validation previously required checking by an encoder and rechecking by the validator and would take 10- 15 minutes per claim.
• The claim validator can now check the claim papers online. He does not have to remember the policy details of every organisation as the system directly gives information on the sum insured, the balance sum insured, applicable exclusions, claim category limit and the percentage of reimbursement according to the type of hospital used.
• The entire data is encoded in the system and it is possible to extract all the data in the form of report. This has saved a lot of double encoding.
• The claim decision tool is no longer prepared manually and comes from the system directly, saving an entire day of manual work.
• The new claim adjudication system has reduced time per claim plus it allows the reduction of the manual errors by the encoder or the claim validator as the system carries out a thorough check.
• At one of the partner organisation in which the new system has been piloted, the turnaround time was reduced to as low as 2 hours, compared to 5 to 6 days in the past. 

Next actions

Uplift will continue in its attempt to register as a multistate cooperative, despite significant challenges in doing so. In the mean time, in order to extend the reach of the savings based products, Uplift has targeted more organizations that have the capacity to collect savings from members as partners. Uplift will potentially be working with three more partner organisations in 2015  (Antyoday-Pune, Social Action and Implementation (SAI) Mumbai, and Nav Nirman Samaj Vikas Kendra (NSVK) Mumbai).

Uplift will share technical know-how of setting up savings-financed health mutuals within a given time period (3-5 years). Once this has been achieved, Uplift will share only core services with the partner organisation. The launch of the web based Management Information System - UTTAM has already made such a transfer of knowhow and back-end operations possible.

Ulift tested sending information through SMS messages under the IVR system. It found that the phones of members did not have the capacity to read SMS messages in regional languages. In addition, the IVR system has to be integrated to UTTAM for it to be able to answer policy claim related questions, and this is planned in the services module that will begin in 2015.