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Refining the piloted health insurance programme in preparation for transfer to the National Social Security Fund -- GRET

About the Project

Project Name: Refining the piloted health insurance programme in preparation for transfer to the National Social Security Fund -- GRET
Type of Facility Project: Microinsurance innovation grantee
Country of Operation: Cambodia
Region: Asia and the Pacific
Sub Topics: Business models, Data analysis and processing, Client interface, Policy and regulation, Subsidies, Claims, Enrollment, Health
Type of Distribution Channel: Employer

Organizational Overview

Created 30 years ago, GRET is a professional solidarity and international cooperation association. Its mission is to contribute to sustainable and fair development as well as to poverty alleviation of and structural inequalities reduction in Africa, Asia, Latin America and Europe. GRET designs and implements field projects, conducts research, operates information and exchange networks, and contributes to the development of public policy. Its actions aim to increase the income of the working poor, reduce their vulnerability, improve their access to quality infrastructure and services, and enable their voices to be heard.

GRET has been active in microinsurance since 1997 and, organizes its activities on several levels: in dialogue with governments on policy frameworks, in support of organized civil society (mutual insurance systems or community based organizations), and in partnership with private actors (microfinance institutions, insurers). GRET is active in health microinsurance in Cambodia and Lao PDR.  It is now extending its activities to include coverage of agricultural risks in Africa.


Project Description

In the past there has been no social security at all in Cambodia, even for formal workers. However, in the last few years there have been some moves towards covering formal workers. Currently there is a national social security fund (NSSF), which offers coverage for accident risks, and plans to cover health. Since 2009, GRET has been piloting its Health Insurance Project (HIP) with funding from l’Agence Française de Développement, and in partnership with the Garment Manufacturers’ Assoc...READ MORE


This project serves workers from the garment industry of Cambodia. Garment workers are mainly young, single and rural migrant women. Their average monthly salary is around USD 79.  They use as little of their salary as possible to support themselves so as to remit as much as possible to their home villages. As young workers lacking experience and social support, they are vulnerable to shocks due to accidents or illness.

The project aims to cover up to 20,000 garment sector workers during the project period before the health insurance programme is transferred (totally or in part) to the National Social Security Fund (NSSF).  NSSF will then make the participation in this insurance programme by the formal sector workers compulsory and be in charge of the management of health insurance programme going forward.


Learning Agenda

Based on experiences from the initial pilot and upcoming refinement phases, the project will strive to answer three key questions:

  1. How can rigorous data collection, performance indicators monitoring and management supported by technology contribute to lower management cost, improved risk management and product management?
  2. What is the extent of client value provided by the HIP to the garment workers and what is the most effective process for developing a health insurance programme and transferring it to a government social security programme?
  3. How effective is product distribution through a workers union and employers? 

Project Status

Key Performance Indicators







Total active policies

1 862

4 818

5 945

6 522

7 144

Number of factories (total)






Number of factories with automatic coverage






Average membership in voluntary factories




From 14% to 35%

From 11% to 58%

Claim ratio (monthly average)






Net income ratio




NA as management costs shared with SKY since July 2012

NA as management costs shared with SKY since July 2012

The HIP claim ratio is satisfactory in terms of value for clients since 75 per cent of the premium collected has been returned in claims at the end of 2010 and 79 per cent in 2011. Despite a comprehensive benefit package that includes primary health care, the risk of over consumption is well under control, since HIP health care provider payment is mainly based on lump sum payments per IP (in-patient) or OP (out-patient) case. With tighter control on drugs reimbursement (with a list of covered drugs) and the majority of HIP members being automatic members, the claims ratio has been decreasing since 2012 to reach an average of 50% as of September 2013. 

The HIP health insurance pilot scheme’s net income ratio is currently negative with a value of -75 per cent at the end of July 2012. However the trend is positive as HIP gross income (earned premium – incurred claims) is increasing faster than HIP operating expenses that remained at a rather stable level. Overall, the HIP scheme currently fully covers the claims of insured workers but not all the operating expenses given its limited membership. The gap was subsidized by donors until the end of September 2013 and after that directly financed by NSSF.

Project Updates
Inception of the project In 2007, GRET conducted a feasibility study to develop a health microinsurance product targeting the garment workers of Cambodia, who represent the major part of Cambodia’s formal employees. Garment workers are to be covered in the future by the NSSF health coverage, but as coverage was not expected to roll out for a few years, the Garment Manufacturers Association in Cambodia (GMAC), an employers’ union, asked GRET to use the intervening time to test the possible...READ MORE

Project Lessons

On transferring knowledge from a pilot to a national scheme It is possible to use the pilot scheme to influence the national scheme, and promote the interests of the beneficiaries. In its discussions with NSFF, the HIP team regularly insists on the importance of the satisfaction of insured members. This was not initially seen as a major priority for the NSSF team, but the continuous dialogue between the HIP and NSSF teams has allowed the HIP team to build aw...READ MORE
On technology It has also been important to find ways to adapt the system to places where electricity is scarce. A system using SMS messaging has therefore been put in place to cater to these limitations. The offline SMS system is particularly important for clients, as it ensures that the insured can be identified even at night, or in locations where the internet isn’t working. This in turn ensures that clients aren’t charged by hospitals ...READ MORE
On distribution It is important to work with both employers’ and workers’ unions to create a more conducive environment for distribution. This has been difficult, given escalating tension between the groups and increased strikes, but, where possible, helps reduce the antagonism that usually arises between workers and managers around health insurance services. When workers’ unions and employers’ unions speak with one voice (although oft...READ MORE
On client value When designing the benefit package, it has been important to use a social protection approach from the beginning. GRET therefore believes that it is important to provide a comprehensive package that provides both primary and hospital care, and to do so on a cashless basis. It has also given specific attention to reproductive health, since most of its insured members are young women. At the same time, it has been important to fi...READ MORE
On promotion It is particularly challenging to find the time and spaces to communicate and promote the product with factory workers. Workers’ representatives have been very important to help the HIP team find ways to promote the product, and to facilitate discussions with workers. It is difficult to capture workers’ attention, but where the factory has a canteen, the HIP team has found opportunities to approach workers during lunch breaks....READ MORE
Project page contributor/s:  Pascale Le Roy (GRET), and Caroline Phily and Alice Merry (the Facility)
Date of last update:  October 2013