Third Party Administration in the Provision of In-patient Health Insurance: An Indian Case Study
This paper discusses third party administration in the provision of in-patient health insurance through a case study of MicroEnsure's venture in India. It gives an overview of the demand for health insurance in India and identifies challenges in the market.
MicroEnsure partnered with SHARE Microfin, a leading Indian MFI, Medicare, a third party administrator and the United India Insurance Company to launch an in-patient health insurance program for the poor. The policy is cashless, compulsory for borrowers of the MFI and covers the policyholder, spouse and children. The role of each partner in the venture is as follows:
- MicroEnsure designed the policy and is responsible for securing underwriter approval, preparing the operating manual, training loan officers and developing client education materials;
- Medicare provides the hospital network and handles administration of claims;
- SHARE Microfin acts as the front office, maintaining a direct relationship with each low-income household.
The challenges in implementation included finding the right underwriter, handling huge volume of claims, developing a verification system to control misuse and educating clients.
