Based on our learnings from urban Bangalore (a small-scale urban pilot) and rural Maharashtra, we plan to offer a comprehensive health insurance product to the low-income segment in Mumbai. Enrolment in the scheme will be for an entire family, i.e. Individual, spouse, upto 3 dependant children and dependant parents. The policy holder family will be issued a photo identity card and will be entitled to the following benefits:

• Primary care outpatient services at conveniently located Swasth Health Centers at following rates -
  • 50% copay on doctor consultation charges
  • 50% copay on primary care basic drugs
  • 70% copay on basic diagnostic tests
• Secondary care outpatient services will be available on a weekly basis at Swasth Health Centers at 50% copay and at a network of clinics / nursing homes on a daily basis.
• Inpatient services will be available on a cashless basis at conveniently accessible network of hospitals / nursing homes
• For inpatient services, there will be a per incidence limit of Rs 10,000 and an annual floater cover of Rs 30,000 for the entire family
• Inpatient cover includes all diseases (including pre-existing), with the exclusions of pregnancy, surgical removal of kidney stones, hysterectomy, venereal diseases, mental disorders and alcohol induced diseases
• Disease prevention and health promotion services to reduce incidence of infectious diseases through conducting awareness campaigns (e.g. Safe drinking water campaign, Anti-malaria drive) and providing access to necessary products (e.g. Chlorine tablets, medicated nets) and knowledge
• Disease management programs for chronic conditions (e.g. hypertension, diabetes) through activities like diagnostic camps for early detection and regular tests and followups to ensure compliance in drug consumption and change in lifestyle

We believe it is important to offer a comprehensive health insurance product to make it attractive and valuable to customers, as well as to make it sustainable by fundamentally reducing the cost by integrating the various components of health care services and reducing the disease burden through preventive-promotive services. This is an innovative feature of our product - in contrast to all health insurance products available in India which provide benefits only on inpatient care.