In July 2005 the Government of Assam decided to implement the Mukhyomantri Jibon Jyoti Bima Achoni. This is a combined health insurance and personal accident insurance scheme for all citizens of the State of Assam whose names appear on the electoral list as in force when the claim is being made along with their dependents. The employees of the Central and State Government, Public sector and Private companies, all those who have an annual gross income before tax exceeding INR 200,000 are not entitled to the benefit for health and accident coverage. However, the employees of tea companies, who are engaged in cultivation and processing of tea in the State, are entitled to the benefit of the scheme both for health and personal accident coverage.
The Government of Assam (GOA) and ICICI Lombard General Insurance Company Ltd (ILGICL) having its registered office at ICICI bank towers at Mumbai and its branch office at Guwahati entered into an agreement for implementation of the Mukhyomantri Jibon Jyoti Bima Achoni. The scheme is implemented by ILGICL through its branch office in Guwahati. It aims to provide health and accident risk insurance coverage to the entire population of 3 crore at a premium of INR 25 crore. The sum assured for each person is INR 50,000 in case of accidental death and INR 25,000 for any health-related eventuality. There would be no third party administration and the district administration alone with Revenue Circle Officer (RCO) as the facilitator, would help out the villagers. The settlement would be made within 60 days.
The Planning and Development Department of the Assam Government, which worked out the deal, had earlier invited bids from a host of insurance companies. Seven insurance companies, including four from the public sector, had expressed interest in it. The contract went to ICICI Lombard because it had the lowest bid of INR 27 crore, inclusive of service tax. The government then squeezed it further, bringing the amount down to INR 25 crore, and this included sales tax and educational cess.
From August 2005 till July 2006 there have been approximately 4205 beneficiaries and Rs.9 crore has been spent on compensation since the scheme was enforced.
INR 25 crore.
State of Assam.
Approximately 1 year.
Monetary benefit: Medical expenses up to a maximum of INR.25,000 under the health insurance scheme for the treatment of certain specified diseases and compensation up to a maximum of INR 50,000 in case of death.
Early settlement of claims: The settlement would be made within 60 days.
No third party administration: The district administration through RCO would help out villagers.
Wide coverage: The coverage includes snake bite, animal bite, drowning in river, tank, pond, flood, falling and drowning in a well, earthquake, landslide, rockslide, lightening, cloud burst, fire related accident, collapse of roof, falling from a tree or high- rise building, vehicle accident, accidental explosions or firing, riot or scuffle, excluding international involvement in the said peril or someone putting oneself in needless perils other than whilst saving human life.
Limited benefit: The person shall not be entitled to any other benefit after the claim is admitted under this policy.
Restricted coverage: The employees of the Central and State Government, Public sector and Private Companies, all those persons who have an annual gross income before tax exceeding INR 2 lakhs are not entitled to benefit from this health and accident coverage insurance.
Commitment of the Government and ICICI Lombard.
Who needs to be consulted
Planning and Development Department of Assam Government.
It is quite sustainable; the government in future may have other insurance schemes also.
This initiative can be transferred to health department from the planning and development department and can be regularised by the health department in future.
Chances of Replication
Health insurance schemes are running in other states of India too.
Revenue Circle Officers (RCOs) have been made Claim Facilitating Officers (CFOs) while Deputy Commissioners (DCs) have been made final arbiter in doubtful claims.
Dhrub Kumar Singh, Research Consultant, Central Bureau of Health Intelligence, New Delhi, October 2006.