Uplift Mutuals Hits Unique Pooling Model of Medical Insurance

In 2002, when a member of Pune-based women’s group had no money after a heart operation, other members hit upon the idea of shielding themselves against such emergenices instead of depending on insurance cover that is never returned if you are not sick in the entire year but make your life miserable when it comes to pay for hospital bills.

Moreover, insurance companies often practice “cherry picking” and “lemon dropping” — that is picking good risks and leaving out bad risks in a typical formula used by commercial insurance products and those in the bottom of the pyramid are left out or less educated about the product’s risks.

Hence, the Uplift Mutuals was born in Pune as a form of risk pooling where risks are not transferred to a third party like an insurance company but managed internally. “We realized that risk sharing would also help in reducing the traditional ills of health insurance (moral hazard and fraud) as members would own the programme and since the contribution is theirs they should be the one deciding the benefits,” said founders of Uplift Mutuals on their website.

In their baseline survey with families living in the slums, they assessed capacity to pay and realised that any health financing for the poor should address families wanted to know the right doctor, right treatment and right cost.

Soon, a new model of self-health care program was born in 2003 with 300 women forming into the Uplift Mutuals and today they boast of 200,000 members across five partner organisation in Maharashtra and Rajasthan.

Uplift has a technical team that designs the entire end to end Health Mutuals scheme that includes actuarial, medical , capacity building, monitoring and evaluation and IT skills.

Kumar Shailabh of Uplift Mutuals says instead of focusing on available and often limited products under social security schemes, the government sponsored health financing schemes should be utilized to provide adequate cover to rural poorer people.

He says efforts should be made to utilize the social capital generated through self-financing model by the groups under the government-sponsored schemes such as NRLM would give way to answer local needs. Health Mutuals facilitate that there is no age based pricing, one price for all, no age entry bar, product exclusions validated by the community based on their context (normal maternity is covered in some communities), informed risk management (rationalized utilisation of services) and focus on family enrollment to ensure that girls are covered.

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