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Women organizing for social protection The Self-employed Women’s Association’s Integrated Insurance Scheme, India STEP Programme Social Protection Sector International Labour Office 4, route des Morillons CH-1211 Geneva 22, Switzerland Tel.: (41 22) 799 65 44 – Fax: (41 22) 799 66 44 e-mail: [email protected] – INTERNET: www.ilo.org/step/publs The programme “Strategies and Tools against Social Exclusion and Poverty” (STEP) of the International Labour Office is an instrument for extending the coverage and effectiveness of social protection throughout the world. Following the conclusions of the World Summit for Social Development in Copenhagen, the STEP programme promotes the design and the implementation of innovative systems of social protection for excluded populations. Based on the principles of equity, efficiency and solidarity, these systems contribute to social justice and cohesion. In its work, STEP combines different types of activities: concrete actions in the field, research, production of methodological tools, reference documents and technical assistance for policy development and implementation. Women organizing for social protection The Self-employed Women’s Association’s Integrated Insurance Scheme, India International Labour Office Copyright © International Labour Organization 2001 First published 2001 Publications of the International Labour Office enjoy copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts from them may be reproduced without authorization, on condition that the source is indicated. For rights of reproduction or translation, application should be made to the Publications Bureau (Rights and Permissions), International Labour Office, CH-1211 Geneva 22, Switzerland. The International Labour Office welcomes such applications. Libraries, institutions and other users registered in the United Kingdom with the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P OLP (Fax: + 44 (0)20 7631 5500), in the United States with the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 (Fax: + 1 508 750 4470) or in other countries with associated Reproduction Rights Organizations, may make photocopies in accordance with the licences issued to them for this purpose. ILO Women organizing for social protection. The Self-employed Women’s Association’s Integrated Insurance Scheme, India Geneva, International Labour Office, Strategies and Tools against social Exclusion and Poverty Programme (STEP), 2001 Social protection, woman worker, self employed, womens organization, informal sector, health insurance, India. 02.03.1 ISBN 92-2-112627-7 ILO Cataloguing in Publication Data The designations employed in ILO publications, which are in conformity with United Nations practice, and the presentation of material therein do not imply the expression of any opinion whatsoever on the part of the International Labour Office concerning the legal status of any country, area or territory or of its authorities, or concerning the delimitation of its frontiers. The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office of the opinions expressed in them. Reference to names of firms and commercial products and processes does not imply their endorsement by the International Labour Office, and any failure to mention a particular firm, commercial product or process is not a sign of disapproval. This publication can be obtained, free of charge from: ILO-STEP Programme Social Protection Sector, International Labour Office 4, route des Morillons CH-1211 Geneva 22, Switzerland Tel.: (+41 22) 799 6544 Fax: (+41 22) 799 6644 E-mail: [email protected] http://www.ilo.org/step/publs Printed in Italy CONTENTS INTRODUCTION 1 Chapter 1: CONTEXT OF THE INTEGRATED INSURANCE SCHEME 3 1. The SEWA movement .................................................................... 3 1.1 SEWA’s origins ....................................................................... 3 1.2 SEWA’s philosophy, goals and membership .............................. 4 1.3 SEWA: A profile of its organizations and activities ............... 6 2. Environment in which the Integrated Insurance Scheme operates ............................................................................................. 14 2.1 Demographic aspects ................................................................. 14 2.2 Economic aspects ...................................................................... 14 2.3 Labour market aspects ............................................................. 15 2.4 Educational aspects ................................................................. 15 2.5 Health aspects .......................................................................... 16 3. Social protection for people working in the informal economy in India ............................................................................. 17 3.1 The major Indian social security schemes ................................... 19 3.2 Other arrangements for people in the informal economy .............. 22 Chapter 2: THE INTEGRATED INSURANCE SCHEME 27 1. Development of the Integrated Insurance Scheme ................... 27 1.1 Birth of an idea: Access to social protection (1977-89) .......... 27 1.2 Introduction of the life insurance scheme (1989-91) .................. 28 1.3 From life insurance to integrated insurance (1992) .................... 29 1.4 Major changes in the Integrated Insurance Scheme between 1993 and 1999 ....................................................................... 32 2. Principal features of the Integrated Insurance Scheme in 2000 ................................................................................ 33 2.1 Target group, membership and beneficiaries ............................... 33 2.2 The benefits package and premiums .......................................... 41 2.3 Administration and management .............................................. 44 v The Self-employed Women’s Association’s Integrated Insurance Scheme, India Chapter 3: SPECIFIC ASPECTS OF THE HEALTH COMPONENT 51 1. Health benefits ................................................................................. 51 1.1 Coverage ................................................................................... 52 1.2 Choosing the services to be covered ............................................. 54 1.3 Diseases covered and the main causes of mortality and morbidity in India .................................................................... 55 2. The Integrated Insurance Scheme and health care providers ....................................................................... 56 2.1 The Integrated Insurance Scheme and SEWA’s health care providers .................................................. 56 2.2 The Integrated Insurance Scheme and external health care providers .................................................... 57 3. Health claims and characteristics of claimants ........................... 58 3.1 The most common claims .......................................................... 58 3.2 Number of claims .................................................................... 59 3.3 Characteristics of the claimants ................................................ 61 4. Cost of services and reimbursement ........................................... 62 4.1 Cost of services ........................................................................ 62 4.2 Reimbursement ......................................................................... 65 5. Health premiums in relation to the Integrated Insurance Scheme members’ income ........................ 65 6. Time taken to process health claims ............................................ 66 Chapter 4: FINANCIAL ASPECTS OF THE INTEGRATED INSURANCE SCHEME 69 1. Accounting treatment ..................................................................... 69 1.1 Major issues ............................................................................. 69 1.2 Subsidiary issues ...................................................................... 70 2. Financial history of the scheme .................................................... 70 3. Financial development of the scheme ......................................... 71 CONCLUSION 79 ANNEX 83 BIBLIOGRAPHY 85 vi ACRONYMS ACCORD Action for Community Organization, Rehabilitation and Development ASSEFA Association of Sarwa SEWA Farms CHC Community Health Centre ESI Employee’s State Insurance EPF/MP Employee’s Provident Fund/ Miscellaneous Provisions FD Fixed deposit GDP Gross Domestic Product GIC General Insurance Corporation of India GIS Group Insurance Scheme GoI Government of India GTZ Gesellschaft für technische Zusammenarbeit (German Technical Development Agency) HDI Human Development Index ILO International Labour Office IIS Integrated Insurance Scheme IRDP Integrated Rural Development Programme LALGI Landless Agriculture Labourers’ Group Insurance LIC Life Insurance Corporation of India NGO Non-governmental organization NIACL New Indian Assurance Company Ltd NSAP National Social Assistance Programme PHC Primary Health Care Centre RBI Reserve Bank of India RGLIS Rural Group Life Insurance Scheme SAAT South Asia Advisory Team SEWA Self-employed Women’s Association SPARC Society for Promotion of Area Resources Centre STEP Strategies and Tools against Social Exclusion and Poverty Programme vii The Self-employed Women’s
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