Community Based Plans

How it works

Community Based Social Health Insurance Programme is a non-profit making programme for a cohesive group of households/individuals or occupation-based groups. It was formed on the basis of the ethics of mutual aid and the collective pooling of health risks, in which members take part in its management.

Membership

This shall be voluntary and open to all residents (families) of the participating communities/occupation-based groups (including retirees). The family or individual members shall be the unit of registration. In order to achieve a critical pool of funds to ensure financial viability, as well as to address the problem of adverse selection, communities/occupation-based groups shall have at least 50% of members willing to participate (or a minimum of 1000 members).

Registration Procedure

Registration of enrollees shall be by technical facilitators or BOTs. Each programme shall have a clearly defined procedure for registering enrollees as well as a form of identification (such as membership card) to assist in the identification of scheme members.

Benefit Package

The benefit package shall reflect preventive, promotive and curative components of health care delivery. It shall aim at minimum primary and secondary curative care, taking into cognizance the prevailing local morbidity and mortality profile, including pre- & post-natal care, normal delivery, child welfare services (including immunization), family planning and health education services.

Contribution/Premium

This shall be actuarially determined flat rate fee per household/individual household member or member of an occupation based group and paid in cash monthly or seasonally in advance.

Donations

Project managers may seek for donations/grants by way of formal launching/fund-raising events, or by targeting individuals, governmental and Civil Society Organizations, including private companies, with the aim to boost the financial base of this scheme.