3 May 2010
By Jinal Shah
Laxmi, a 25–year–old eunuch belonging to Mangti sect, earns her living by begging in local trains. Uncertain of her own future after she was detected with HIV four years back, she prays for commuters’ good health and financial growth with every clap.
Now Laxmi has a reason to cheer. Mumbai’s People Living with HIV (PLHIV) will soon be covered under a unique group medical insurance policy tailor–made for
them. The project ‘Connect’ designed to build public private partnership in combating HIV will be partly funded by NGO Population Services International (PSI). When an insured gets admitted in a Network hospital he/she can go in for cashless hospitalization.
“I take care of my ailing mother from whatever I earn from begging but if I fall ill there is no one to take care of me. Even if I have small bouts of fever, I end up in a hospital and each visit costs me somewhere between Rs 3,000 and Rs 4,000. All my money goes in paying medical bills,” says Laxmi.
The scheme will cover PLHIVs attached to Mumbai Network of positive people (NPM+) and other NGO’s from Mumbai and Thane area. It involves a private insurance company, Star Health and Allied Insurance, and is supported by the United States Agency for International Development (USAID).
The scheme is open to a group of 200 PLHIV, with a CD4 count of 300. Initially, the client will get a health cover of Rs 30,000 for which a premium of Rs 1,511 will have to be paid to the insurance company. The policy holder is entitled to pay only Rs 750 and the rest subsidized by PSI. There are two other variations of the policy where one can be insured for Rs 40,000 with a premium of Rs 1,919 and Rs 60,000 for a premium of Rs 2,545. However, the other conditions remain.
“The policy will provide a health cover of Rs 30,000 including Rs 15,000 for hospitalization at the onset of AIDS and Rs 15,000 for treatment of other illnesses like opportunistic infection. It will
help provide access to cashless treatment in about 187 private hospitals in Mumbai,” said Vijay Bhende, co–ordinator for Connect project at Network of Maharashtra People with HIV (NMP+).
“Last week we received 222 forms with premium amount from PLHIV's in Mumbai and Thane. By this month end, the company will issue insurance policy and insurance cards,” said K S Mathew, manager Star Health and Allied Insurance Company.
Like other insurance policies, this one also has exclu sions –all diseases and injuries which are pre–existing and contracted in the first 30 days of taking the policy will not be covered. Also there is a 90 days waiting period for AIDS stage benefit.
“This policy is a major achievement in the fight against the discrimination of PLHIV. The best part is that there is no age limit and covers pre–hospitalization expenses for 30 days, inpatient services and post hospitalization expenses up to Rs 50,000,” said Bharti Sonawane, president NPM+.
Under the policy, confiden tiality of the patient will be maintained. A photo Id card containing ID number, policy number, insurance validity, toll free helpline number and address of the insurer will be issued. HIV status of the person will not be revealed in the insured ID card.
Experts in the field welcomed the move. “With introduction of antiretroviral therapy, opportunistic infections have gone down and longevity of HIV patient has increased. Many insurance companies in Britain have offered medical cover with high premium. In USA they are covered both under general and medical insurance,” said Dr Alaka Deshpande, incharge of JJ Hospital ART centre.
“I need to secure my future.
Though the insured sum is too less, it is a beginning towards a life free of discrimination,” said Laxmi.
The project is running successfully in Karnataka, Andhara Pradesh and 10 districts in Maharashtra including Pune, Solapur, Sangli, Satara, Kolhapur, Yavatmal, Nagpur, Aurangabad and Chandrapur where about 493 people are insured.
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