Health Insurance Pilot Project for RMG Worker in Bangladesh

Background:

In 1973, GK introduced locally organized Health Insurance (HI)-based on social classes and income. Rich people pay higher premium and poor pay little but receive comprehensive health care with a reasonable price. GK is not a profit making insurance company but introduced a social class based health scheme with affordable easily accessible and reduce out of pocket money for the common people in the health care services. This model will be a role model for universal health coverage for low income group people.  After the Shahriar garments collapse, Tazreen Garments fire and the biggest tragedy in the Garments sector of world Rana Plaza collapse, GK developed a strategic paper to provide comprehensive health care to RMG workers in Bangladesh. In this aspect GK make a partnership with SNV a Netherlands base development organization to provide SRHR services for the women RMG workers only. But during the service delivery time demand from the workers GK extended its services to the male workers also. GK provide dental care, Physiotherapy, Ophthalmic care along with general health services to ensure comprehensive health care services of the low income group people. The current project is funded by WOF (Weave Our Future) and technical assistance by SNV Netherlands Development Organization.

 

Responsibilities of all parties for service

All parties will strive to accomplish the following activities to achieve the objectives of the project.

a)     Responsibility of GK:

1.     Ensure good management of the centers and provide all promised health care services.

2.     Availability of the service for all garment workers covered under Health Insurance. If necessary they will be referred in hospitals and surgery will be done as and when necessary.

3.     GK has to notify the Factory one month in advance for any training program developed for the workers.

4.     GK will share health information report generated from the software to the factory on quarterly basis.

Service Delivery points

  1. Factory level: 2 days per week by a team of MBBS doctor and paramedic.
  2. Clinic level (Panishail): 24/7.
  3. Referral hospital: GK Savar & Dhaka Nagar (Dhanmondi) medical college hospital, 24/7.

 

b) Responsibilities of Factory.

The factory management will:

1) Be agreed to the proposed premium;

2) Organize to share as per the clause 6 & 7;

3) Provide support to GK to enroll the workers of the factory under health scheme;

4) Participate in different sensitizing meeting, quarterly meeting organized by GK;

5) Allow the factory workers’ to participate different training/awareness programs organized by GK;

6) Provide instruction to the factory medical center to refer workers in GK Health facilities;

7) Share business indicator like absenteeism, migration, sick leave and productivity related data to GK for study purpose for the project period;

 Cooperate with GK for conducting different survey and research in the factory regarding the scheme.

Health Service provision in the Scheme:

   Services available in the packages for the workers:



 * Renal dialysis at cheaper rate for the RMG workers at GK Nagar hospital                         

 ** N.B: All the services provided in GK facilities. None can claim services in other clinic or hospital


b) Services not covered by the health insurance:

No benefit shall be paid under this Contract for expenses or losses resulting from or incurred in connection with or in consequence of the followings:

·         Hearing Aid

·         Spectacles in case of eye sight problems

·         Artificial teeth and adjusting of jig jag teeth

·         Root canal with Cap

·         Conveyance for attending hospital/ clinics, food and healthy foods.

·          Cancer therapy and medicine.

·         Cosmetic surgery

·         Lens for Phaco Surgery (Surgery will be free but member has to purchase the materials)

·         CT/ MRI Examination

·         Kidney dialysis

·         Electrical and Artificial Limb implantation

·         Bypass Heart surgery

·         Head and Neurosurgery

·         ICU and CCU care

·         Any congenital infirmity: shall mean a physical abnormality that is present since birth, or is usually present from birth irrespective of the presence of any symptom and/or sign relating to that abnormality.

·         Mental, emotional or psychiatric disorders, alcoholism or any other narcotic addiction.

·         Obesity i.e., treatment for, or required as a result of obesity

·         Health screening including routine physical examinations (health check-ups), radiotherapy-X-ray radium or radioactive isotopes treatment(except hospitalization), chemotherapy or hospitalization due to complication of chemotherapy(except hospitalization) or any form of treatment when not incidental or necessary to the treatment of the injury/illness which caused the hospitalization

·         Injury arising due to accident while participating in any unlawful activities (e.g., driving a car without a license)

·         Sleep disorders i.e., treatment for insomnia, sleep aponea, snoring, or any other sleep related breathing problem

·         Injury, destruction or damage caused by nuclear fission, nuclear fusion or irradiation

·         AIDS and HIV diseases.

·         Poisoning and factory accident due to fire/collapse

·         Ambulance services

·         If required to refer to a specialized hospital for treatment.

Premium:

Premium for the scheme is BDT 600 per worker per year. The premium sharing during the project period is given in the table:






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