Health takaful and SSP
In today’s world, treatment of diseases and accidents has become very costly. Although governments try to offer health services in state hospitals on highly subsidized rates but at times, their quality becomes questionable. Due to which, people prefer private hospitals for treatment but they are expensive and many people can’t afford their cost. Facilities of private hospitals can still be used in a cost effective way through taking appropriate health coverage from takaful and insurance companies.
Takaful is Islamic alternative of conventional insurance. Takaful companies provide health and other coverages in a Shariah compliant way. Presently, more than 10 companies are offering health takaful products in Pakistan. The Government of Khyber Pakhtunkhwa has also taken a historical initiative “Sehat Sahulat Programme (SSP)” by taking health coverage for all the people of KP from the country’s largest state owned company, State Life Insurance.
In this coverage, OPD expenses are not covered while only hospitalization treatments and some day care procedures are covered. State life also has a takaful division and can also issue SSP coverages from their takaful division. We will discuss SSP later in detail; first, we will try to understand health coverage.
Health coverage pays compensation for the costs of treating an illness or injury. There are two categories of coverage: OPD and hospitalisation. OPD covers doctor’s fee, the cost of prescribed medicines and the cost of medical tests, whereas hospitalisation coverage is used when a covered client becomes ill and has to stay in hospital and company covers his/her medical expenses up to a specified limit. Health coverage is usually provided to employees and their dependants (husband or wife and children, parents) by their employers. It can also be taken privately for a family covering client and his/her dependents.
In this regard, SSP covers all KP residents having their CNIC with permanent address of any district of KP, whereas people of KP living in other provinces but having their permanent addresses in CNIC can take health treatment from those local hospitals which are included in the panel hospital list of State Life. The list can be accessed from the State life official website.
SSP covers family head and his dependents (wife and unmarried children). There is no age limit and exclusion of pre-existing condition (except “Standard Exclusions”). SSP coverage has two levels. First level covers treatments normally provided by District Headquarters hospitals, including emergency service, surgery, pediatrics, orthopedics, gynae/obs, ENT, eye and so on. For these treatments, every family member has an annual limit of Rs40,000. The second level provides Rs400,000 annual limit for the whole family and covers major surgeries like heart bypass, kidney transplant and dialysis, cancer treatments, diabetes related complications and neurosurgery etc.
Eligible medical expenses include general ward charges, operation theatre charges, surgeon’s fee, anaesthetist’s fee, consultant’s fee, medicines and drugs, diagnostic tests and five days medicine prescribed in discharge report. If client dies in hospital then Rs10,000 is given for meeting his/her burial expenses.
Since SSP covers all the KP permanent residents, therefore, there is no need of Sehat Insaf Card and CNIC becomes your sehat (health) card. For treatment in other cities, a client has to take a referral letter from own district hospital. Moreover, one should have original CNIC if his/her age is above 18 or form “Bey” if the patient’s age is less than 18 when admitting in a hospital.
Here it is to be mentioned that the coverage should not be used for those treatments which are already free or with minimum expenses. The coverage should be availed either at private hospitals or at governments hospitals where treatment cost is high. For people’s guidance, every panel hospital has a State life representative who can be contacted for any information. One may call at toll free number 0800 89898 of the State Life Insurance.
The writer has worked for 15 years in insurance and takaful companies. Presently, he is working as a lecturer at the Centre for Excellence in Islamic Finance (CEIF), Institute of Management Sciences (IMSciences), Peshawar. He can be contacted at: email@example.com.