1. Micro Insurance -
PWDS – Bharti AXA General Insurance
Operations & Claims-Training Initiative
Process Excellence – Ops & Claims

2. PWDS Training Initiative
AIM: To launch the proposed Health Insurance plan to the members of PWDS, federation of Self Help
Groups spread over 9 districts in Tamil Nadu, almost on the southern tip of Indian subcontinent
Concept: The growth of Micro Insurance in India is yet to pick up as most of the insurers do not view
it as a business opportunity. Out of 121 new insurance products approved by IRDA during 2005-06, only
two were Micro Insurance products. The Self Help Group movement has opened up credit access to poor.
But still many poor households are vulnerable to a variety of risks. For securing against the most
unexpected bigger loss events like accidental injuries, surgery or prolonged hospitalization, Micro Health
Insurance (MHI) emerges as the best option for poor households.
A health survey (2005) revealed that 40 percent of rural hospitalized members depended on money
lenders and 13 percent of members sold their assets to meet the hospitalization expenses.
Major challenges noted in the field were such as poor understanding of the concept and product features
by the clients, difficulty in establishing the cases of pre-existing diseases, Process delays by the insurers
for claims settlement, rejections without valid reasons / without mentioning the reasons / oral rejections,
Non receipt of insurance identity cards by clients, Non-receipt of insurance commission from the
insurers, Difficulty in getting the bills / reports from the doctors, Doctors not aware of the product
features / claim formats, NGO staff turnover, Lack of capacity of NGOs/CBOs (Community Based
Organizations – Federation of SHG’s) in claim handling, Some moral hazards and lack of MIS.
Micro insurance is an integral part of Sales of any General Insurance Company as laid by the norms of
IRDA. Contrary to the sales model in urban and semi urban areas, Rural Sales pose a challenge and a
tough task for any insurance organization in India. Outlook of rural populace is much different from that
of urban and approach towards Insurance and Sales. A typical Indian state has as many as 5 different
slangs and usage of colloquial words. People have a hypocritical outlook towards scientific and modern
gadgets and a typical Training venue would typically include a school or a welfare centre without any
Public Addressing support and infrastructure.
Servicing readiness to Rural Sales and concept of Training to Rural population is an initiative taken by
Operations & Claims as a model program to support the Micro Sales of Bharti AXA General Insurance.
Foundation of Basic Mechanism of Insurance has to be laid and inbred and a platform has to be created so
as to build the higher concepts of Insurance and to explain the working of an Insurance Product.
Concept of Health Insurance can only be trained after a basic knowledge of working of Insurance is
arrived at.
Process Excellence – Ops & Claims

3. Customer Profile
PWDS is a Federation of Self Help Groups with a member base of more than 54000. These members are
typically women representing their families and belong to lower income groups of society. Members
belonging to lower strata of society and
PWDS, founded in 1977, continues its journey of serving all marginalized and disadvantaged. PWDS
manages three network programs covering 28 districts of Tamil Nadu. NEERA, a decade old network
program of PWDS, promotes mainstreaming to sustain the impacts beyond the project framework and
has promoted 3211 SHGs in 1108 villages and 54398 families (221788 members) are under its fold.
Approach: With the linguistic support from Trainer Saravana Kumar and Zonal O&C, Mr.Yaseen
Shah, this concept is build after dealing explicitly in the following concepts
1. Basics of Insurance – Scope and Working
a. Life
b. General
2. Health Insurance
3. Working of Insurance
4. Plan
a. Details
b. Benefits
5. Health Insurance Claim Process
a. Claim Process
b. TPA Administration and Working
c. Hospital Network
6. Service and Support
Some Sample Training content prepared for the Training:
Process Excellence – Ops & Claims

4. Implementation Phase 1:
TIPS & CARDS SHGs –
Kanyakumari, Tamilnadu
Discussion started with Basics of
Phase 1 of this program started in Insurance and proceeded to Plan The next day started early by 9am
Kanyakumari, Southern tip of India Benefits, Claim Process. Day closed with a recap of the previous day’s
also called as Cape Comarin, India. with claim process. Mr.Yaseen Shah discussion. The group has discussed
34 members of 2 SHGs, TIPS and was the key speaker and Tamil was and has prepared a report of the
CARDS gathering in a Christian the main language of the discussion. previous day’s activity which is read
missionary convent. Training started Atmosphere was cool with lively sea by an IC. The report was exhaustive
at 11am in an open hall of the breeze and drizzle making the entire and touched upon all the topics.
convent with lot of breeze and light day very congenial to learning. Even
making the place lively and natural. though the group was a bit reluctant
and silent in the beginning but no
sooner the discussion on Plan
Benefits started, group has become
lively and interactive with many
clarifications and questions. Typical
examples involving Maternity related
situations have evolved. Many of Continuing the discussion,
such clarifications were referred back Dr.Deveswar from TPA has
to Mr.Partha Chakraborty, National addressed the group for the next
Resources and infrastructure is basic Head, Health Claims and were hour on enrolment criteria, network
but lively and apt for the clarified immediately. All such hospitals and claim process. Also
environment and surroundings. questions are listed and are made covered in the discussion are the
Training group from Bharti AXA is into a list of FAQs. diseases covered and exclusions.
represented by Saravana Kumar, Mr.Yaseen Shah has revised all the
Yaseen Shah and LVN Murthy. This topics again. Quiz program was
group was introduced by the local conducted on the topics covered and
coordinators Mr.Chandra Babu and everyone has participated with lot of
Vijil. Audience is a group of women interest. There were prizes for
represented from surrounding winners and everyone in the group
villages and are members of has won a prize indicating
Federation. involvement and interest.
Process Excellence – Ops & Claims

5. Implementation Phase II: The level of understanding
and assimilation were slightly
SEDCO SHG – Tirunelveli, Tamilnadu lower as compared to those of
Kanyakumari.
Phase 2 of program continued in Tirunelveli on 22nd
May. All the members have congregated and the Even though all the trainees are educated, age
discussion started by 10.30 am. Training venue was a disparities among them are very high leading to a
Christian social service convent called ‘TSSS’ located complex group dynamic structure. However, with an
almost 15 km outside of Tirunelveli. efficient engagement skill and language Mr.Yaseen has
made the Concepts and Mechanism of Insurance very
lively and all the members could relate to real life
scenarios which they have come across.
The Flow of training remained the same with Product
benefits following with claim Process. By Lunch time,
we could complete basics of insurance and post lunch
The group of trainees is little less compared to Phase 1.
the discussion started with product benefits. Dr.
All the trainees belong to
Deveswar explained the working of TPA and a Q&A
SEDCO self help group. The temperature outside was
session followed. Quiz program was the last part of the
hot however, due to trees and vegetation, the training
Training by the end of the day and every one
room was comparatively cooler from outside.
participated in Quiz with interest and encouragement.
Mr.Yaseen Shah started the discussion about Basics of
Insurance and continued in the same flow as that of the Feedback from the participants was very positive and
Phase 1 Training. encouraging showing enthusiasm for repeated training
and more information.
Process Excellence – Ops & Claims

6. Core Member Group
Members of Core group from Bharti AXA General Insurance consisted of Mr.Milind Joshi, Sr.VP, Ops &
Claims, Mr.Partha Chakraborty, National Manager, Health Claims, Ms.Hritu Kumar, Manager Process
Excellence, Saravana Kumar, Yaseen Shah and LVN Murthy . Ms.Hritu Kumar, Mr.Partha Chakraborty
and Mr.Milind Joshi have directed and whetted the entire process.
Saravana Kumar is currently Manager Training for
Operations and Claims and is the key person in preparation of
content for the Training Program. The Training content
involved powerpoint presentations which in English as well as
Tamil. JPG-ASCII Font conversion method was applied so that
Tamil Fonts can be viewed comfortably. Actual formats which
are part of the process were shown during the presentation so
as to make Trainees aware of the real time processing.
Also given leaflets and reminders of Product Benefits, Exclusions under the Policy and sample Proposal
Form
Yaseen Shah is currently handling the offices Bharti AXA as
Zonal Head, Operations and Claims, a strategic responsibility
spanning over states of Andhra Pradesh, Tamil Nadu and
Kerala. Owing for his extensive experience in Insurance Claims
domain, by being based out of Chennai and by being well
versed in all slangs of Tamil, Yaseen was a natural choice for
imparting such Training program which needed better
engagement skills and making easier the concepts of Insurance.
Yaseen has created an example for imparting training programs for tough audience of rural origin.
Mr.L.V.N.Murthy currently heading the Rural Sales division
of Bharti AXA General Insurance and Rural Sales by being tied
up with PWDS is his brain child. Right from the inception stage
he has been Liasioning with the authorities of PWDS and have
brought the project to this stage of implementation. Post
Training and the sales kickoff, the project is to start its coverage
from 1st July 2009. He has travelled extensively through the
districts where PWDS is spread. He is supported by
Mr.Hemanathan, Sales Officer in this project who was also
present during Training.
Looking from the response after Training at both Kanyakumari as well as Tirunelveli, all the
trainees have expressed their confidence in making this project a huge success.
Process Excellence – Ops & Claims