Collective Auroville Health Fund

- as reported in the AVNews, December 2001

For some time now the Auroville Health Care Group and the Economy Group have been studying possible ways to take care of the costs of hospitalisation and other medical expenses of all Aurovilians and Newcomers. Various options have been thoroughly looked into, including going to an outside insurance company.
The outcome of these discussions and research is to propose to the community that we experiment for one year, from January 1st 2002, with an in-house co-operative insurance scheme called the Auroville Health Fund. The main reasons for choosing this option are that we feel that the creation of such a co-operative health fund would be closer to the aims and ideals of Auroville and that we would be able to cover more needs than by going to an outside collective health insurance such as the 'Mediclaim' insurance, standard in India, under which only hospitalisation expenses (with a few exceptions) are covered.

The Auroville Health Fund

The Auroville Health Fund would be set-up as a co-operative insurance system. This implies that all the income of the Auroville Health Fund, which would come from contributions, would be used to cover the medical expenses of those who have agreed to participate. If, at the end of the year, there were any money left over in the Auroville Health Fund, that money would be carried over to the next year. In the case that there were no money left over by the end of the year and the Auroville Health Fund had more expenses than income, the deficit would be shared proportionally among all the participants. This means that every participant would pay a bit extra in proportion to their yearly contribution. For example, if the total income of the Auroville Health Fund is Rs 40 lakhs, and there is a total deficit of Rs 10 lakhs and a person has contributed Rs 2,400/- per year, the extra contribution required by the participant would be Rs 600/-. In this way the community would carry the medical costs of all Aurovilians and Newcomers together.

Income

1. Contributions

It is proposed that initially the contribution for each Aurovilian and Newcomer of 18 years and older would be Rs 200 per month and the contribution for each Aurovilian and Newcomer below the age of 18 would be Rs 100 per month.
This amount would be paid:
1) By the unit for which the Aurovilian/Newcomer works and also for their children. In case the parents work for different Auroville units, the contribution could be divided between them.
2) By the Aurovilian/Newcomer him/herself.
3) By the Central Fund for those who are being maintained by the Central Fund.

2. Donations

The Auroville Health Fund would also fundraise for donations to cover exceptionally high medical expenses, which may arise from time-to-time.

Those who already have health insurance could join the Auroville Health Fund at the moment their insurance expires. Alternatively, they could also immediately join the Auroville Health Fund. But in that case only the costs of medical expenses that are covered by the Auroville Health Fund but are not covered by the insurance would be reimbursed.

Medical expenses not covered

According to the research done it appears that at the above rates of contribution it would not be possible to cover all expenses. As we feel that they are the maximum the community could support at this time, we propose that certain medical expenses will not be covered by the Auroville Health Fund. These expenses are those listed in the annex to this note.

Participating would imply:

1) authorising the transfer of the monthly amount required either from the individual's or the unit's account with the Financial Service.
2) agreeing that, in case there is a deficit, the extra amount required as calculated proportionately, can be automatically transferred from the relevant individual or unit account to the Auroville Health Fund in accordance with a general statement given at the end of the year to all the participants.
3) following the guidelines laid down for the running of the Health Fund, which would be that before incurring any expense, an Auroville doctor mentioned in the annex is to be consulted and his/her advice followed. In the case that an Auroville doctor mentioned in the annex is not available or in an extreme emergency, one could visit any of the by the group recommended hospitals/clinics in Pondicherry directly. In the case where a participant is travelling elsewhere in India, they could go to a local medical facility.

As a general rule, participants would be expected to visit a doctor of any of these institutions only after prior consultation with a doctor from Auroville mentioned in the annex.

Administration

There would be an office where participants could register and request advances and reimbursements from the Auroville Health Fund. In order to be eligible for an advance or reimbursement, the participant would have to produce a duly signed prescription for medicine, treatment or tests from an Auroville doctor and/or from one of the above-mentioned hospitals/clinics in Pondicherry as well as the bills or estimates. If it is clear that the request was covered by the conditions of the Fund, the funds would be transferred to the relevant account at the Financial Service. In the case of any doubt, the matter would be referred to the Health Care Group whose decision would be binding.

Monitoring

The Economy Group would have an overview of the income and expenditure of the Auroville Health Fund.
The Health Care Group would approve the payment of any expenses requiring special consideration.

For further information, contact: avhealth@auroville.org.in