Published in Mint on Sep 07 2016, Written by Kapil Mehta
The building, in Delhi, where I stay has 11 residents with 15 supporting domestic staff consisting of full-time maids, drivers and security guards. Since there are about 400 homes in my locality this means our small colony alone has over 5,000 domestic staff. They earn, on average,Rs.10,000 a month. Almost none have insurance. That’s unfortunate because, like the rest of us, the urban poor fall ill and some also die an untimely death. But unlike us, they do not have the means to take care of themselves. On relatively small matters of health, domestic staff faces hurdles of cost, access and attitude.
A maid’s baby had high fever and fits. She was rushed to a hospital known to be non-commercial and considerate. The doctors observed the baby and did an MRI. Fortunately, the baby was fine and discharged the next day. However, since no Economically Weaker Section (EWS) rooms were available, the treatment cost was Rs.18,000 or the equivalent of three months’ pay for the maid.
Another domestic worker I know, went to the government hospital for high fever. She returned unable to reach the doctor. Her employers had to accompany her the next day to break through the crowds. Yet another daily wage worker had insurance and approached a hospital to have his kidney stones removed. The receptionist sent him away without even looking at his papers. I had to get on the phone to convince them otherwise.
One doesn’t need to go inside a hospital to sense the gravity of the situation. Just walk into the metro station at All India Institute of Medical Sciences and Safdarjung Hospital, both leading government hospitals, and you will see scores of people who have made the station floor their home, waiting for their turn at OPD or for a relative to be discharged from hospital. Citizens deserve better.
The easy response is to blame government but we, as employers and industry, also have a responsibility that is largely unmet. Consider the limited health insurance options available to domestic staff. Insurers prefer selling high-value sum assureds of Rs.5 lakh or more. These are too expensive for domestic staff to buy. The cheapest insurance for a 35-year-old individual costs Rs.5,200 a year, well outside her budget. Thankfully, public sector insurers continue to market low sum assured products. These are affordable and a Rs.1 lakh sum assured insurance can cost under Rs.2,000 per person. The issue, however, is that these insurances are designed with small towns in mind. So, hospitalisation needs to be in a room that costs less than Rs.1,000 per night, an impossibility in the metros.
Life insurance plans suffer a similar problem. Insurers have steadily pushed up the minimum limits of insurance by setting thresholds for minimum premium or sum assured. It is hard to buy less than Rs.10 lakh of sum assured or spend premium lower than Rs.4,000 per year. Even if domestic help wanted to buy this insurance it would be difficult because they would not have the income proofs required. Micro-insurance products are available but take considerable effort to find and come with limitations.
Insurance products are designed for steady incomes. Miss one health insurance premium and you lose waiting period benefits. Miss your term insurance premium and the insurance lapses. Domestic help has uncertain income. Many workers do not have a valid age proof. This is common enough in the cities, despite the progress of Aadhaar cards. Some insurers have got around this by issuing insurance without an age proof, with the caveat that the age proof will be needed when a claim is made. Such claims are likely to go unpaid. If someone does not have an age proof today how will that change in the future?
Surprisingly, even those who have insurance are unable to use it properly. The hospital intimidates them. A poor worker suffering from heart disease and with insurance got himself admitted to a good hospital. He found the experience so overwhelming that he left the next day, without treatment, for the village.
Listing the issues is easy. Finding answers is more difficult. There are three things you can do. First, have your staff subscribe to the government insurance schemes. These are excellent. The Pradhan Mantri Suraksha Bima Yojana offersRs.2 lakh of accidental death benefit for Rs.12 a year; Pradhan Mantri Jeevan Jyoti Bima Yojana has Rs.2 lakh of term cover for Rs.330 a year. Buy them from your bank.
Second, buy your staff health insurance with a sum assured of Rs.1 lakh-2 lakh. An agent or the insurer’s branch can do this. The insurance can be done in a day if the staff has an age proof.
The third step is to act at an institutional level. The Caddies Welfare Trust, which I have observed for four years now, is one good example. A group of well-heeled individuals got together and bought group health cover for about 300 caddies and their families. These caddies, who are daily wage earners, make less than Rs.10,000 a month and much less in bad weather. With insurance, over 60 of them have been treated for diseases ranging from cataract, kidney removal to dengue. They have successfully identified hospitals that treat them properly and confidently navigate the medical system.
So, spare a moment to look into the affairs of your staff. Buying them a good insurance is a small cost to give them a little bit of financial and health security.