INSURANCE SANDBOX MODEL

Concept Note – V.1.0

 Preface
In the realm of agricultural sustainability and the welfare of our farming communities, the
Pradhan Mantri Fasal Bima Yojana (PMFBY) stands as a pivotal initiative to secure the
livelihoods of our invaluable farmers. As the custodians of our nation's food security, their well-
being is intrinsically linked to the prosperity of our country.

This concept paper unveils an innovative endeavour — the Sandbox Platform for Insurance
products exclusively for farmers. Born from the vision of the PMFBY office, this sandbox is a
testament to the commitment to bolstering the resilience of our farmers against the diverse
spectrum of Environmental, Social, and Governance (ESG) risks they face.

At its core, this pioneering platform seeks to expand the horizons of insurance offerings,
extending beyond the boundaries of crop insurance. The overarching goal is proactively
mitigating risks and fostering resilience among our farming communities while aligning with
the Sustainable Development Goals (SDGs).

This paper delineates the phased implementation strategy of the Sandbox Platform. The
inaugural phase strategically focuses on standardising insurance products, such as Hospital
Cash and personal accident policies, explicitly designed for farmers. Subsequent phases are
meticulously crafted to broaden the offerings, encompassing various insurance domains—
from Health, Home, and Shop to Life insurance. Additionally, these phases are geared towards
introducing specialised parametric crop insurance and coverage for farm equipment and
vehicles.

This concept paper is a beacon of innovation and collaboration, inviting stakeholders,

policymakers, and experts to contribute their insights and expertise. Together, let us embark
on this transformative journey toward securing the future of our farmers and charting a course
towards a more resilient and equitable agricultural sector.
 Comprehensive risk protection for Farming Communities

We have conducted an extensive analysis and identified a range of insurance products

tailored specifically for the farming community. These products have been designed to fortify
farmers against a spectrum of uncertainties they may encounter. Our objective is to foster
resilience among cultivators nationwide, mitigating income shocks arising from extreme
climate events and other unpredictable variables through the provision of comprehensive
insurance coverage.

Our strategy involves a phased rollout of these insurance products on our platform, aimed at
empowering farmers and safeguarding their livelihoods.

S. No Product LoB Phase

Standardised Products Available with Insurer
1 Personal Accident Casualty Phase 1
2 Hospital Cash Health Phase 1
3 Aarogya Sanjeevini Health Phase 2
4 Bharat Griha Raksha Property Phase 2
5 Bharat Udhyam Suraksha Property Phase 2
6 Life Insurance Life Phase 3
7 Two Wheeler Motor Phase 3
8 Tractor Motor Phase 3
9 LCV Motor Phase 3
Tailored and customised insurance products
10 Parametric Crop Insurance (Non-PMFBY Crops) Crop Phase 3
11 Health Insurance + Tele Medicine Consultations Health Phase 3
12 PA cover is restricted to the cultivation cycle and risks Casualty Phase 3
13 Agri equipment insurance Property Phase 3
14 Insurance for Livestock (Loss of Life) Property Phase 3
15 Cattle Insurance – Loss of yield BI Phase 3
Table 1: Insurance products aligned for Insurance sandbox
 ICs Sandbox - MoAFW AIDE Intermediaries Farmer

B. AIDE C. Insurance
Sourcing

A. Insurance E. Payment &

Products Policy

D. D2C Portal

F. Grievances H. Reports &

Dashboards

G Claim Status
& Payments

Figure 1: Insurance Sandbox - Big Picture

Legend Process Brief
A Insurance Insurers are required to furnish the insurance products outlined for the Ministry, encompassing:
Products 1. A Pricing Grid
2. Customer Information Sheet
3. Toll-free and Grievance Escalation Matrix
4. API Kit enabling Phygital and Digital Distribution
5. Claim Form in PDF format
6. Document outlining the Claims Process
7. Claims API

B AIDE The AIDE App has been exclusively developed for intermediaries engaged in enrolling farmers for the PMFBY scheme,
and it will also host additional insurance product offerings. Insurers are responsible for informing intermediaries
about these selling opportunities and delivering appropriate product training to ensure the prevention of mis-selling

C Insurance The AIDE intermediary acts as the conduit for farmers to acquire insurance and is responsible for educating
Sourcing policyholders about the product pre-purchase. The Intermediary is committed to facilitating a seamless Phygital
process for selling insurance to farmers, encompassing premium remittance, policy delivery, servicing, and claims
support. In the event of grievances related to mis-selling or fraudulent practices by the intermediary, the insurer will
take corrective measures and report the case to the ministry for review and documentation.

D D2C Portal Sandbox Platform will feature a direct-to-consumer (D2C) interface, allowing farmers to purchase the insurance they
need directly through a self-service platform.

E Payment & Premium remittance offers convenient options across various modes. Farmers can make payments through payment
Policy gateways or UPI or remit payments to the AIDE intermediary. Policies are shared with the insurer via registered mobile
numbers through messages and WhatsApp. Additionally, AIDE intermediaries can share policy copies with the
farmers. Insurers will provide the farmer with a physical copy of the insurance policy upon request.
Legend Process Brief
F Grievances The farmer can raise grievances concerning policy servicing and claims directly with the insurer or through the FGR
call centre. The insurer is responsible for updating and maintaining records of all grievances and their respective
statuses. These details are reflected in reports and dashboards within the Sandbox platform and are available for
review by ministry officials and the designated team.

G Claims Status The Claims lodged under the policies sourced under the Sandbox Scheme are to be reflected live in the Sandbox
& Payments Platform. The status of the claims should contain the
1. Date of Claim,
1. Date of Intimation,
2. Claim status
2.1. (Under process by Insurer, Await claim documents, under investigation, Claim Paid, Claim repudiated, CWP)
3. Date of final document received from farmer,
4. If Claim Paid
4.1. Date of claim Paid,
4.2. Claim Amount Paid
4.3. UTR Number
5. If repudiated
5.1. Reason for claim repudiation,
6. If CWP
6.1. what were the pending claim documents

H Reports and The Sandbox portal features a comprehensive dashboard that tracks the model's advancement. This includes:
Dashboard
I. The count of policies sold via Intermediaries using AIDE and Direct-to-Consumer (D2C) channels.
II. A breakdown of products sold by state and Insurance Company (IC).
III. A dedicated dashboard for claims.
IV. An overview of grievances lodged.

Table 2: Key Process in Sandbox Platform

 1.4 AIDE/ AIDE
1.1 Insurance 1.2 Proposal 1.3 Pricing Grid 1.5. Intermediary
Sandbox
Products Data Points Assistance
(Web)

Sandbox (Web)
1.6 Quote Engine

1.11 QC and 1.10 Premium 1.9. Premium 1.8 Proposal & 1.7 Product
Validation by IC Ackn. Receipt Payment KYC Selection

1.12 Accepted
Accepted/ 1.13 Policy 1.14 Policy 1.15 Policy
Rejected Approved copies to RMN Uploaded in NCIP

TAT of 7 working days from

Rejected receipt of premium

1.16 NCIP - Rejection 1.17 Premium

Reason Updated Refund

Figure 2: Insurance Product Integration - Phase 1 - Non API Journey

Legend Process Brief
1.1 Insurance The non-API approach is exclusively intended for the initial phase due to time constraints in developing and
Products integrating APIs for PA and Hospital cash products. It serves as a temporary solution until the technology integration
is fully operational. Subsequent phases will progress toward API integration for all products within a sandbox
platform, prioritising seamless insurance distribution. During the Non-API Journey, insurers are expected to provide
the following requirements:
1. Customer Information Sheet
2. Toll-free and Grievance Escalation Matrix
3. Claim Form in PDF format
4. Document outlining the Claims Process

1.2 Proposal data The essential data points necessary for creating the E-proposal form for the product must be established within both
points AIDE and Sandbox D2C platforms. These requisite proposal data points are to be shared by Insurance Companies
(ICs)

1.3 Pricing Grid The product's premium pricing grid is essential information required from the Insurance Companies (ICs). The
platform auto-calculates premiums based on proposal data points using the shared pricing grid from the ICs. Once
the pricing grid is finalised within the platform, it undergoes release in the UAT (User Acceptance Testing)
environment for ICs. The UAT phase clearance by the competent authority within ICs is required, and written
communication explicitly signifies their agreement to proceed with the UAT phase, indicating their satisfaction with
the system's readiness for the go-live stage must be provided within four working days of the UAT interface release.

Note: Post-platform launch, any subsequent changes in premium pricing required by ICs need to be notified to the
sandbox team at least seven working days in advance for incorporation into the platform

1.4 AIDE/ Sandbox The insurance is available for purchase through two interfaces: AIDE, an insurance intermediary platform facilitating
Platform (Web) physically assisted insurance buying for farmers, and the sandbox platform, offering direct purchase options for
farmers.
Legend Process Brief
1.5 Intermediary The AIDE intermediary serves as the link for farmers to access insurance and is responsible for educating
Assistance policyholders about the product before purchase. The intermediary is dedicated to streamlining a seamless Phygital
process for selling insurance to farmers, covering premium payments, policy delivery, service provisions, and claims
assistance.

1.6 Quote Engine The quote screen displays the premium pricing for all products derived from the premium pricing grid shared by the
Insurance Companies (ICs). This feature enables farmers to compare and select the most competitive options from
various ICs' offerings.

1.7 Product The farmer chooses the suitable product offered by an Insurance Company (IC) that aligns with their specific
Selection requirements.

1.8 Proposal & KYC Post-product selection, additional proposal data points and KYC-related information are gathered, offering the farmer
a snapshot to review and make any necessary edits.

1.9 Premium After completing the proposal and KYC stages, the platform navigates to the Payment screen for premium remittance,
Payment providing convenient payment options across multiple modes. Farmers can complete payments via Net Banking,
Credit or Debit cards, QR-based payments, and UPI.
1.10 Premium Ackn. Upon successful premium remittance, the sandbox platform generates an acknowledgement receipt. It's important to
Receipt note that this acknowledgement represents acceptance of the premium and does not signify the commencement of
risk until the successful completion of KYC and validation of proposal details.

1.11 QC and A dashboard and functionality are available for Insurance Companies (ICs), enabling them to oversee the total
Validation by number of applications and conduct validation processes. Within this platform, ICs can conduct quality checks (QC),
IC validate shared details, and access KYC data received from farmers. The shared data also encompasses the transaction
ID for premium remittance, allowing ICs to appropriately tag payments in their system.
Legend Process Brief
1.12 Accepted/ Insurance Companies (ICs) are required to either approve or reject a received proposal within seven working days. In
Rejected instances where cases remain pending beyond this period, the risk commencement is considered to start from the 8th
working day due to the breach of the Turnaround Time (TAT) by the ICs.

1.13 Policy Upon approval of cases, Insurance Companies (ICs) generate policy numbers and copies. Concurrently, Sandbox
Approved sends an SMS to the farmer, confirming the approved status of the insurance and notifying them that they will receive
the policy copy on their Registered Mobile Number (RMN).

1.14 Policy copies to Insurance Companies (ICs) distribute the policy copy link via SMS to the Registered Mobile Number (RMN).
RMN Additionally, they include their toll-free number in the SMS, allowing farmers to contact the call centre and request a
physical copy of the policy if they encounter difficulties downloading it.
1.15 Policy The Insurance Companies (ICs) also upload insurance policy copies onto the NCIP portal for accessibility by farmers
Uploaded in and for record-keeping purposes within the Ministry.
NCIP
1.16 NCIP - Insurance Companies (ICs) must provide the reason for rejection in the Portal for cases that are rejected. Rejections
Rejection must be impartial and reasonable. If the Sandbox team seeks clarification regarding any rejection, the ICs are required
Reason to provide justified explanations.
Updated
1.17 Premium For the rejected cases, the premium will be reimbursed to the farmers' bank accounts within 15 working days of the
Refund premium receipt date. Bank account details are collected during the proposal stage, and the refund will be processed
to the same account.

Table 3: Process – Process involved in Insurance Product Integration - Phase 1 - Non-API Journey
 2.3 AIDE/ AIDE
2.1 Insurance 2.2 Quote API 2.4 Intermediary
Sandbox(Web
Products from Insurer Assistance

Sandbox (Web)
2.5 Quote 2.6 Product
Engine Selection

2.11 Policy copy to 2.10 Instant Policy 2.9 Policy 2.8 Insurer payment 2.7 Proposal &
RMN WhatsApp Generated Generation API Gateway API KYC

2.12 Policy
Uploaded in NCIP

Figure 3: Insurance Product Integration - API Journey

Legend Process Brief
2.1 Insurance Following the Phase 1 launch encompassing Hospi Cash and PA, the Sandbox platform will integrate products via API
Products Integration. The Phase I products will also transition to an API journey to streamline distribution. The insurance
product kit provided by insurance companies will include:
1. API Kit enabling Phygital and Digital Distribution (Quote, Payment Gateway & Policy Generation)
2. Product Customer Information Sheet
3. Toll-free and Grievance Escalation Matrix
4. Claim Form in PDF format
5. Document outlining the Claims Process
6. Claims API

2.2 Quote API When the pertinent Proposal information is provided, the Quote API of the Insurance Companies (ICs) is activated,
generating insurance quotes for the chosen insurance product.
2.3 AIDE/Sandbox The integration of the Product API will take place within both the AIDE app and the Sandbox portal. AIDE will operate
portal as an assisted insurance sales model, while the latter will function as a direct-to-consumer (D2C) platform, allowing
farmers to purchase insurance directly.
2.4 Intermediary The AIDE intermediary is the link for farmers to access insurance and is responsible for educating policyholders about
assistance the product before purchase. The intermediary is dedicated to streamlining a seamless Phygital process for selling
insurance to farmers, covering premium payments, policy delivery, service provisions, and claims assistance.

2.5 Quote Engine The quote engine lets farmers compare and select the most competitive options from various ICs' offerings.
The quote screen displays the premium pricing for the products fetched by the quote API of ICs integrated with the
platforms.

2.6 Product The farmer chooses the suitable product offered by an Insurance Company (IC) that aligns with their specific
Selection requirements.
Legend Process Brief
2.7 Proposal and Post-product selection, additional proposal data points and KYC-related information are gathered, offering the farmer
KYC a snapshot to review and make any necessary edits.

2.8 Insurer The process links to the Insurance Companies' payment gateway, enabling the farmer or AIDE intermediary to
payment complete the transaction for the insurance premium.
Gateway API
2.9 Policy Upon successful payment, the transaction ID is used to initiate policy generation within the API Journey.
Generation API

2.10 Instant Policy The policy generated instantly via the Insurance Company's API is readily accessible in both the AIDE App and the
Generated Sandbox Portal, ensuring seamless sharing with the farmer.

2.11 Policy copy to Insurance Companies (ICs) will send SMS messages to Farmers containing a link to download the policy, along with a
RMN toll-free number for farmers to contact. Upon request, ICs will provide the physical copy of the insurance policy to the
farmer.
2.12 Policy The Insurance Companies (ICs) also upload insurance policy copies onto the NCIP portal for accessibility by farmers
Uploaded in and for record-keeping purposes within the Ministry.
NCIP
Table 4:Process involved in Insurance Product Integration - API Journey
 3.1 Claim 3.2 Claim Through 3.3 Claims API
Occurrence Intimation Sandbox

Through
Insurer

3.4 Manual 3.5 Submit Claim form 3.6. Ref. No. - Claim
Intimation & Requirements. Acknowledgement

Yes No
3.13 Claim Payment 3.12 Claim 3.11 3.8 Query 3.7 Claim
AADHAR Linked Bank A/c Consent Approved. raised. Processing

No Yes
30 days and receipt
of Payment

3.15 Update NCIP 3.14 Repudiation 3.9 Call/letter 3.10 Requirement

letter Complied

Table 5: Claims Module for Insurance Sandbox

Legend Process Brief
3.1 Claim Occurrence Claim occurrence means the day the insured peril/ event strikes the insured and the loss occurs.

3.2 Claim Intimation Upon the occurrence of a loss, the insured farmer or representative will promptly notify the Insurance Companies
(ICs) without undue delay. Claims can be reported through various channels:

I. Notifying the AIDE Intermediary, who will report it within the AIDE App where the IC has integrated the
claims module via API.
II. Accessing the Sandbox portal where ICs have integrated the claims module via API.
III. Directly contact the insurer through Toll-free, Email, WhatsApp support, or by visiting a local branch.

3.3 Claims API The integration of the insurer's claims API module into the AIDE App and sandbox portal will establish a smooth
and transparent journey for processing claims involving all stakeholders. Within the API journey, farmers can
initiate claims, submit necessary claim requirements, provide consent for claims, and track their claim status.

3.4 Manual Intimation Farmers or their representatives can directly notify claims through insurance channels by:
I. Contacting the Toll-free number of IC
II. Visit the nearest branch of the insurance company (IC).
III. Through email.
IV. Communicating via WhatsApp handles of IC

Insurance Companies (ICs) are obligated to entertain such direct claim notifications, acknowledge receipt, and
ensure that the claim information is accessible in the Sandbox Portal for review by the Ministry team.
Legend Process Brief
3.5 Submit Claim Mandatory claim requirements and documents must be submitted to proceed with the claim processing. The
form & Insurance Company (IC) will furnish a standardised list of claim requirements, specifying the necessary documents
Requirements for submission.

Furthermore, the ICs will supply the Sandbox team with a comprehensive document and requirement checklist for
all products and loss scenarios. This resource will be accessible to farmers through the AIDE App and sandbox
portal, serving as a ready reference for farmers' convenience.

3.6 Ref. No. - Claim Each lodged claim is assigned a distinctive claim reference number, which remains the unique reference number
Acknowledgement (URN) until the insurance claim is resolved.

3.7 Claim Processing The IC claims team proceeds with the assessment and further processing of the claim based on the received claim
requirements.

3.8 Query In certain cases, the nature of the claim necessitates additional requirements to be fulfilled.
Raised
3.9 Call/letter During such occurrences, the Insurance Company (IC) communicates with the claimant to gather additional
requirements and seek clarification. The IC employs a multi-channel approach, reaching out to the
policyholder/claimant through a Registered letter, preferably in the regional language, as well as via telephone to
address supplementary requirements and queries, ensuring clarity on the insurance claim.

If any grievances are raised to the Ministry/Sandbox team by the policyholder/claimant, the IC is obliged to
substantiate the need for such clarification.

3.10 Requirement Upon the satisfactory fulfilment of the clarifications and requirements requested by the Insurance Company (IC),
Complied the claim advances to the subsequent stages of assessment and processing.
Legend Process Brief
3.11 Approved Following the claim processing, its outcome may result in approval, signifying acceptance, or repudiation,
indicating rejection.

3.12 Claim Consent Upon claim approval, the claimant/policyholder's consent is necessary for the assessed claim amount. Once this
letter consent is received, the claim proceeds to the payment processing phase.

3.13 Claim Payment The processed claim amount is disbursed to the farmer/claimant's Aadhaar-linked bank account. At this stage, the
AADHAR Linked Unique Transaction Reference (UTR) number is recorded for reporting purposes.
Bank A/c
3.14 Repudiation letter In case of claim rejection, an official claim repudiation letter, accompanied by a detailed explanation for the
rejection, must be provided to the insured policyholder/claimant.

Should the claimant raise a grievance regarding the repudiated claim to the Ministry/Sandbox team, the Insurance
Company (IC) must address the matter thoroughly. This entails presenting relevant and substantial evidence
supporting the repudiation decision's rationale.

It's important to note that no claim will be rejected solely due to non-submission of documents. However, the
claim may be closed without payment if necessary documents are not provided. In such instances, when the
policyholder/claimant furnishes the required documents and specifies the reason for the delay, the IC can reopen
the claim for further processing.

3.15 Update NCIP For approved claims, the Insurance Companies (ICs) must update the Unique Transaction Reference (UTR) Number.
In the case of repudiated claims, the ICs must upload the repudiation letter onto the NCIP portal.

Note Insurance Companies (ICs) will establish real-time integration with the sandbox portal/AIDE App, enabling access
to a claims dashboard displaying the total number of lodged claims, those in process, those paid, and those
repudiated. This functionality allows the Ministry to download and analyse the claims data whenever necessary.
Table 6: Claims Module brief
S. No Factor Brief TAT
1 Free Look Cancellation If a cancellation occurs during the Free Look Period, any owed refunds will be 15 days
processed according to the guidelines in the IRDAI (Health Insurance) Regulations,
2016. The Insurer aims to process refunds swiftly, typically within 15 days of receiving
the cancellation request
2 Claim Payment Regarding claims, the Insurer commits to settling them within 30 days of receiving all 30 days
necessary documents. In case of any delay, the Insurer will pay interest at a rate of
2% above the bank rate from the document receipt date until the claim payment
date.
3 Claim Payment for Should an investigation be necessary for a claim, the Insurer will promptly initiate and 45 days
cases under complete it within 30 days of receiving all the required documents. In such cases, the
investigation Insurer undertakes to settle the claim within 45 days from document receipt. Any delay
beyond this period will result in the Insurer paying interest at a rate of 2% above
the bank rate from the document receipt date until the claim payment date

Table 7: Provisions and TAT under IRDAI (Protection of Policyholders’ Interests) Regulations, 2017