Center for Financial Inclusion

(December 2012) In South Africa, people living with HIV (about 18 percent of the population) are often unable to access basic financial services. AllLife, founded in 2004, provides life insurance and health management services to HIV-positive clients across income groups in South Africa. The company provides financial services, gives individual counseling, and facilitates access to health services. Recently AllLife Co-Founder and Managing Director Ross Beerman visited CFI and discussed AllLife’s unique model, why life insurance is vital to those with HIV in South Africa, and future opportunities for the company.

CFI: Why is it so important to provide life insurance to people living with HIV in South Africa?

Ross Beerman:  If we look at the economically active, people who earn more than 500 dollars a month, we’re talking about 2.5 million people [in South Africa] living with HIV. If you get declined for life cover from a life insurance company, really what the company is telling you is that they don’t think that you’re going to live long enough for them to make a profit. Whether it’s HIV, or it’s cancer or something else, there are certain ways you behave if you think you’re terminally ill. You withdraw from your support structure… You don’t invest in long-term projects. That means that you don’t get educated, necessarily. You don’t buy a house. You don’t start a business… That’s what happens in South Africa.

So we come along and we say something very different. We provide life insurance to people living with HIV. We do that because we help them manage their health. We tell them what is the right thing to do to stay healthy. That changes their mortality. Our clients can expect to live a long time. And they’re pretty much getting the economic message that we’re a for-profit business and for us to make a profit our clients need to live a long time… So we call up our clients. We tell them what they should do. They want to stay healthy. We need them to stay healthy. Everybody pulls in the same direction… We come along, we change the message around the terminality of the illness, so we reduce the stigma. We change the behavior of our clients and then our clients go on living like everyone else. So they buy houses, get educated, kind of live their lives… And they actually just get to be general participants in society.

CFI:  It’s really interesting because you’re upending the paradigm most insurance companies use.

Beerman:  Yeah, what the traditional life insurance model says is the past is the predictor of future behavior. So if you used to smoke, you’re assumed to keep smoking. What we do is different. We really don’t care how our clients used to behave. We are going to help them behave correctly when it comes to managing the disease going forward. So how they used to behave is irrelevant to our life insurance process. If you come into our environment we’re going to help you stay healthy. That’s going to change your mortality. What that means is that we’re talking to our clients. We talk to our clients an average of once a month…which for the insurance industry is pretty unheard of. We had to create these systems to deliver this at low cost to a mass market, because we’re talking about millions of people in South Africa who are excluded from normal participation in the financial service world just because of their [HIV] status.

CFI:  Can you talk about the different needs for insurance between the poor populations and the better off? Why is insurance especially important for those with less stable incomes?

Beerman:  The interesting thing for us is that across the board there are certain universal requirements…everybody wants to take care of their dependents if something happens to them. The implications of not getting insurance are different at different ends of the income stream. So if you’re wealthy, it doesn’t necessarily mean that if you pass away your kids are going to be kicked out of your house, or that they are going to lack access to education, or that your mother is not going to be able to eat. Whereas if you’re at the bottom end of the income spectrum, the impact for your dependents is often far more traumatic, in that they could lose shelter, they could lose access to food, they could lose access to education. What that in turn means is that you probably take far less risks if you’re lower down the income spectrum.

But for our product we actually cover the entire spectrum. We’re not particularly focused at the bottom end. In South Africa, HIV covers every income group: 8.5 percent of professionals; 20 percent of people who earn 500 dollars a month. Our client base is quite skewed towards women, which is unusual in the insurance space. Normally it’s skewed towards men. Over 60 percent of our clients are women, mostly single parents, where the consequence of their death on their kids is quite dramatic. There isn’t a second bread-winner. There isn’t a second support structure. Hence we get a lot of single parents entering our environment because their risk is obvious.

CFI:  What have been some barriers or obstacles that you’ve encountered in providing insurance to your clients?

Beerman:  We had to build systems that didn’t exist anywhere in the world. The fact that we interact with our clients so regularly [means] we have to do it in a cost-effective way… So we had to develop that from scratch. We then had to engage with the health care industry in South Africa because one of the key drivers of cost was accessing people’s information. So how did we know how people were doing – how healthy they were, whether they were doing the right thing. We linked into the health care industry – 95 percent of the health care industry’s data from a backend perspective. So if our client goes for a test we can see that data. They don’t have to print out the copy and fax it through to us… We’ve taken that out of the process. Because in South Africa most of the data is captured electronically. This is often not true in places like the U.K. or the U.S. We leverage off of what I would call first world technology to be able to deliver a solution in a developing market. We leverage off of the banking infrastructure for premium collection. We leverage off of the fact that there is a primary health care network for treatment. There’s no point in telling someone what to do if they can’t actually do it. We’re operating in an emerging market but we’re utilizing first world infrastructure to deliver our business model.

CFI:  What do you see for the near future? What’s the next frontier?

Beerman:  We have a massive market to grow into. We can reach far more people. The big thing when it comes to insurance, whether it’s ours or anyone else’s, is new business strain. So the rate at which we can grow is largely limited by the capital we can access. And because we’re a direct marketer—we advertise on TV, we text, we have automatic voice messages on people’s phones, we use Google and the internet—we pay for marketing costs. That generates leads. Those leads then become paying clients. But you first have to pay for the marketing and new business strain.

When you sell a can of Coke, you buy it for a dollar, you sell it for two. When you’re in the insurance industry you acquire a customer for a thousand dollars and then they pay you a dollar a month for a long time. So you have to fund the thousand dollars, and that constrains growth for us. But we’re still growing pretty aggressively. We’re growing at about 40 percent per year and have done so for the last four or five years. We have the option to grow faster, we just can’t afford to…

We also do post-test counseling for the industry. If clients go to most of the other life insurance companies in the country and find out they’re HIV positive, the companies send those clients to us. We will do a post-test counseling call. About a 45 minute call with the counselor, a nurse. This is probably one of the most impactful calls they’ll ever receive in managing their health. In the past, life companies used to send their clients a letter saying you’ve been declined for life cover, please go speak to your doctor… Only 10 percent of people would ever go to see their doctor for counseling. Now when we call clients we say, “You’ve just been declined for life insurance, would you like to discuss the reasons on the phone?” About 75 percent of people say yes. We do it for the life companies for free. Because at the end of the call we say, if you’d still like life insurance you can talk to AllLife. Some people say yes, some people say no, but either way it’s a dramatic win for the individual, it’s a win for the original life company because we’re not competitive, and they’re being a good corporate citizen – they’re actually telling people they’re HIV positive and how to treat it. And we win because we impact our core market directly and we access potential clients. They then feed into our sales process. So this is one of the few things that’s kind of win, win, win for everybody.

What’s new for us, what we’re currently piloting, is a product for diabetics.

Understanding the Opportunities and Challenges of the Market at the Bottom of the Pyramid
By Elisabeth Rhyne - Published: June 2009