Thinking · Design

Heat insurance pays the worker. Who pays for the clinic visit?

Abhijith Magal · 21 September 2026 · 8 min read

Parametric heat insurance in India has gone from pilot to programme in three seasons. The idea is simple. Instead of assessing each person's loss, the policy pays everyone in a place when a measured temperature crosses a threshold agreed in advance. No claim form, no adjuster, no wait for a loss to be proved. For a woman selling from a pushcart in Ahmedabad, whose earnings halve in the hottest months because nobody shops in the afternoon, the payment arrives as a text message and a bank credit.

I think this is one of the better things to happen to informal workers' heat exposure in years. I also think it has quietly settled on the wrong finish line. It pays the worker. It does not get her anywhere near a clinic, on the very days the data says she needs one most.

How the two largest programmes work

The Self-Employed Women's Association, the union of more than three million informal women workers, piloted its programme in 2023 with Climate Resilience for All, which co-funds premiums and provides technical support. ICICI Lombard underwrites it and Swiss Re carries part of the risk. The 2023 threshold was set too high, and women got nothing on days that were brutally hot; SEWA adjusted it. By 2024 the programme covered 50,000 members, and NPR reported that it disbursed around USD 350,859 that year.

Mahila Housing Trust, an Ahmedabad-based grassroots organisation, has run its own programme since 2024. Members pay a subsidised premium of Rs 90 for four months of cover, capped at Rs 2,000 in total payouts. In 2026 it covered around 30,800 women in Gujarat and expanded to Delhi and the National Capital Region on 4 May. By July, Reuters reported, citing MHT, that more than 39,300 women were insured and Rs 20.6 lakh had been paid out after temperatures crossed the trigger.

The design has critics, and they are worth hearing before anyone funds a copy. Down To Earth's reporting on the Delhi pilot quoted experts warning that temperature-only triggers, low payouts and data gaps limit the protection. A dry-bulb reading from the nearest station does not know about humidity, a tin roof, a pregnancy or a heart condition, and a dense city has microclimates no single station captures. Those are real limits on the money. They are not the limit this piece is about.

The missing step

Think about what a trigger event is. It is a verified, dated, geolocated statement that a named population is facing dangerous heat right now. Health systems spend a great deal of effort trying to know that. The insurance programme already knows it, and has a working channel into each member's phone.

Today that channel carries a payment notice. It could also carry the nearest place to get checked, a call from a community health worker to members with a known condition, or a heat-illness check scheduled at the local clinic for the day after. Workers have told reporters they spent payouts on food and medication, which is a health use, arrived at alone. The payout is the alert. Nobody is listening to it.

Income replacement has moved fast. Care has not moved at all. The trigger day is a care day that nobody has scheduled.

One design is already closer. HERA, which partners with MHT, announced in June 2026 a heat-pregnancy insurance product due for the 2027 heat season. Pregnant women will enrol, and verify confidentially, through the local clinics where they receive prenatal care. It is the first Indian design I have seen where the route into insurance runs through a care point. It is worth watching less for the payout than for what the clinic does with the knowledge that its enrolled patients are in a trigger week.

What a funder can add

This is the component a CSR budget can own. Premium subsidies move money to the insurer; whether a subsidy on its own qualifies as CSR for a given programme is a question for counsel, and the rules that decide it are set out in Section 135 and climate-health. A care layer sits squarely inside promoting health care, including preventive health care, and it produces a measurable result. Employers with contract or supply-chain labour in the same heat belt will recognise the other half of the argument from the workplace heat duty of care: the law requires protection from heat without saying when the duty switches on, and a trigger temperature is one defensible answer.

The programmes that built parametric heat cover in India did the hard part. They proved a threshold can move money to the right people on the right days. The next season's question is whether the same threshold can move care.

Common questions

How does parametric heat insurance work in India?

It pays out automatically when a measured temperature crosses a threshold set in advance for a place, with no claim form and no loss assessment. In SEWA's programme in Ahmedabad, members received a payment when the daytime temperature exceeded 43.6 degrees Celsius for two consecutive days, and a larger one above 44.1 degrees. In Mahila Housing Trust's Delhi programme in 2026, the trigger sat between 45.27 and 47 degrees Celsius, with payouts of Rs 100 to Rs 500.

Does heat insurance cover medical costs?

Not directly. The Indian programmes running today replace lost income: the payment arrives in the worker's bank account and she decides how to use it. Workers have described using it for food and medication, but nothing in the design routes the payout, or the person, to a clinic. HERA's heat-pregnancy product, due to launch in the 2027 heat season, is the first to enrol women through the clinics where they receive prenatal care.

Who runs parametric heat insurance for informal workers in India?

The two largest programmes are run by the Self-Employed Women's Association (SEWA), with Climate Resilience for All, ICICI Lombard and Swiss Re, and by Mahila Housing Trust (MHT), with partners including HERA, CelsiusPro and Humanity Insured. SEWA's programme covered 50,000 members in 2024. MHT's covered more than 39,300 women in Gujarat and Delhi in 2026.

Can a company fund heat insurance through CSR?

A company can fund premium subsidies or the care component around them, but whether a premium subsidy qualifies under Schedule VII for a particular programme is a question for your CSR counsel. The care-linked element, a clinic contact or heat-illness check triggered on payout days, sits more cleanly under item (i), promoting health care including preventive health care.

Abhijith Magal

Founder, Syntropy Earth. Nine years across two global pharmaceutical multinationals in patient access and commercial roles, with health-equity work alongside the WHO-Foundation and UNICEF. He works on climate-access: where climate disruption breaks the link between patients and care.

Programme figures change every season and several come from programme statements as reported; check with the programme before relying on them. This page is not insurance or legal advice.

Last updated: 21 September 2026