Discussion Paper on proposed Health Insurance Scheme:
IBA’s proposal of Health Insurance Scheme in lieu of existing Hospitalisation Expenses Reimbursement Scheme.
As you are aware, presently, under our Bipartite Settlement, hospitalisation expenses are reimbursed upto 100% for employees and 75% for eligible family members as per the prescribed schedule of charges. In our Charter of Demands for the 10th Bipartite Settlement, we have demanded for improvements in the scheme to cover 100% of the expenses for self and family without any restrictions. In response to our demand, in the last round of discussions, IBA proposed introduction of Health Insurance Scheme in lieu of the existing reimbursement scheme.
The broad sketch of the proposed scheme is as under:
Ø 100% reimbursement or cashless settlement of hospital bills for self and dependent family members with the following ceiling:
Officers : Rs. 4,00,000 per year
Clerks : Rs. 3,00,000 per year
Sub-staff : Rs. 2,00,000 per year
Ø Corporate Buffer of Rs. 100 crores to be available and to be utilised in case individual ceiling is exhausted.
Ø For employees only, if any critical illness (like cancer) is diagnosed, Rs. 1 Lac will be paid in addition to reimbursement under the scheme.
Ø Definition of Family: Same as per existing provisions of Bipartite Settlement.
Ø There would be no sub-limits or item-wise ceiling for Surgeon Fees, X-Ray, Tests, ECG, etc. and total bill upto total ceiling of Rs. 2, 3 or 4 lacs will be reimbursed.
Ø Bed Charges upto Rs. 5,000/- per day.
Ø Expenses of Pre-hospitalisation upto 30 days and Post hospitalisation upto 60 days will be covered.
Ø Maternity Expenses covered upto Rs. 35,000/- for normal delivery and Rs. 50,000/- for caesarean cases.
Ø Domiciliary treatments as existing under Bipartite Settlement will be covered in the proposed insurance scheme also.
Ø Their Insurance Scheme will cover treatment under Ayurvedic, Unani, Sidha, Homeopathy & Naturopathy as available in the existing Bipartite Settlement.
Ø For treatment under package cases, it would be paid upto overall individual ceiling.
· The existing reimbursement scheme would be completely withdrawn.
· Each employee will be given an Insurance Card and they have to directly submit the bills to the Third Party Administrators of the Insurance Company.
· For rejection / reduction in claim or any dispute, employee cannot take up the matter with the Bank and has to deal with the Third Party Administrator.
There are few advantages like, cashless treatment in hospitals where the Insurance Company has tie up with the hospital, no item-wise ceiling, etc. But there are also drawbacks and disadvantages and the entire scheme will be outside the control of the Banks.
Finally UFBU rejected the proposal and go with old Scheme with improvements.
If we accept the proposed reimbursement of medical expenses by TPAs, we will be at the mercy of the TPAs. The Banks will not come into the problems to be faced by the employees/officers with regard to the reimbursement of hospitalisation expenses or Domiciliary treatment reimbursements as the Banks will wash their hands out. However it is better to continue the existing reimbursement of medical expenses scheme as per 9TH BPS.
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