Wednesday, June 4, 2014

HEALTH INSURANCE SCHEME FOR EMPLOYEES OF BANKS!

You might have read some articles in fainacial dailies about the Health Policy for Bank employees, that may be implemented along with the bi-partite settlement.

I give below more details for your discussion.

I repeat, this is not the final one. It is a discussion paper doing around from
Insurance Company=>IBA=>UFBU

After mutual discussion decision will be taken.

************************************************
HEALTH INSURANCE SCHEME FOR EMPLOYEES OF BANKS IN LIEU OF  "REIMBURSEMENT OF HOSPITALISATION EXPENSES/ DOMICILIARY TREATMENT"  UNDER X BIPARTITE SETTLEMENT/JOINT NOTE. 
The Insurance Company offered the following revised offer:

The Third Party Administrator would not be in the picture and the Employees would deal directly with the Bank as is the position at present.

We hereby confirm to the above.

The insurance coverages would be identical to the scheme submitted to you without the Employees having to deal directly with the Third Party Administrator.


The claim settlement will be continued to be managed at all the present bank locations, from where it has been done at present. At all these locations the Insurance Company will set up a help desk, as a support system for claim administration to the banks on immediate bases.

The help desk will consist of
1. A customer relationship executive who will reply to any queries raised by employees and help in smooth servicing. 2. A data entry executive who will enter the claims into our software and 3. A doctor for processing of claims.

The employees would deal with the banks exactly in the same process as they have been dealing in the past. Over and above this there would be a dedicated 24x7 call centre for the Employees of the Indian Banks' Association, as a support system for queries, registration of claims and claim settlement.
Terms and consitions of the policy::

Text Box: Page 2 of 4



Policy Period
:
Fresh Policy
Plan Type
:
Group Health Policy - Family Floater
Beneficiary
:
Employee + Spouse + Dependent Children + two dependent Parents or In Laws.
Total Number of Lives Covered at inception
:
Employees : 7,43,832
Spouse        .
Dependent Children  :
Dependent Parents     :
Sum Insured (Annual cover amount)
Critical Illness
Corporate Buffer

Group Mediclaim Policy Number of Families.
-Officers          : Rs. 4,00,000            3,04,090
Clerical Staff   : Rs. 3,00,000            3,08,175
Sub Staff         : Rs. 2,00,000            1,31,567
Critical Illness - Sum Insured Rs. 1,00,000
In case an employee contracts a Critical Illness as per the list, the total Sum Insured of Rs.1,00,000 is paid, as a benefit without any bills, immediately on diagnosis, of the Critical Illness.
He can further claim on the same from the Group Mediclaim Policy as reimbursement of expenses for the treatment taken by him.
Corporate Buffer INR 100,00,00,000
(In case an individual exhausts his sum insured the balance would be
augmented to the credit of the Employee from this Corporate Buffer.)
Coverages

·         
·         
·        Inpatient Hospitalisation expenses
·        Listed Day Care Procedures
·        Pre/Post hospitalization expenses covered. Pre-hospitalisation for 30 days and Post Hospitalisation for 60 days.
Room Rent
-
·          Room Rent restricted to Rs. 5,000 of the sum insured per day.
·          ICU restricted to Rs. 7,500 of the sum insured per day.
Ambulance Charges
:
·          Ambulance charges Rs. 1000/- per trip
·          Taxi and Auto in actual maximum up to Rs. 750/- per trip
Maternity Covered without waiting period
:
·          Normal Delivery : Rs. 35,000
·          Cesarean Delivery : Rs. 50,000
·          Complications on Maternity would be covered up to the Sum Insured plus the Corporate Buffer.

New Born Baby Expenses

.
Covered under the floater sum insured of the family.
Domiciliary Coverage:

Domiciliary Treatment: Medical expenses incurred in respect of following diseases which need domiciliary treatment as may be certified by the recognized hospital authorities and bank's medical officer shall be deemed as hospitalization expenses and reimbursed to the extent of 100%.
Cancer, Leukaemia, Thalassemia, Tuberculosis, Paralysis, Cardiac Ailment,
Pleuresy, Leprosy,  Kidney  ailment, Epilepsy,           Parkinson's    Disease,
Psychiatric disorder, Diabetes, Hepatitis-B, Hepatitis-C, Haemophilia, Myastheniagravis, Wilson's disease, Ulcerative Colitis,__ E'pidermolysis bullosa, Venous Thrombosis (not caused by smoking), Aplastic Anaemia, Psoriasis, Third Degree Burns, Rheumatiod Arthritis, Hypothyroidism and Hyperthyroidism expenses incurred on radiotherapy and chemotherapy in the treatment of cancer and leukemia shall be considered for reimbursement under domiciliary treatment.
The cost of medicines etc. in respect of domiciliary treatment shall be reimbursed for the period stated in the Specialist's prescription. If no period is stated, the prescription for the purpose of reimbursement shall be valid for a period not exceeding 90 days.
Congenital internal / External
diseases / defects/ anomalies
:
Covered in the policy.
Pre-existing Diseases Coverage
:
Covered
30 days Waiting period
:
Waived Off
1st year - 4th year waiting period
:
Waived Off

And some minor clarifications and conditions.

My comments:

If at all it is decided, to implement this scheme:

Clerk and substaff to be clubbed and the limit should be Rs.4,00,000
For Officers, If  IBA wants to give more they may decide a little extra, as prevailing in bi-partite settlement( only bed charges are higher for officers in settlement)

Policy should  be taken from Public sector Insurance company,
Like United India, National ,New India, Oriental Insurance.


2 comments:

punit pathak said...

400000 is very less amount for family of even 4. At least 10 lacs has to br tthere with 10% increase every year in sum insured. Also room rent cap to be removed.

Vikas Dhama said...

Thanks for sharing the information.

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