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.
Note
:
·
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would be completely withdrawn.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.
Courtesy:AIBEA
Finally UFBU rejected the proposal and go with old Scheme with improvements.
1 comment:
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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