Friday, April 24, 2015

AIBOA Suggestions on Medical Insurance Policy!


A.K.Nayak Bhavan, 2nd Floor 14, Second Line Beach,
CHENNAI-600 001
Phone: 25265511 / M 9840645081  /  FAX: 044-25249081  / e mail:

April 14, 2015

The Deputy Chief Executive Officer,
Indian Banks Association,
Cuffe Parade,


REG;   Draft Medical Scheme for employees of member banks of IBA and their family members in lieu of existing Hospitalization Scheme.

REF;     1. Your e mail dated 13.03.2015.
            2. Our letter IBA: BKS:22:2015 DATED 14.03.2015.

Further to our email communication, as an interim response, our organization strongly feels that tie up arrangement with any Insurance company and routing through the claim to TPA is amounting to outsourcing of the staff related matters, hence deserves to be rejected in toto. Apart from the above hardly 15% of the employees are claiming the reimbursement under Hospitalization Scheme, the same should be handled by the Personnel department of the individual Banks. As the standardization is the principled approach in similarly placed employees in Banks, the best of schemes available in State Bank of India as well as in Bank of India may be harmonized and extended to all Banks.

The employee shall deal only with the Bank and not with the Insurance company/TPA.

Notwithstanding the above we suggest as under the clause wise observations.

Clause 1.1       Dependent Income-   Looking to increased cost of living inflation and high medical costs ceiling on monthly income of dependents be increased to Rs. 20,000/- excluding Pension.

                        Is there any need for fixing income for dependants when we take separately Mediclaim no such insistence is there

Clause 1.3      
A.            Officers; Rs.6,00,000 , Employees Rs 4,00,000. Higher coverage upon payment of premium by the individual employees, as in the case of LIC should be permitted.
B.            A lump sum  of lac available to self fir critical illness should be made available to dependents also

Clause 1.5       ICU when ventilator is used max.  Ceiling should be reimbursed upto  Rs.20000/- per day.

Clause 2.12     Hospital / Nursing Home : At centres having population below 1 lac, requirement of 10  bed hospital should be removed.

                        Minimum bed of 10 as inpatient should be removed if area is Rural/Semi urban but a good Hospital / Nursing Home /Doctors are available and are found fine.

Clause 2.15     The id card issued to the employees should have embossed the name of IBA/respective Bank for availing cashless facilities.

Clause 2.22     Medical expenses: Clause seems to be arbitrary as there is no mechanism to compare charges/expenses of other hospitals/doctors.  Bills certified by treating Doctors may not be disputed

Clause 2.23     Even if not hospitalized expenses made for scan like MRI / CT scan should be reimbursed.

Clause 2.30     No restriction pre existing disease should be accepted.  The 48 months stipulation is arbitrary.

Clause 3.1       Diphtheria diabetic medicines, Blood pressure to be added

Clause 3.2       Pluracy, Diphtheria and chronic hepatitis /diabetic.  We have a recent case of FGM, CBI, and Chronic where 18 lacs is spent on pluracy / diabetic treatment.

                        Any invasively implanted on a permanent basis on one’s body like transplanted heart/kidney should be fully reimbursed.  No ceiling.

                        Pace maker implanted like dual chamber etc.  No ceiling should be there as it costs more than 7 lacs now

                        Donor’s expenditure like kidney donor.  In such cases too restriction on Hospitalization or domiciliary should not be there in reimbursement.

Clause 3.4       Alternative Therapy: There may be only few clinic/hospitals of alternative therapy recognized by Govts., and treatment is usually taken from practitioners. Such expenses should also be covered.

Clause 3.5      Maternity Expenses Benefit Extension: At Metro and bigger centres, cost is very high.              Thus ceiling needs to be raised to Rs.50,000/- for normal and Rs. 1,00,000/- for caesarean section.

Clause 3.7     If a patient is to be moved to outside urban agglomeration or municipal limit, taxi     charges to be reimbursed @ Rs.20/- per km upto maximum of Rs.2000/- as available in some Banks  even now.

Clause 4          The exclusion clause should be revisited, as there are glaring deficiencies prevailing in the existing scheme.

Clause 4.3       Cost of spectacles, contact lenses and hearing aids be covered as these are the devices to cover illness of employees and improve his working capacity.

Clause 4.4       Dental treatment or surgery be included in day care treatments without restrictions. Similarly treatment of Obesity or Infertility also needs to be covered.

Clause 4.5       Barring use of intoxication drugs/alcohol not correct. These treatments should be covered as these are very much diseases. and cure /   rehabilitation is socially desirable.

Similarly cases of treatment of self inflicted injuries also need to be covered adopting       humanitarian approach’

Clause 4.6       Whole world is trying to eradicate misgivings about treating Aids as stigma thus its exclusion in scheme is very much retrograde.

Clause 4.7        Clause is arbitrary and can be misused. These are discretions of treating doctors which             can not be challenged or controlled by the patient. Thus all investigations done during    hospitalization to be reimbursed

 Note:              Exclusion of declared/undeclared War related or Enemy inflicted injuries may not be   Justified as bank staff has to work near border areas also moreover 26/11 type instances also occur.

Other Suggestions:

1.    Full Income tax exemption for the reimbursement of hospitalization expenses should also be ensured.
2.    There is a need to have in built system to have the Health Check up system.
3.    Treatment taken abroad should also be covered.
4.    In the event of claim ration is less than 50% during the renewal of the master policy some more additional coverage may be thought of.
5.    All the retirees are to be extended the cover by paying one time contributory premia.

Yours faithfully,



1 comment:

Anonymous said...

Existing Insurance companies charge heavy premium and create lot of hurdles for settlement of claims. They will not have any insurable interest other than collecting premium. Banks are posting employees to nook and corners of the country. deterioration of health while working in inhospitable areas is to be understood by employers. If the claim is rejected any amount of insurance is of no value to the employees.