Procedure for claim as per Indian Bank instructions:
*********************************************************************************
Following presentation is for retired employees.
But, it hold good for serving employees also, except definition of family and payment of premium.
click the following link and read the A to Z of the Medical Insurance scheme.
Power Point presentation of Medical Insurance Policy
courtesy: bankpensioner.blogspot.in
****************************************************************************
Family Definition for Serving Employees:
Premium will be paid by the Bank.
* No Age Limits for Dependent Parents.
Either Dependent Parents or parents-In-law will be covered.
Parents would be considered dependent if their monthly income does not exceed
Rs. 10,000/- per month, which is at present, or revised by Indian Banks’ Association
IBA informed that the new scheme on hospitalisation/ medical expenses reimbursement scheme has commenced from 1-10-2015 (for serving employees)
Procedure for claim as per Indian Bank instructions:
**************************************************************************
For Retired Employees:
Family Definition :
SUB : MEDICAL INSURANCE SCHEME:
In terms of the X Bipartite Settlement
/ Joint Note dated 25.05.2015 signed between Unions / Associations and IBA on
behalf of member Banks, a new Medical Insurance Scheme for officers and award
staff has been implemented with effect from 01.10.2015 for reimbursement of
medical expenses in lieu of the hospitalization scheme. In case of retired
staff, the scheme is effective from 01.11.2015 subject to payment of stipulated
premium by them.
The insurer for the scheme is M/s
United India Insurance Company Limited and the Third Party Administrator (TPA)
allotted to our Bank is M/s Paramount Health Services (TPA) Pvt Ltd.
The salient
features of the scheme are as follows:
- The
Sum Insured for Hospitalization and Domiciliary Treatment coverage per
annum for Officers is Rs.400000/- and for Award staff is Rs.300000/-
- All
new Officers / employees shall be covered from the date of joining as per
their appointment letter.
- The scheme covers
hospitalization as well as domiciliary treatment.
- The
scheme has built in facility of cashless treatment in network hospitals
enlisted by the TPA.
- The
scheme will also cover the existing retired officers / employees and
spouse subject to payment of stipulated premium by them..
Under the Scheme, for hospitalization
of self or dependent family members, employees (in case of retirees, retiree or
his / her spouse) can avail cashless facility in any network Hospital or claim
reimbursement of hospitalization expenditure incurred by submitting the
required medical bills and documents.
Procedure to avail cashless facility:
·
A list of network hospitals where
cashless treatment can be availed is hosted in HRM online site. The list is
also available in the website of the TPA, www.paramounttpa.com/providernetwork/providernetwork.aspx.
·
In case of an emergency, the concerned
staff has to arrange for the Admission Request Note to be sent by the Network
Hospital to TPA within 24 hours of admission. The Admission Request Note is
available in the TPA counter ( Insurance Help desk) of the network hospital.
In case of a planned hospitalization, the
staff has to arrange for the Admission Request Note (Pre-Authorisation Form) to
be sent by the Network Hospital to TPA seven days in advance.
·
The Admission Request Note is to be
filled in by the treating Doctor with his signature and stamped by the
Hospital.
·
It is mandatory for the staff to
mention the PHS ID number which will be available in the e-card / ID card
provided by the TPA , SR No (employee id) , name of the Bank and branch in the
Claim Form for proper identification / verification and further processing of
the claim.
·
The staff should ensure that all the
required details are furnished in the Admission Request Note, sign it and
submit the completed admission request note to the TPA desk (Insurance Help
Desk) of the Hospital . The TPA desk will in turn send the request form to M/s
Paramount Health Services for approval.
·
On receipt of the Request Note by the
TPA, the claim will be registered and a unique claim number (FIR / CCN) will be
generated. This number should be quoted in all correspondence relating to that
particular hospitalization.
·
The TPA will verify the claim and if
admissible, an Authorisation Letter will be sent (faxed / mailed ) to Hospital
and a copy will be mailed to the staff, if his e-mail id is available. An SMS
alert regarding the authorization will be sent to the mobile number of the
staff registered with the TPA.
At the time of discharge:
v
The ineligible expenses and other
charges which are outside the purview of the scheme are payable by the staff.
v
If the bill amount exceeds the
eligible limit (i.e. Rs.300000 for Award staff and Rs.400000 for officers) ,
staff will have to pay the difference amount in excess of the eligible limit to
the hospital.
v
Network hospital, wherein the staff
/ dependent has availed cashless facility, will not give the Original Bill,
Discharge Card, Investigation Reports, etc. (as they have to send these to the
TPA for settlement with the Insurance Co.). However staff may ask for copies of
the same for their records & subsequent follow-up for which the Hospital
may charge a nominal amount for issuing duplicates.
v
Prior to discharge staff should
verify the Final Bill & duly sign the same.
Points to remember:
Ø
Staff should carry the e-card / ID
card, valid Photo ID Proof like Bank identity card, voter-id, driving license
etc for the patient (self or dependent) while requesting for cashless facility.
Ø
Staff should ensure that the
hospital has sent the required documents to the TPA for processing the request
for cashless facility.
Ø
Staff should sign the final
hospital bills at the time of discharge.
Ø
Staff should collect the Photo copy
of the entire documents like Medical Bill, Discharge Summary, Medical reports
etc for future reference.
The
above procedure shall be followed for the retired staff and spouse for availing
cashless facility.
Procedure for claiming reimbursement of Hospitalisation expenditure:
Where
the staff has paid the medical bills for hospitalization either in network
hospital without availing the cashless facility or in non-network hospital, the
procedure for claiming reimbursement is as follows:
The
Institution from where medical facility is availed (in case of non-network
hospital) should have been registered as a Hospital with the local authorities.
Staff
should submit the claim for reimbursement as per format in Annexure I within 30
days from Date of Discharge to the respective Zonal Offices. Similarly, in the
case of retired staff the claim should be submitted to the respective Zonal
office or Corporate office directly. A representative of the TPA will collect
the claim forms received at Zonal Offices for processing at their end.
Claim
forms can be downloaded from CBS Helpdesk - HRM Online Site or from the
Internet at the website www.paramounttpa.com.
Documents to be submitted with the Claim form:
v
Completely filled in Claim form (Original)
v
In case of delay in submission,
reason for delay in submission.
v
Schedule of Expenses
v
Copy of the PHS ID card/e card.
v
Original Discharge Card/ Summary.
v
Original hospital final bill with
complete breakup of the expenses.
v
Original numbered receipts for
payments made to the hospital
v
All original bills for
investigations done with the respective reports
v
All original bills for medicines
supported by relevant prescriptions
v
Upon approval, the amount of
reimbursement will be credited to the SB account of the staff through NEFT by
the TPA.
The
above procedure shall be followed for the retired staff and spouse for claiming
reimbursement of domiciliary treatment expenses.
Pre and post hospitalization expenses:
The
following documents are to be submitted in case of claim for reimbursement of pre
and post hospitalization expenses.
u
Claim form as in Annexure-I
u
It should be mentioned in the first
page of the form at the top that the claim is for reimbursement of pre and post
hospitalisation expenditure.
u
Copy of the e-card / ID card.
u
Original consultation bills
supported by consultation note / papers of the doctor.
u
Original Investigation /
Pathological / Radiological test bills supported by Reports & advice for
the same.
u
Original Pharmacy bills supported
by respective prescriptions for the
same.
u
Copy of Discharge Summary of the
Hospitalization.
u
The required documents as stated
above should be sent to Zonal Office within 7 days from completion of Post
Hospitalization Benefit under the policy, i.e. 90 days.
The above procedure shall be followed
for the retired staff and spouse for claiming reimbursement of pre and post
hospitalization expenses.
Domiciliary
Treatment:
The following
documents are to be submitted in case of domiciliary treatment:
u
Claim form as in Annexure-II
u
Copy of the Medical certificate and
prescription certified by the attending medical practitioner and / or Bank’s
Medical Officer.
u
Copy of the e-card / ID card.
u
All Original bills for
investigations done with the respective reports
u
All original bills for medicines
supported by relevant prescriptions
u
All payment receipts in Original.
u
The required documents as stated
above should be sent to Zonal Office.
u
The claims for domiciliary
treatment will be collected by the TPA from the Zonal Offices by 10th
of every month for processing and reimbursement.
The
above procedure shall be followed for the retired staff and spouse for claiming
reimbursement of domiciliary treatment expenses.
A
list of Zone wise contact details of the TPA is provided in Annexure III. Zonal
Offices are requested to contact the representative of the TPA allotted to
their Zones for any requirement relating to the Medical Insurance Scheme.
At
Zonal offices, a separate register is to be maintained for recording all
Hospitalization / Domiciliary medical bills received from staff and retirees.
The hospitalization bills will be collected by the TPA as and when it is
received. The domiciliary bills will be collected on the 10th of
every month. All Medical bills under this scheme should be delivered to the TPA
under proper acknowledgement.
All medical bills relating to
Hospitalisation where date of hospitalization was prior to 01.10.2015 and
domiciliary treatment expenses incurred prior to 01.10.2015 shall be processed
and reimbursed as per erstwhile scheme.
*********************************************************************************
Following presentation is for retired employees.
But, it hold good for serving employees also, except definition of family and payment of premium.
click the following link and read the A to Z of the Medical Insurance scheme.
Power Point presentation of Medical Insurance Policy
courtesy: bankpensioner.blogspot.in
****************************************************************************
Family Definition for Serving Employees:
Premium will be paid by the Bank.
The Scheme Covers Employee + Spouse + Dependent Children +
2
dependent Parents /parents-in-law.
* No age limit for dependent children. (including step children and
legally adopted children )
A child would be considered dependent if their
monthly income does not exceed
Rs. 10,000/- per month; which is at present, or
revised by Indian Banks’ Association
in due course.
* Widowed Daughter and dependent divorced / separated daughters,
* Sisters including unmarried /
divorced / abandoned or separated from husband/ widowed sisters
* and Crippled
Child shall be considered as dependent for the purpose of this policy.
* Physically challenged Brother / Sister with 40% or more disability.
Either Dependent Parents or parents-In-law will be covered.
Parents would be considered dependent if their monthly income does not exceed
Rs. 10,000/- per month, which is at present, or revised by Indian Banks’ Association
in due course, and wholly dependent on the employee as defined in this scheme.
IBA informed that the new scheme on hospitalisation/ medical expenses reimbursement scheme has commenced from 1-10-2015 (for serving employees)
Procedure for claim as per Indian Bank instructions:
**************************************************************************
For Retired Employees:
Family Definition :
Self and Spouse.
Premium Should be paid by the Retirees.
Scheme for retired employees will be effective from 01.11.2015
Scheme for retired employees will be effective from 01.11.2015
Group Medical Scheme introduced by IBA is though more or less identical for employees and retirees, the following features/ facilities will not be available to retirees.
(a)In case of retirees, only self and spouse will be covered under this policy. Dependent Parents/ Children will not be covered as available to the employees during the service period.
(b)Banks will be only selling point for retirees and insurance claims will have to be handled and settled by the retiree directly with the insurance company through TPA while claims of employees under the policy will be settled by banks and banks will handle the claim with the insurance company.
(c)Entire insurance premium for buying the policy will have to be borne by the retiree while premium charges for employee by borne by the bank.
(d)As per clause 3.2 of the scheme, employees will be eligible to receive lump sum cash payment of Rs. 1lakh for certain critical diseases which will not be available to the retirees.
4. We wish to draw your kind attention on the following features of the policy.
(a)Eligibility: Retired Employees and their dependent spouses.
(b)Amount of Insurance: Retired Officers: Rs. 4lakhs and Retired Clerk and Sub Staff Rs. 3 Lakhs. These amounts of sum assured are fixed one with no flexibility.
(c)It will be floater Policy. Total sum assured will be available to one or both for settlement of claim in the year.
(d)As mentioned above insurance premium will have to be borne by the retiree in advance. First year premium including service tax is Rs. 7493 for policy of Rs. 4 lakhs and Rs. 5620 for policy for Rs. 5620/- approx. It should be importantly noted that next year and subsequent yeas premiums apyable will be subject to change. It is important point for retirees as the premium has to borne by the retirees.
(e)If husband and wife both are bank retirees, each can take separate policy as per their entitlement subject to payment of premium.
(f)The scheme will be implemented by the individual banks. It will be optional for the retirees to join the scheme. The retiree will have to submit the application in the prescribed format to the bank within the stipulated time.
(g)The retiree will have to give authority to the bank to debit designated account for premium amount for first year and subsequent years. Therefore it is necessary for the retiree to maintain sufficient balance in the designated account during the relevant period to enable the bank to debit the account and remit the premium to the insurance company. Any default in this regard will make the retiree ineligible from benefit of the policy.
(h)There is no age limit for joining the scheme and for subsequent renewals.
(i)Pre-existing diseases will be covered from day one without any waiting period.
(j)No Medical examination will be necessary for joining the scheme.
(k)Cashless facility for the treatment will be available at the networked hospitals. In other cases retiree will have to pay the charges and subsequently claim reimbursement from the TPA.
(l)With certain stipulations Day care and domiciliary expenses will be eligible for reimbursement.
(m)Allopathic/Ayurveda/Homeopathy/Naturopathy treatments are also covered under this policy.
(n)The retiree will have option to withdraw from the scheme any time in future but will not have option to join it after the date notified by the bank/ IBA
