Renewal of Group Medical Insurance Policy for Retired Employees with their Spouse
G I S T
- The Group Mediclaim Insurance Scheme Policy for the Retired Employees with their spouse has been renewed for the year 2013 -2014 with M/s United India Insurance Company.
- The new Policy No. is 030400/48/12/41/00008769 which is effective from 30/03/2013 and valid up to 29/03/2014.
- Value of Sum Assured per Retiree with spouse is Rs. 2 lacs.
- Total Premium payable to the Insurance Co. per retiree per annum is Rs.10,112/- inclusive of Tax, out of which, Retirees' Contribution will be Rs.1890/-.
- Renewal applications of the existing members correct in all respect, shall be received upto 30th April 2013 only. Retired Employees, who are still not a member of the scheme and wish to become members, may opt for the same but in their case also the retirees' contribution shall be Rs.1890/- and coverage shall be available from the date of receipt of the contribution by the Insurance Company.
- The old membership cards will continue to be effective for old members, however new Cards will be issued to the new members.
- Insurance Coverage for renewal applications received up to 30th April 2013 and thereafter, shall be available from the date of receipt of contribution/premium towards renewal of the Mediclaim Policy by the Insurance Company, for the Financial Year 2013-14. There will be no prorata deduction of retirees' contribution in the event of receipt of application for renewal of the policy by the old existing members.
- For Employees retiring during the Financial Year 2013-14, Bank's Contributionas well as Employees' Contribution towards the Premium payable to the Insurance Company shall be calculated and paid on prorata basis.
- The Third Party Administrator (TPA) shall be M/s TTK Healthcare TPA Pvt. Ltd.Reference is invited to H.O. Circular No. CHO/PMG/50/2010-11 dated 29-03- 2011 , CHO/PMG/08/2011-12 dated 23.05.2011 and CHO/PMG/19/2012-13 dated 26.09.2012 issued in respect of Group Mediclaim Insurance Scheme for the Retired Employees with their Spouse.Further to the above, for information of all concerned, Bank has renewed its Group Mediclaim Insurance Policy for Retired Employees alongwith their Spouse. The Group Mediclaim Policy is effective from 30.03.2013 to 29.03.2014 fpr a Total Sum Assured of Rs.2 lacs on floater basis.
Important Points to Note :
a. ELIGIBILITY
All retired employees with the maximum age of 80 years (retired/voluntarily retired from Bank's Services except employees whose services have been terminated as a consequence of punishment awarded by way of disciplinary action or who have resigned from Bank's Service) are eligible.
b. COVERAGE
The Coverage is Rs. 2 lacs on floater basis for the retired employees and their Spouse in case of Hospitalization for medical treatment. The benefit does not cover Domiciliary Treatment.
c. PREMIUM
For 2013-14, the Annual Premium is Rs.10,112/- inclusive of tax per retired employee. Out of which Bank will bear Rs.8,222/- from Staff Welfare Fund and Rs.1,890/- shall be borne by the Retired Employee.
d. Addition of new members during currency of the policy
Retired employees, who are not members of the Group Mediclaim Policy, may join the policy on any date after 30th April, 2013 but their contribution towards the total premium will remain the same, i.e. 1,890/- and Coverage shall be available from the date of receipt of contribution/premium by the Insurance Company.
e. Renewal of the Group Mediclam policy
The policy may be renewed on completion of one year depending upon the decision of the competent authority after review of the scheme. The Insurance Premium may increase or decrease during the subsequent years on the basis of the claim ratio and/or any other relevant factors.
f. Third Party Administrator :
All claims arising out of the Group Mediclaim Insurance shall be processed and settled by the Third Party Administrator, M/S. TTK Health Care TPA Pvt. Ltd. having its Office at Flat No. A-12, 6th floor, Chatterjee International Centre, 33A, Jawaharlal Nehru Road, Kolkata-700 071. The said TPA shall be acting on behalf of the Insurance Company and the Insurance Company shall be liable for any lapse/inaction or misconduct on the part of the TPA.
Operational Guidelines :
1 .Submission of claims with the TPA
- Retired efnployee/spouse of retired employee may get admission as an indoor patient in any hospital/nursing home as defined by the insurance company in their scheme.
- After discharge from the hospital, the retired employee will submit bills, receipts, reports, prescriptions and discharge certificates etc. in original with duly filled in claim form(enclosed copy of such form may be xeroxed for use) directly to the TPA for reimbursement of claim as per the insurance scheme within 45 days of discharge from Hospital/Nursing Home. A check list (marked Annexure) is enclosed.
- The TPA will process the bill gnd make payment to the claimant either by issuing a cheque in his/her name and sending it to the concerned retiree directly / directly crediting the claimant’s Account in any bank through NEFT .
2. Additional and optional Cashless Hospitalization benefit
- This benefit would be made available by the TPA only when medical cards are issued to the retired employees and their spouse. Retired officers/ employees and/or their spouse may avail cashless facility in network hospitals/nursing homes of TPA for treatment as indoor patient on production of medical card followed by intimation of admission to TPA within 24 hours. The TPA may be intimated in this regard on their Telephone Nos. 033-2288 4191/92/93/98 and Toll Free Telephone Number 1800-345-7069 followed by written communication through e-mail address kol@ttkhealthcareservices.com/ swatl.b@ttkhealthcareservices.com or on Fax No.033-2288 - 4194. The issue of cashless facility will be taken up by the concerned hospital/nursing home with the TPA.
- The TPA will extend cashless facility to the member admitted as indoor patient in the network hospital up to extent of applicable limit, per annum per family (husband and wife).
- In case the bill amount is more than Rs.2.00 lac, the excess amount beyond the admissible limit under Group Medical Insurance Scheme alongwith non-medical expenses and Taxes etc. will have to be paid by the member before getting discharged from the hospital.
Pre and Post Hospitalization Medical Expenses
Member retired officer/employee may submit to the TPA, additional bill, if any, in respect of 30 day's pre and post hospitalization medical expenses for reimbursement, after completion of treatment in a hospital.
List of Network Hospitals will be provided by the TPA. Old Health Cards will continue to be effective, however, TTK will issue a letter to all members regarding the same.
NOTE : The Retired Officers/Retired Employees having another Mediclaim Insurance Policy with any other Insurance Company, can submit their claim with United India Insurance Co. Ltd. up to their limit at the first instance and then for balance amount, may submit xerox copies of claim settlement papers along with a certificate to the effect issued by United India Insurance Co. Ltd. with the other insurer.
OR
In such cases where the Retired Officer/Employee would like to prefer claim under Mediclaim at the first instance with other insurance company, and thereafter, for payment of balance amount, the employee may submit his/her claim with United India Insurance Co. Ltd. along with xerox copies of settled claim papers and a certificate to the effect issued by the other insurer/s.
For any type of query related to Group Mediclaim Insurance Policy for Retirees, Branches/Offices/ Retired Employees may contact - Shri S. N. Dutta, Manager, PSD @ (033) 4455-9259 or Mob. 086409-93167.
Branches/Offices should display this Circular prominently on the Notice Board for information of all concerned. Branches/Offices should also make endeavors to contact the retired employees and inform them about the aforesaid Group Mediclaim Insurance Scheme.
(Ajit Kumar)
DEPUTY GENERAL MANAGER
Personnel Services Department
Encl.
i. Annexure .
ii. Annexure-I.
iii.Bio-data .
Annexure
CHECK LIST OF DOCUMENTS/PAPERS TO BE SUBMITTED FOR SETTLEMENT UNDER GROUP MEDICLAIM INSURANCE SCHEME FOR THE RETIRED EMPLOYEES
- DULY FILLED UP CLAIM FORM
- ORIGINAL/DULY ATTESTED COPY OF DISCHAGE SUMMARYI
- ORIGINAL HOSPITALISATION BILL WITH BREAK-UP AND "PAYMENT RECEIPTS".
- SURGERY/CONSULTATION BILLS, IF ANY
- OPERATION THEATER/PHARMACY BILLS [ORIGINAL ONLY]
- MEDICINES BILL WITH DOCTOR'S PRESCRIPTION [ORIGINAL ONLY]
- PRE-HOSPITALISATION BILLS [ORIGINAL ONLY]
- POST HOSPITALISATION BILLS [ORIGINAL ONLY]
- ORIGINAL/DULY ATTESTED COPY OF INVESTIGATION REPORTS WIITH DOCTOR'S ADVICE
- MLC [MEDICO LEGAL CERTIFICATE] / FIR IN CASE OF ROAD TRAFFIC ACCIDENT.
- ORIGINAL/DULY ATTESTED COPY OF X-RAY REPORT [X-RAY PLATE NOT NEEDED , BUT IN CASE OF FRACTURE, PLATE IS REQUIRED.]
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