Group Medical Insurance Scheme in Banks

AIBEA Has circulated information pertaining to group medical insurance scheme and how did it perform during preceding years. It is submitted below for creating awareness among bank employees.

CIRCULAR LETTER No. 28/24/2017/25                           13-7-2017

TO ALL OFFICE BEARERS/STATE FEDERATIONS/

ALL INDIA BANKWISE ORGANISATIONS / ALL UNITS

Dear Comrades,

Reg: Group Medicliam Insurance Policy

Under 10th Bipartite Settlement, medical/hospitalisation expenses are reimbursed/settled under the Group Mediclaim Insurance Policy. The policy for the in-service employees/officers began from 1-10-2015 and for retirees from 1-11-2015.  The policies have been renewed from 1-10-16 and 1-11-16 respectively.  

We wish to share the following details for the information of our unions.

Banks covered under the Policy       :     33  ( for 2016-17 )

Employees covered       :    326,600

Officers covered       :    295,400

Total staff covered      :    622,000

Total lives/family members covered  :   19.25 lacs

Total Premium paid                        :    Rs. 762 cr + Tax

Claims settled so far/under process

As of end of June, 2017                  :    Rs. 515 cr

(Last year i.e. 2015-16 : 39 Banks – 7.10 lac employees/officers covered – Premium paid Rs. 390 crores – Claims settled Rs. 775 crores)

REITREES ( 2016-17 ) From Nov. 2016 upto June, 2017

	WITH    DOMICILIARY	WITHOUT DOMICILIARY	TOTAL
RETIRED EMPLOYEES/ OFFICERS COVERED	89,300	1,00,400	1,89,700
TOTAL LIVES COVERED	1,74,600	1,92,400	3,67,000
PREMIUM PAID	148 CR	129 CR	277 CR
CLAIMS PAID/UNDER PROCESS UPTO END OF JUNE 2017	195 CR	109 CR	304 CR

2016-17 – IN SERVICE EMPLOYEES/OFFICERS  - UPTO END OF JUNE, 2017

	CLAIMS PAID	UNDR PROCESS	TOTAL
BY CASHLESS	210 CR	70 CR	280 CR
BY REIMBURSEMENT	112 CR	51 CR	163 CR
UNDER DOMICILIARY	61 CR	11 CR	72 CR
TOTAL	383 CR	132 CR	515 CR

2016-17 – RETIREES  -  UPTO END OF JUNE, 2017 ( WITH DOMICILIARY)

	CLAIMS PAID	UNDR PROCESS	TOTAL
BY CASHLESS	76 CR	23 CR	99 CR
BY REIMBURSEMENT	29  CR	11 CR	40 CR
UNDER DOMICILIARY	47 CR	9 CR	56 CR
TOTAL	152 CR	43 CR	195 CR

2016-17 – RETIREES  -  UPTO END OF JUNE, 2017   (WITHOUT  DOMICILIARY)

	CLAIMS PAID	UNDR PROCESS	TOTAL
BY CASHLESS	61 CR	20 CR	81 CR
BY REIMBURSEMENT	20 CR	8 CR	28 CR
TOTAL	81 CR	28 CR	109 CR

Thus, we find that the scheme is benefitting large number of employees.  However, there are many grievances and complaints about the undue delay in settlement of claims, problems in cashless treatment in hospitals, problems being created by TPAs, unilateral rejection of claims, delay at Bank-level in forwarding the claims to TPA, etc.  In order to take up these issues with the IBA for plugging the loop-holes in the scheme and to ensure effective implementation of the scheme in favour of the employees, we request our units to inform us the important problems faced by the employees at the grass-root level for being taken up with IBA.

Since this is one of the important issues in the current 11th Bipartite charter of demands, we seek the co-operation of our units to furnish the above details at the earliest.