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Sunday, July 16, 2017

Top Up Health Insurance For Bankers

Top Up Medical Insurance Policy being offered by New
India Insurance Co. Ltd. to Retired Bank Employees  

The present insurance covers of Rs.4/- lacs to retired bank officers and Rs.3/- lacs to retired clerical and sub staff are felt inadequate by many of us. There is, therefore, a growing demand for some Top Up cover. After persistent efforts, our apex organization - All India Bank Retirees' Federation has arrived at an understanding with the New India Insurance Co. Ltd. to extend Top Up covers of Rs.4/- lacs to retired Officers and Rs.3/- Lacs to retired Clerical and Sub Staff with the same terms and conditions which are in the IBA Medical Insurance Scheme with the United India Insurance Co. Ltd. (Ofcourse, there will not be any cover for domiciliary treatment). The premium to be charged will be very reasonable i.e. Rs.3,806/ for additional cover of Rs.4/- lacs and Rs.3,511/- for Rs.3/- lacs additional coverage. The Top Up policy will be effective from 1st November,'17. 

In this regards, please see the attached Circular issued by AIBRF and other three related attachments. 

Yours sincerely,
General Secretary

Ref:2017/78                                                                                Date: 15.07.2017
   The office Bearers/ Central Committee Members/ State Body Chiefs
   Dear Comrades,

                        Re: Launching of Super Top Med claim Insurance
                              Policy designed by New India Assu. Co. Ltd
                              For Bank Retirees

As all of you are aware, Indian Banks’ Association had introduced Group Medi Claim Insurance Policy designed by United India Insurance Company for bank retirees with effect from 1st November, 2015. The policy is in operation in the second year and next renewal of this group policy is due after about 14 weeks,  on 1st November, 2017

2.  We find that in the scheme of IBA there is no provision for top up facility for the retirees which common option is given to the insured by the insurance companies nowadays to meet individual needs. AIBRF had approached IBA at the time of last renewal to consider providing option of Top Upfacility to those retirees who need it and want to go for it. We also pointed out that premium will ultimately be borne by the retirees, so IBA should not have any problem in this regard and it will be good insurance business for United India Insurance Company. However, our request in this regards was not considered favourably. As all of you know, AIBRF/ Retiree representatives have not been involved at any stage in designing or implementing it by IBA despite the fact that entire cost of premium running in to crores of rupees is borne by the retirees from their pockets.

3. We have been receiving continuous several representations from individual members/ affiliates requesting AIBRF to take initiative in launching super  top up policy for bank retirees as group to take care of their future  requirement  to meet increasing cost of treatment due to inflation/introduction of new technology in medical science and the fact that increased insurance cover will not be easily available to the retirees subsequently at the advancing age.

4. Considering the above genuine requirement of our membership for effective health management in coming days, AIBRF took steps to approach insurance companies to design top up  scheme for bank retiree group which is suitable to them and in conformity to the terms and conditions of the basic policy of United India Insurance Co. Ltd. We gave the following mandate to the broking firm to consider them and invariably include them in the final product.

  1. Terms and Conditions of the Super Top policy should be 100 per cent identical to the basic policy of United India Insurance Company to make both policies as integrated product for the retirees with seamless benefits. In other words, there should not be any age bar to join it, all deceases/ illness given in the basic policy should be included for claim, claim ratio under various heads should be similar to the basic policy.
  2. There should not be any condition for medical test to join top up policy
  3. It should be floater family policy to include retiree and his/ her spouse and widows of deceased retirees.
  4. Premium should be affordable and reasonable.
5. We are now happy to inform you that after prolonged discussions, exchange of information/ several documents, hard negotiations with several insurance companies, we have been now able to finalise the scheme of top up policy for bank retirees with New India Assurance Company Limited. Main features of the scheme are as under:


(a)New India Insurance Company is the public sector and largest insurance player in the country.
(b) Top up policy designed for bank retirees will have 100 per cent same terms and conditions and will be completely identical to the basic policy.
(c) All bank retirees who are currently members of group insurance policy of United India Insurance Co. will be eligible to purchase top up insurance policy with no age bar.
(d) There will be two slabs for sum insured on the lines of basic policy. It will be 3 lakhs for award staff retirees and 4 lakhs for officer staff retirees.
(e) Premium for top policy will be Rs. 2975 for 3 lakhs limit and Rs.3225 for 4 lakhs limit plus applicable taxes. In other words, premium will be less than 1 per cent of some insured for top policy.
(f) Policy will cover only hospitalisation charges with 30 days pre-hospitalisation and 90 days post hospitalisation expenses on the lines of basic policy. However domiciliary benefits will not be available under top up policy.
(g)  The policy will become operative from 1st November, 2017 to coincide with due date for next renewal for basic policy subject to getting minimum 10000 applications with premium payment before the date .
(h) Both the policies put together will give seamless cover of Rs.6/ 8 lakhs to the retiree and spouse at the reasonable premium of about 2.15 per cent of sum insured (bout 4 per cent for basic policy and 0.98 for top up policy). It will be much cheaper compared to the United India Insurance Company policy given to the retirees of SBI.

(i) Insurance of Rs. 6/8 lakhs will take care of all future eventualities in the area of health management for senior citizens at least for next 10 years if not more without any botheration.

(j) We enclose 3 annexures giving complete details/ background of the scheme for your information/ information of members.

6. We find that some of our affiliates have entered arrangements for top up policy for the members. On-going through terms and conditions of the policy we find that there are some restrictive clauses in it like co-pay clause, restrictions on sum assured for major surgeries etc. putting the retiree in some disadvantageous position in claim settlement. In this regard proposed policy of New India Insurance Co. is superior in settlement of claim amount.

7. We now request our affiliates/ office bearers/ central committee members/ other activists to take the following steps

  1. Make publicity of the scheme based on enclosed documents among the primary members
  2. Meetings can be held at local level to explain the scheme to the membership.
  3. All affiliates are requested to send their initial estimate on the likely membership under the scheme before 30th August, 2017.
  4. Give feedback about the scheme, if any.

8. We shall issue detailed circular about implementation of the scheme in coordination of the insurance company after some time.


Q No.01 What is Super Top Medi-Claim Insurance policy
  1. It covers risk and provides reimbursement of expenses to the insured when sum insured of the basic policy is completely exhausted.
  2. It is additional financial comfort to the insured in the environment of increasing medical expenses.
  3. It makes retirees who are senior citizens free from all financial worries for medical treatment.

Q.No.2  What is Super Top up Policy of AIBRF
  1. It is designed and will be issued by  Public Sector Insurance Company, New India Insurance Company which is the largest insurance company of the country.
  2. It is designed only for Retired Bank Employees.
  3. Retired Bank Employees who have taken Group Insurance Policy of United Insurance Company Ltd. (designed by IBA) and renewed for 2016-2017 will be eligible to apply for this policy.
  4. Terms and Conditions of Super Top Policy for settlement of claims will be the same as applicable to the basic policy of United India Insurance Co. Ltd. (except domiciliary benefits.)

Q.3: What is the launching date?
Ans.It will become operative from 1st November, 2017, the date which will coincide with  date of renewal for basic policy of United India Insurance Co.

Q. 4 What are the Special Features of this policy
  1. No Age Limit to join it. Irrespective of age any bank retiree can buy this policy.
  2. All existing diseases without any waiting period will be covered and eligible for claim without waiting period of one day.
  3. All sorts of hospitalization/ illness covered in United India Insurance Company including some critical illness will be eligible for claims.
  4. No medical test is required to buy the policy.
  5. Coverage will be available to the bank retired employee, his/her spouse and widow/ widower of the deceased retiree.

Q No.5 What is the sum insured under the top up policy?
Sum Insured will be as under

  1. Officer Staff                             Rs. 4 Lakhs
      (b)  Award Staff                              Rs. 3 Lakhs

Q No. 6 What will be the total coverage available to the retirees who opt for the Super Top Up policy?
                                                Award Staff                            Officer Staff

United India Ins.
Co. Ltd.- Basic Policy            3.00 Lakhs                             4.00 Lakhs
New India Ins. Top
Up Policy                                3.00 Lakhs                             4.00 Lakhs

Total                                       6.00 Lakhs                              8.00 Lakhs

In other words, the retiree will get total insurance cover on the same terms and conditions for aggregate amount of Rs. 6 lakhs for award staff and Rs. 8 lakhs for officer staff. The two policies will only determine the order in which claims are to be made.

Q No. 07 What will be premium for Super Top Up Policy ?

  1. For Rs. 3 Lakhs Policy                            Rs. 2,975 plus taxes
(b)For Rs. 4 lakhs Policy                              Rs. 3,225 plus taxes

Q No. 08 What will be aggregate premium liability on retirees who opt for top up policy ?
                                       For 3 Lakh Policy                         For 4 lakh Policy

United Ins. Co. Ltd          10,452                                           13,935

New India Ins. Co.             2,975                                             3,225

Total                                   13,427                                           17,160
                                     Plus Taxes at the applicable Rates

Note: Premium payable for next renewal for United India Insurance basic policy will be subject to change. The above premiums of United India is excluding premium payable for domiciliary benefits.

Total Premium load of sum          6 Lakhs Policy                  8Lakhs Policy

United India _Basic                            3.48 per cent               3.48 per cent

New India Top Up                              0.99  per cent               0.80 per cent

Aggregate                                           2.23 per cent                 2.14 per cent

Note: The above load workout is excluding of taxes payable and premium payable for domiciliary.

In life span of 10 years total premium payable for both policy will be around 22/23 percent of aggregate sum insured giving advantageous position to the retiree with tension free treatment in case of emergency.

Q. No 9 When Claim will trigger in Super  Top up Policy ?
  1. After exhausting total limit of basic policy for hospitalization (without domiciliary benefits) in one or multiple claims.
(b)Thereafter, claims can be made under top up policy on the same terms and conditions as
     applicable to the basic policy on one or more occasions during the currency of the top up policy.
(c)Co-Pay clause will not be applicable. In other words no amount will be deducted from the
     admissible claim to put burden on the retiree.

Q. No 10  Whether Pre & Post Hospitalization expenses  willbe reimbursed under Top up policy ?
Yes. 30 days in case of pre- hospitalization & 90 days post hospitalization

Q. No.11 What will be procedure for lodgment of  claims
  1. TPA, one or more than one will be appointed by New India Insurance Co. for processing claims under the policy and giving authorization for cashless facility.
  2. Claim will have to be submitted in the forms prescribed for this purpose within the stipulated
       period.  Detailed instructions/guidelines in this regard will be circulated shortly.

Q. No 12 How to buy policy under the scheme ?
  1. Omnibus master policy will be issued in favour of AIBRF
(b)  Each member will have to make application in the prescribed form within the stipulated  period.
       Detailed instruction will be issued for submission of the application.
(c)Application will be accompanied by cheque of the required amount in favour of New India
    Insurance Company
(d)On acceptance of the proposal each insured will be issued health card for using at the time of
    hospitalization/ treatment.

Q. No 13 Any addition cost will be levied on retiree for administration of the scheme ?
No. Administration expenses of the scheme will be borne by the insurance co / AIBRF in the first year.

Q No 14 Any target fixed for scheme become operative ?
(a)Minimum 10000 applications are required before 30.09.2017 from the eligible retirees to become the   
     scheme operative.
(b) In case the target not achieved, amount of premium collected will be refunded after deducting nominal
      amount of Rs. 100 per application in next 2 months.

Q. 15 Any other details ?
Letters received from insurance advisor giving details of the scheme are enclosed.

                                                                     GENERAL SECRETARY

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