Know About Developments In Medical Insurance Scheme

CLRIFICATIONS FROM UIIC TO ONE OF THE BANKS ON RETIREES MEDICAL INSURANCE

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C H VENKATACHALAM				11:44 PM (12 hours ago)

CLARIFICATION SENT BY UIIC TO ONE OF THE BANKS

FOR YOUR INFORMATION

Issue	Our query	UIIC clarification
Modalities of domiciliary expenses .	What will be the modalities of reimbursing the claim under domiciliary expenses to retirees ?	It can be send to TPA directly or to the nearest Bank office from where it has to be forwarded to zonal office enabling the TPA officer to collect it.
Format for claiming domiciliary  expenses.	Whether you have introduced any prescribed format for claiming domiciliary expenses for retirees ? If yes, please provide us a copy of the same.	Same claim form as being  used for hospitalization. Please advise the retiree to write on the top "For domiciliary treatment".
Nature of expenses admissible.	Please clarify what type/nature of expenses are covered for the treatment of identified 59 ailments.	Same as applicable to employee policy.
Extension of domiciliary treatment to such retirees, who are not the member at present.	Since the  UIICL has introduced option for domiciliary expenses  now, whether such retirees who have not become member of the Scheme so far,  can join the Medical Insurance Scheme now ?	Only present retirees who are covered in the current policy are allowed to join the renewal policy.
Switching over from domiciliary expenses benefit to normal renewal (without domiciliary cover) or vice versa.	Please clarify whether a retiree who opts for domiciliary expenses benefit (Option II) now, be allowed  to  switch over to normal renewal next  year or Vice-versa	The final decision would be taken at the time of r

C H VENKATACHALAM

GENERAL SECRETARY AIBEA

98400 89920
Subject: Clarifications - Reply received from TPA of UIIC
 

Dear members,

We attach the document incorporating the replies of the Paramount Health Services P Ltd., on rules and procedure for reimbursement of domiciliary treatment/expenses and other issues of our concern for information of members.

Regards,

R.K. Powar, GS, AIUBRF,
Asst. General Manager(Retired)
Union Bank Of India
Tel: (M) 7710030963
email: rkpowar@gmail.com

ALL INDIA UNION BANK RETIREES’ FEDERATION (Affiliated to All India Bank Retirees’ Federation) A/12, Girdhar Apt., Kastur Park, Shimpoli Road, Borivali (W), Mumbai 400 092       Chairman                                       President                           General Secretary    D. A. Masdekar                              B. G. Raithatha                             R. K. Powar     9970899393                                   9427207021                               7710030963 damasdekar@gmail.com             ubiretirees@gmail.com               rkpowar@gmail.com

No.106/2016-17                                                                 19th September 2016

Dear Members,

Group Insurance Medical Policy: Reply of T.P.A.

DOMICILIARY TREATMENT – CLARIFICATIONS

We have in our earlier communication informed the members that the Federation has requested The Paramount Health Services Pvt. Ltd, the Third Party Administrator (TPA) of UIIC to clarify the rules and procedure for reimbursement of domiciliary treatment expenses to remove uncertainty.

We have received the reply from TPA which is appended here below for the information.

No.	AIUBRF’s  query	Reply of T.P.A.
1	Why is the procedure for reimbursement of domiciliary treatment not clearly outlined? It is being confused with the domiciliary conditional clause of individuals unable to be hospitalized or lack of space in hospitals?	It is a Domiciliary Treatment and not a Domiciliary Hospitalization.
2	Whether the rules and procedure followed/adopted in respect of in-service employees for sanction of reimbursement of domiciliary treatment is the same for retirees?	YES
3	How frequently can the retired employee be permitted to claim the reimbursement for domiciliary treatment i.e. weekly, monthly, or quarterly?	Monthly
4	Whether the retired employees would be sanctioned reimbursement for domiciliary treatment as per the list of 59 diseases circulated by the Bank, such as Diabetes, hypertension etc., on self certification or based on prescription of the general / family doctor or is it compulsory to obtain prescription from the hospital?	To Claim Domiciliary will need Doctor Consultation, prescription, Medicine bills/Investigation reports all in original.
5	How often must the retiree get fresh certification from the doctor/hospital?	Valid upto 90 days i.e. 3 months and if the prescription says LIFE LONG TREATMENT the same will be valid for 180 days.
6	Are those who retired from the Bank in the last year, entitled to Opt under this new Scheme?	Only who were covered in last year policy.
7	An important advantage of the Scheme is the Cashless facility available for treatment in hospitals. But many hospitals are not covered by tie-up and hence employees are asked to pay for the treatment and then seek reimbursement. How can retires avoid such difficulties to avail cashless treatment facility?	We would request those retirees to check on the portal www.paramounttpa.com/iba the Network list before getting hospitalized.
8	The Settlement and the Scheme clearly provide that retirees would submit the Bills to the Banks and in turn the Banks to submit the Bills to the TPA to get the reimbursement. But in many some of the managements are asking the employees to submit the Bills directly to the TPA.	Should be submitted at your branch office from where you collect your pension.
9	There are instances of death occurring during treatment in hospital and if it happens to be Sunday or holiday, the hospital/TPA does not come to the rescue and the family is facing problems in getting the body of the patient in time.	We are processing the Cashless on week days and on national holidays also so there is no question that TPA doesn’t help during crisis; only issue is there when the Sum Insured is exhausted.
10	Treatments like Dialysis, etc. are disallowed by the TPA though covered by the Scheme and the employees are forced to pay the cost to the hospital. How can the scheme be implemented by the TPAs so that employees are not put into such hardship.	Day care list is already shared to all by Union Bank of India - Day Care List, and we have settled lot of Dialysis cases so where is the question of disallowing the same.
11	In the case of Bills submitted to the Banks for domiciliary treatment, there are many complaints of undue delay by the TPAs and managements are not taking steps to liaise with them to expedite the claims. Special attention is required in this regard.	Last year there was no Domiciliary treatment so where the question of delay and delay is only happens when the documents are not proper or there is a deficiency. So we would request all to submit proper documents and in the given time frame.

We have also requested the Department of Personnel, Central Office and UIIC to clarify on other issues of our concern.  No sooner we receive the same; we will inform all the members.

With warm regards,

      Yours truly,

    (R. K. Powar)

  General Secretary

UNION BANK RETIRED EMPLOYEES' ASSOCIATION

(Registered under Trade Union Act, 1926 : Registration No.G-6201)
(Affiliated to All India Bank Retirees' Federation
through All India Union Bank Retirees' Federation)
403, Sadhana Down Town, Near Punjab National Bank,
Jubilee Chowk, Rajkot - 360 001 (Gujarat).  Phone: 0-94272-07021

  E-mail < ubiretirees@gmail.com > < rajkot@ubiretirees.in >  

======================================================

Date: 10th October,'16

To

All the regular recipients of our Association's e-mails,

Friends,

59 diseases for which bank retirees will be covered in Group

II for reimbursement of domiciliary treatment expenses

   Please see another e-mail and its attachment forwarded herewith (received from Shri R.K.Powar, General Secretary, All India Union Bank Retirees' Federation). 

Yours sincerely,

B.G.Raithatha,

General Secretary

From: "Powar R K" <rkpowar@gmail.com>
To: 
Sent: Monday, 10 October, 2016 16:22:06
Subject: Renewal of Insurance Premium - clarification

Dear all,

We have informed you that the insurance company has sent the communication for the renewal premium for 2016-2017 with two options. (1) Normal Renewal on as is basis (Without Domiciliary cover) and (2) with Domiciliary Expenses Benefits Option (59 diseases as per Employee Policy).

We attach the list of 59 diseases as per Employee Policy for the information of the members which will be covered under Option No. 2.

Regards,

R.K. Powar, GS, UBRA

Asst. General Manager(Retired)
Union Bank Of India
Tel: (M) 7710030963
email: rkpowar@gmail.com

Click Here To Know Nams of Diceases Covered Under Domiciliary Treatment Scheme

Sr. No. Treatments 1 Cancer 2 Leukemia 3 Thalassemia 4 Tuberculosis 5 Paralysis 6 Cardiac Ailments 7 Pleurisy 8 Leprosy 9 Kidney Ailment 10 All Seizure disorders 11 Parkinson’s diseases 12 Psychiatric disorder including schizophrenia and psychotherapy 13 Diabetes and its complications 14 Hypertension 15 Hepatitis –B 16 Hepatitis - C 17 Hemophilia 18 Myasthenia gravis 19 Wilson’s disease 20 Ulcerative Colitis 21 Epidermolysis bullosa 22 Venous Thrombosis(not caused by smoking) Aplastic Anaemia 23 Psoriasis 24 Third Degree burns 25 Arthritis 26 Hypothyroidism 27 Hyperthyroidism expenses incurred on radiotherapy and chemotherapy in the treatment of cancer and leukemia 28 Glaucoma 29 Tumor 30 Diptheria 31 Malaria 32 Non-Alcoholic Cirrhosis of Liver 33 Purpura 34 Typhoid 35 Accidents of Serious Nature 36 Cerebral Palsy 37 Polio 38 All Strokes Leading to Paralysis 39 Haemorrhages caused by accidents 40 All animal/reptile/insect bite or sting 41 Chronic pancreatitis 42 Immuno suppressants Domiciliary Hospitalization / Domiciliary Treatment Sr. No. Treatments Domiciliary Hospitalization / Domiciliary Treatment 43 Multiple sclerosis / motorneuron disease 44 Status asthamaticus 45 Sequalea of meningitis 46 Osteoporosis 47 Muscular dystrophies 48 Sleep apnea syndrome(not related to obesity) 49 Any organ related (chronic) condition 50 Sickle cell disease 51 Systemic lupus erythematous (SLE) 52 Any connective tissue disorder 53 Varicose veins 54 Thrombo embolism venous thrombosis/venous thrombo embolism (VTE)] 55 Growth disorders 56 Graves’ disease 57 Chronic Pulmonary Disease 58 Chronic Bronchitis 59 Physiotherapy and swine flu shall be considered for reimbursement under domiciliary treatment.


Clarification on whether reimbursement is possible for Dental treatment
dkj

UNION BANK RETIRED EMPLOYEES’ ASSOCIATION

(Registered under Trade Union Act,, 1926 : Registration No.G-6201)

(Affiliated to All India Union Bank Retirees’ Federation)

-: Office :-

403(A), Sadhna Down Town, Near Punjab National Bank,

Opp. Alfred High School, Jubilee Chowk, RAJKOT – 360 001 (Gujarat).

‘E’ mail : < ubiretirees@gmail.com  > Cell : 0-94272-07021

Ref:Insurance:2016:129 Date : 15th October,’16

To                                                                                          Only by e-mail

All the members of our Association,

Friends,

Group Medical Insurance scheme

(A) Domiciliary treatment expenses

1. From several messages being received through WhatsApp and other media, it is understood that  there is some confusion among the retirees as to whether by paying higher premium the retirees will really get reimbursement of medical expenses incurred for domiciliary treatments (without hospitalization). Hence our Association thinks it proper to express its views as under.

2. If we refer Schedule IV of the 10th Bipartite Settlement, it contains following particulars for reimbursement of medical expenses.

1. Day Care Treatment undertaken in a hospital for less than a day

2. Domiciliary Hospitalization means medical treatment taken at home when condition of the patient is such that he / she is not in a position to be moved to a hospital or the patient takes treatment at home because of non-availability of room in a hospital

3. Domiciliary Treatment: treatment taken for specified diseases which may or may not require hospitalization. (59 diseases are identified for this purpose)

Though apparently all the three i.e. (a), (b) & (c) mentioned above look identical, in reality terms those are different. For (c) i.e. domiciliary treatment hospitalization is not essential.

3. In the 10th BP Settlement, the Indian Banks’ Association had agreed with the United Forum of Bank Unions to take insurance cover for serving and retired employees for hospitalization and also for the treatments specified in 2(a) (b) & (c) above. But the Insurance Company had not agreed to grant reimbursement to the retired employees for the domiciliary treatment (i.e. mentioned in Para 2 (c) with an apprehension that the claims of the elderly people would be much more. The Insurance Company had offered refund of the premium to those who were not willing to continue in the Insurance Scheme because of exclusion of the domiciliary treatment. The stand taken by the Insurance Company was consistent with the law, as any proposal can be accepted partially also and in that case the other party has right to cancel the deal.  

4. Now, when our Insurance Policy is due for renewal, the Insurance Company is agreeing to grant reimbursement of domiciliary treatment expenses even to the retirees provided they pay more premiums.

5. The reimbursement of domiciliary treatment expenses is already being granted to –

1. Employees in service of all the Banks (including their spouses, dependent children and parents or parents in law)
2. Pensioners of State Bank of India

6. On our casual inquires with the (i) Leaders of the serving employees’ / officers’ organizations as well Office Bearers of State Bank of India Pensioners’ Association, it is understood that the system of granting reimbursement of domiciliary expenses is working well. Their claims are being settled. Therefore, there is no reason of any apprehension in our mimfd that our claims would not be settled.

(B) Reimbursement of expenses incurred for dental treatment

8. A similar confusion is persisting for reimbursement of expenses incurred for dental treatment.

9. Please refer the Master Insurance Policy No. 500100 /48 /15/41 /00000522 dated 6th November,’15 issued by the United India Insurance Company for retired employees of our Bank. In Clause No.3.3 thereof certain diseases are specified for which day care treatment is reimbursable provided the treatment is undertaken under General or Local Anesthesia in a hospital / day care centre. Certain diseases include Dental Surgery also.

10. However, in terms of Clause No.4.4 of the same Insurance Policy, expenses incurred for dental treatment / surgery is not reimbursable in the following circumstances.

1. Treatment is taken in a Dental Clinic or
2. The treatment is cosmetic in nature

11. In view of these, the expense incurred merely for clearing the teeth is nor reimbursable, because it is cosmetic in nature. However, if we undergo root canal or tooth implant treatment / surgery, it is reimbursable.

12. To cite specific examples –

1. When I had given an intimation to TPA for my own root canal treatment in a dental clinic, the permission was denied to me.

2. Shri J.P.Shah, a member of our Association – now settled at Baroda had sought permission of TPA for root canal treatment of his two / three teeth in a Multi Specialty Hospital (which had more than 15 beds). The permission was accorded and expenses of around Rs.30,000/- was reimbursed.

13. Therefore, if you want reimbursement of dental surgery from the Insurance Company, please choose any Multi Specialty ora  Corporate Hospital, wherein there are minimum 15 beds; though in fact actual hospitalization is not required for dental treatment.

14. If we go for purchasing any direct Insurance Policy or if we join any other Group Medical Insurance Scheme, dental surgery even in a Hospital having more than 15 beds is not reimbursable. But the IBA’s group medical insurance policy applicable to us is granting this benefit.

15. It is a subjective matter of an individual whether to continue in the renewed insurance policy and that too with or without domiciliary treatment. But the basic idea for issuing this e-circular is to remove misconception, if any, as regards (i) domiciliary treatments and (ii) dental surgeries.

16. This circular is being sent by e-mail to those members whose e-mail IDs. are available with our Association with a request to pass on this message to the members who have no e-mail facility.

 Yours sincerely,

(B.G.Raithatha),

General Secretary

 

ALL INDIA UNION BANK RETIREES’ FEDERATION (Affiliated to All India Bank Retirees’ Federation) A/12, Girdhar Apt., Kastur Park, Shimpoli Road, Borivali (W), Mumbai 400 092       ChairmanPresidentGeneral Secretary D. A. Masdekar                              B. G. Raithatha                             R. K. Powar     9970899393                                   9427207021                               7710030963 damasdekar@gmail.comubiretirees@gmail.comrkpowar@gmail.com

No.105/2016-17                                                                 18th September 2016

Dear Members,

Group Insurance Medical Policy: Perceptions and Suggestions:

In September 2016 Union Bank had sent emailsto retired employees informing them that the premium renewal amount of the Medical Insurance Scheme of Insurance Policy for 2016-2017 was likely to be increased to Rs. 16,026.00 for retired Officers and Rs. 12020/- for retired Award staff.

Many retired employees were shocked at the unjustified and unilateral hike in the premium amount. Our All-India Federation had taken up the matter on 10/10/2016 with the Chairman & Managing Director of our Bank conveying the feelings of the retirees at this steep hike, &requesting Bank to understand the financial difficulty which a retiree is undergoing or likely to undergo because of this unjustified hike in the premium and also the short period within which the amount is required to be paid.

We understand that the Union Bank management is in the process of clarifying the issues taken up by our All-India Federation, more particularly the introduction of reimbursement of domiciliary treatment, under the new option by paying additional premium to the extent of Rs. 40,000/- and Rs. 30,000/- within the overall ceiling/insurance cover of Rs. 4.00 lacs and Rs. 3.00 lacs for officers and award staff respectively.

Many of the retired employees are constantly contacting the leaders of our All-India Federation stating that they are unable to take a decision whetherto continue to subscribe to the insurance policy or not, pending clarifications on the issues raised by Federation. Considering this, we are making the following clarificationsfor the consideration of our members.

1. PRESENT RULES OF MEDICLAIM POLICY OF OTHER INSURANCE COMPANIES:

1. Present individual medi-claim policies, for the person in age group of 51-65 and age group of 66 and above, require individuals to undergo pre-acceptance medical tests such as Medical Examination Report, Treadmill Test, Complete Blood Count, Lipid Profile, HBA1C, Serum Creatinine, Urinalysis, SGOT, SGPT and GGT, before accepting them as policy holders.

2. All pre-existing diseases/illness/injury/conditions as defined in the Insurance Policy would be eligible for reimbursement of hospitalization only after 36/48 months of continuous coverage have elapsed from joining the Policy.
3. The CO PAY policy - ranging from 15% to 25% is required to be contributed by the insurer out of the amount of claim.
4. Certain diseases such as cardiac, kidney and bone related major surgeries the claim is restricted to Rs. 2.00 to Rs. 2.50 lacs irrespective of higher coverage.
5. The premium amount of private insurance companies for an insurance cover of Rs. 3.00 lacs ranges from Rs. 26,593.00 to Rs. 36,802/-p.a.
6. Other Nationalized Assurance companies such as National Insurance Co Ltd., New India Assurance Co. Ltd., Oriental Insurance Co. Ltd. and SBI General Insurance Co. Ltd., will not be allowed to quote the premium for Group Insurance scheme because these companies are the co-insurers of the UIIC under Group Insurance Scheme for retired employees of banks to extent of 2.5% to 15% coverage.

2. WHAT SHOULD BE THE APPROACH OF THE RETIRED EMPLOYEES TO THE EXISTING INSURANCE POLICY:

1. In view of the above mentioned negative features of individual medi-claim policies, Banks should not opt out of the IBA Scheme, which could be calamitous for retirees.
2. Non continuity will spell disaster, as re-entry into medi-claim policies of any other insurance company will be difficult for retirees at such advanced age and may also become ineffective as pre-existing diseases will not be covered.
3. Subscribing to alternative insurance policy of other insurance company is not practical as criteria of loading premium will be the same in all cases, depending upon claim ratio, vis-à-vis premium paid.
4. The coverage under the existing group insurance policy is beneficial because of 100% coverage without any sub-limit riders as in other policies, and beneficial despite the higher cost of premium.
5. NO CO-PAY stipulation in the existing group insurance policy.
6. All pre-existing illness/diseases are allowed for reimbursement of hospitalization.
7. Coverage from the date of policy without waiting period i.e. cooling period.
8. No medical tests/examination was conducted as in case of individual medi-claim policy.

3. STEPS INITIATED BY AIUBRF:

1. A delegation of the AIUBRF met the GM & other Personnel Officials in the HO&conveyed members’ apprehensions, &proposed some suggestions to the authorities.
2. AIUBRF has written a letter dated 10/10/2016 to CMD of the Bank placing on record the feelings of the members, and making suggestions for financial assistance for the retiree such as:

1. The bank has decided to recover the premium amount from 24/10/2016. Many of the retirees may not have maintained sufficient balance to meet the increased amount of premium on 24/10/2016; hence Federation requested the Bank to release the pension earlier coinciding the recovery of premium amount, so that most of the retirees can continue to get cover of the Insurance Policy.
2. The AIUBRF leadership is now informed that the Bank is agreeable to credit pension on 25/10/2016, & will continue to debit pension a/cs thereafter till the last date possible for retirees to be covered under the Ins Scheme.
3. The Bank has also agreed to extend the date to accept Options upto 24th October, 5 p.m. received at CO by email or passed on by branches or handed over by our retirees themselves or through leaders.
4. The Bank has agreed to seek clarifications of the points raised by AIUBRF from UIIC on the rules and procedure for reimbursement of domiciliary treatment for retired employees, and to communicate the same to the Federation.
5. AIUBRF has requested the Bank to consider subsidizing the premium amount from UBIREMAS for retirees, as has been done by several Banks.
6. AIUBRF has also asked the Bank to increase the diagnostic charges in REMAS, to meet the increased cost of the same by hospitals/Clinics.
7. AIUBRF has requested the Bank for specific exemption in the case of family pensioners, since only single life is covered.

3. Federation has also written a letter to TPA to clarify the procedure adopted by them for scrutiny and sanction of domiciliary treatment. Other clarifications on the increase of premium such as notice period, quantum of increase etc. have also been raised.

Replies & Information adduced from these letters will be circulated to all members as soon as they are given to us.

WHAT SHOULD BE THE DECISION OF THE RETIRED EMPLOYEE?

The retired employees should introspect on all the above aspects dispassionately and should take informed decisions to ensure medical cover for self and spouse for any unforeseen medical exigencies.

Any information on further improvements or mitigation of financial difficulties by the Bank will be conveyed to all immediately,

With Greetings,

Yours faithfully

 (R. K. Powar)

General Secretary

   I submit below the copy of letters issued by AIBEA in protest against abnormal rise in Insurance premium.  My comments are given at the foot of this letter.


ALL INDIA BANK EMPLOYEES' ASSOCIATION

Singapore Plaza, 164, Linghi Chetty Street, Chennai-600001

ALL INDIA BANK OFFICERS’ ASSOCIATION

AK Nayak Bhavan, 14, 2nd Line Beach, Chennai-600001

 

chv.aibea@gmail.com/ aiboa.hq@gmail.com   98400 89920 / 98406 45081

16.10.2016

THE CHAIRMAN                                  

INDIAN BANKS’ ASSOCIATION

MUMBAI

Sir

Reg: ABNORMAL INCREASE IN THE  MEDICLAIM INSURANCE PREMIUM BY UIIC – REVISTING THE ISSUE

Our attention has been drawn to the information to the member banks in the matter of payment of Insurance Premium by in-service employees/officers and elders for renewal of the Policy from the year 2016-17.   

We observe that the huge increase in premium by the UIIC Ltd. is unfair and not in conformity with the understandings with our Unions while the Scheme was formulated.

Even as per the Matrix given by them last year, the increase is unjustified and abnormal.  Further, it is learnt that the Contract between IBA/Banks and UIIC stipulates that any revision or change in the terms has to be intimated atleast 3 months in advance.  We also find that even though the Scheme was introduced in the Banks after discussion and signing of the Settlement/Joint Note with the Unions, IBA has not taken the unions into confidence while such major revision in premium has been accepted by the IBA.

In terms of the existing policy, the premium stipulated as well as the proposed enhancement are as under.

FOR SERVING AWARDSTAFF EMPLOYEES:

EXISTING PREMIUM FOR 2015-16	REVISED PREMIUM  FOR 2016-17	% OF INCREASE
Rs. 4,930 + 690                   = Rs. 5620	Rs. 10,462 + 1,568                     = Rs. 14,950	112 %

FOR SERVING OFFICERS:

EXISTING PREMIUM FOR 2015-16	REVISED PREMIUM  FOR 2016-17	% OF INCREASE
RS.6,573  + 920            = Rs. 7,513	Rs. 1,3935 + 2090                       = Rs. 16,025	112 %

FOR RETIRED EMPLOYEES / OFFICERS :

EXISTING PREMIUM FOR 2015-16	PROPOSED PREMIUM FOR 2016-17 ( WITHOUT DOMICILARY TREATMENT COVERAGE)	% OF INCREASE
AWARD STAFF-                Rs. 4930+ 690 = 5620	10,452 + 1,568 = 12,020	112 %
OFFICERS -                        Rs. 6573+920 = 7513	13,935 + 2,090 = 16,025	112 %

EXISTING PREMIUM FOR 2015-16	PROPOSED PREMIUM FOR 2016-17 ( WITH DOMICILARY TREATMENT COVERAGE)	% OF INCREASE
AWARD STAFF-                            Rs. 4930 + 690 Rs. 5620	13,000+ 1,950=14,950	165%
OFFICERS -                     Rs.  6573 +920 = 7513	17,400+ 2,610= 20,010	165%

Thus, it can be observed that the premium has been unilaterally enhanced by 112% for in service employees and by 112 % / 165 % for retirees without any reference to the IBA/ Banks/ Unions/ employees/ officers/ retirees.

The Policy/Agreement also provides for revision of premium based on a given matrix which provides as under:

Claim ratio  of: loading in premium

Claim ratio of	Loading in premium
111 – 115%	5%
116-120 %	7%
121-125 %	10%
126 – 130 %	13%
131 – 135 %	15%
136 – 140 %	18%

Now when the reported claim ratio is around 182% and around 200% for in service staff and retired staff respectively, the revision in premium also has to be in that proportion and cannot be disproportionately and unilaterally fixed by UIIC to the detriment of the Banks or the employees/officers/retirees.   But UIIC has increased the premium and doubled the rates as shown above and that too at short notice without any discussions.

You will appreciate that the elders’ group consist of Pre 1986 retirees, family pensioners, subordinate cadre employees, part time employees and retirees prior to  November 2002 for whom the quantum of pension is quite insufficient, when compared to the retirees after the settlements inked on 25.4.2010 and 25.5.2015.

Further, IBA vide its letter HR /2015-16/XBPS/J/1644 dated 27th November 2015 had taken up with UIIC authorities based on their direct communication (which they should not have) to member banks that the domiciliary treatment coverage is not applicable to elders and requested them to extend with the facility.  But UIIC Ltd. has chosen to violate our Agreement and denied this important benefit to the elders’ claims.

We would like to draw your pointed attention to the understanding arrived at between the 9 constituents and IBA on 25 5 2015 that the revised medical scheme would also be extended to the elders subject to the payment of the same premium by them.  The coverage for the serving employees has the domiciliary  treatment and also the Corporate Buffer for the over and above the limits specified (ie Rs. 4,00,000 & Rs. 3,00,000) and denial of the same by UIIC is not acceptable and IBA is also bound to honour the agreement with the unions in this regard.

Lacs of employees/officers and retirees and their family members are covered by the scheme and such unilateral and high-handed decisions of the UIIC have raised lot of apprehensions in the minds of the workforce and retirees.

Already employees/officers/retirees are facing many problems at the hands of TPAs, and the unilateral and unfair decisions of the UIIC have added fuel to fire.  We strongly feel that a public sector institution like UIIC cannot afford to behave in this manner.

There are breach of the contract committed by UIIC viz.,

1. Denial of domiciliary treatment reimbursement for elders
2. For change of terms and conditions three months’ notice period not adhered too.

It would be appropriate on the part of IBA to arrange for a tri-partite meeting with the Insurance Company authorities along with Unions and IBA at the earliest

Already elders are handicapped on account of non-resolution of demands like 100% DA for pre-Nov. 2002 retirees, improvement in Family Pension formula, periodical updation of pension, etc., and this heavy dose of increase in premium is creating lot of problems and there is possibility that many of them would be unable to renew the policy in the above circumstances .  Hence the steep increase in premium amount needs to be revised downwards.

We also feel that IBA should strongly pursue the matter with the IRDA about the manner in which the UIIC Ltd. Is handling the whole matter of revising the premium at their sweet will,

Awaiting the response from the IBA.

Yours faithfully,   

                                                  

                       S. NAGARAJAN                               C.H. VENKATACHALAM                                         

                  GENERAL SECRETARY                          GENERAL SECRETARY

                                AIBOA                                                   AIBEA

ALL INDIA BANK EMPLOYEES' ASSOCIATION

Singapore Plaza, 164, Linghi Chetty Street, Chennai-600001

ALL INDIA BANK OFFICERS’ ASSOCIATION

AK Nayak Bhavan, 14, 2nd Line Beach, Chennai-600001

 

chv.aibea@gmail.com/ aiboahq@gmail.com   98400 89920 / 98406 45081

16.10.2016

To

Consumer Affairs Department                    

Insurance Regulatory & Development Authority

3rd Floor, Parishram Bhavan

Basheer Bagh,

Hyderabad.

Sir

Reg: Insurance Linked Hospitalisation/Medical Expenses Reimbursement Scheme in Banks - Unilateral and abnormal increase in premium and non-adherence to clauses of contract by United India Insurance Company Ltd. (UIIC Ltd.) – Intervention of IRDA requested

All India Bank Employees Association and All India Bank Officers Association ( AIBEA and AIBOA ) are  Industry level negotiating Unions with Indian Banks’ Association (IBA) in the matter of service conditions more particularly periodical wage revision  and other related matter for the entire workforce of employees and officers.

We have entered into an understanding/settlement with IBA for introduction of Insurance linked Hospitalisation/Medical expenses Reimbursement  Scheme for the serving and retired employees/officers and the Settlement/Joint Note was signed on 25.5.2015.  By virtue of the same, IBA/all banks entered into an Agreement with M/s United India Insurance Co Ltd  for extending the benefits under Health Coverage Policy.

The premium for the period from 1.10.2015 to 30.9.2016 was fixed for the in-service employees/officers ( Officers Rs. 6,573 + Service Tax and Workmen Staff  Rs.4,930+ Service Tax). The same quantum of premium was also agreed to be made applicable to the retired officers and employees but the Policy was made effective from 1.11.2015 to 31.10.2106.

It was clearly stipulated that the retirees would also be reimbursed  expenses incurred for the domiciliary treatment as that of the serving employees.   On this basis, the retired employees and officers subscribed to this Policy and paid the premium amount also.  However, subsequent to issuing the Policy and unilaterally and suddenly, UIIC Ltd, had directly written to the member banks (which they should not have) that the company would not be in a position to reimburse the expenses of retirees for domiciliary treatment.  There are 2.05 lacs retirees from  35 banks who have subscribed for the scheme.  It was a bolt from the blue and totally an unfair action on the part of UIIC.

Further, it is learnt that there is also a contract clause in the agreement that 3 months’ notice period will be given for any change of terms & conditions including the quantum of premium amount.  Deviating from this condition in the Agreement, UIIC Ltd has failed to honour the terms of contract and has now unilaterally and abnormally increased the premium for the next year both for in-service employees/officers as well as for the retirees.

The unilateral change in the premium is as under:  

FOR SERVING AWARDSTAFF EMPLOYEES:

EXISTING PREMIUM FOR 2015-16	REVISED PREMIUM  FOR 2016-17	% OF INCREASE
Rs. 4,930 + 690                   = Rs. 5620	Rs. 10,462 + 1,568                     = Rs. 14,950	112 %

FOR SERVING OFFICERS:

EXISTING PREMIUM FOR 2015-16	REVISED PREMIUM  FOR 2016-17	% OF INCREASE
RS.6,573  + 920            = Rs. 7,513	Rs. 1,3935 + 2090                       = Rs. 16,025	112 %

FOR RETIRED EMPLOYEES / OFFICERS :

EXISTING PREMIUM FOR 2015-16	PROPOSED PREMIUM FOR 2016-17 ( WITHOUT DOMICILARY TREATMENT COVERAGE)	% OF INCREASE
AWARD STAFF-                Rs. 4930+ 690 = 5620	10,452 + 1,568 = 12,020	112 %
OFFICERS -                        Rs. 6573+920 = 7513	13,935 + 2,090 = 16,025	112 %

EXISTING PREMIUM FOR 2015-16	PROPOSED PREMIUM FOR 2016-17 ( WITH DOMICILARY TREATMENT COVERAGE)	% OF INCREASE
AWARD STAFF-                            Rs. 4930 + 690 Rs. 5620	13,000+ 1,950=14,950	165%
OFFICERS -                     Rs.  6573 +920 = 7513	17,400+ 2,610= 20,010	165%

Thus, it can be observed that the premium has been unilaterally enhanced by 112% for in service employees and by 112 % / 165 % for retirees without any reference to the IBA/ Banks/ Unions/ employees/ officers/ retirees.

The Policy/Agreement also provides for revision of premium based on a given matrix which provides as under:

Claim ratio  of: loading in premium

Claim ratio of	Loading in premium
111 – 115%	5%
116-120 %	7%
121-125 %	10%
126 – 130 %	13%
131 – 135 %	15%
136 – 140 %	18%

Now when the reported claim ratio is around 182% and around 200% for in service staff and retired staff respectively, the revision in premium also has to be in that proportion and cannot be disproportionately and unilaterally fixed by UIIC to the detriment of the Banks or the employees/officers/retirees.   But UIIC has increased the premium and doubled the rates as shown above and that too at short notice without any discussions.

Lacs of employees/officers and retirees and their family members are covered by the scheme and such unilateral and high-handed decisions of the UIIC have raised lot of apprehensions in the minds of the workforce and retirees.

Already employees/officers/retirees are facing many problems at the hands of TPAs, and the unilateral and unfair decisions of the UIIC have added fuel to fire.  We strongly feel that a public sector institution like UIIC cannot afford to behave in this manner.

We fervently appeal to you to intervene in the matter for breach of contract by UIIC Ltd  and also  advise them appropriately in the matter of the steep increase in the premium  amount stipulated w.e.f 1.10.2016/1.11.2016.

Yours faithfully,   

                                                  

                       S. NAGARAJAN                               C.H. VENKATACHALAM                                         

                  GENERAL SECRETARY                          GENERAL SECRETARY

                                AIBOA                                                   AIBEA

My Comments are as follows:

It is a matter of pleasure that at least AIBEA has taken initiative to oppose abnormal rise in premium . Decision taken by Insurance company is totally improper and unjustified.

I too strongly oppose the whimsical rise in premium demanded by insurance company and I expect consumer forum will realize the gravity of the matter and penalise or advise the company suitably.

It is really sad that IBA and banks as well as individual banks have thought it unnecessary to protest the rise or at least negotiate for reduction .

Danendra Jain