HEALTH & WELLNESS POLICY

Transcription

1 HEALTH & WELLNESS POLICY Wellbeing of employees is one of the key imperatives of the organization. Tata Power is committed to extend all possible help to its officers in leading a healthy life and provide all enablement in times of medical need. The aims and object of this policy encompasses physical, emotional and spiritual aspects of health and wellbeing. The scope of policy also covers certain provisions and benefits for dependents and family members. This policy details the health and wellness benefits that are extended to officers while in India. This policy is applicable to all officers in the Management stream and on the permanent rolls of Tata Power and select group companies - CGPL, MPL, IEL, TPTCL, TPREL, TPSSL, CTTL, PTL and any other company which may be incorporated in future with applicability of Tata Power HR policies - hereinafter referred to as 'Company' / 'Organization' in this policy. This policy is effective from 1 April 2017 and supersedes all prior policies and communication on this matter. Any exception to this policy requires the approval of CEO & MD. Version 1.0 Date of Issue: January 2017 Released by: Chief - HR

2 1. Summary of health and wellness benefits applicable to officers Sl Type of benefit Details Applicable to Mediclaim scheme for hospitalization Policy coverage: Officers, except those at Jojobera, are eligible for a family floater policy coverage, as per the table below: Work Level / Grade Sum Insured (` per annum) MA, MB,MC 10,00,000 MD 7,00,000 ME01, ME02 5,00,000 ME03, ME04 4,00,000 Officers at Jojobera are covered under Tata Main Hospital, Tata Motors Hospital and Tinplate Hospital at Jamshedpur. They also have the option to avail a mediclaim cover of ` 2,50,000 for which 50% of the premium will be paid by the Company and 50% paid by the officer. Officer & family members covered under the scheme. Details in Mediclaim Top- Up Cover Officers can opt for top up of their Mediclaim cover (sum insured) as decided on a yearly basis. According to the officer's choice & the work level, the premium amount shall be paid by the officer through deduction in salary. The premium amount will be announced annually. Officer & family members covered under the Mediclaim scheme 3 4 Medical Scheme Fund Medical Advance in case of hospitalization In case an officer or his family members incur hospitalization expenses in excess of the sum insured under the Mediclaim scheme for hospitalization, the excess amount can be claimed under the Medical Fund Scheme, as per extant rules of the scheme. However, 10% of the total expenses incurred (including that covered by the Mediclaim scheme for hospitalization) should be borne by the officer. Medical Fund Scheme is applicable only in one of the following three cases: a. Sum insured exhausted- as explained above b. Single Diagnostic Test of ` 2,000 & above c. Claims not admissible under Mediclaim, approved by Chief Medical Officer ('CMO'), Tata Power Medical advance in case of hospitalization under specified conditions and limits may be availed, subject to approval. This advance shall be recovered as follows: a. Adjustment against Mediclaim amount received from insurance company b. Adjustment against amount released through Medical Fund Scheme c. The balance amount shall be recovered in 6 or 12 or 24 equal monthly installments as defined in 2.4 [c] 5 OPD facilities The OPD facilities provided are detailed in Clause 2.5 Officer & family members, covered under the Mediclaim scheme except parents-in-law Officer & family members covered under the Mediclaim scheme Officer, spouse, dependent children (Parents subject to location specific guidelines) in a sustainable way 2

3 6 7 Disbursement of medicines for chronic illness Executive Health Checkup ('EHC') Medicines for chronic diseases may be availed from the Medical Centre, Carnac on approval of CMO, Tata Power. a. Statutory EHC b. Wellness EHC Officer, spouse, dependent children & dependent parents Officer *The word 'Dependent' in this policy refers to children, parents, parents-in-law of the officer (as per age and number prescribed in the policy) not gainfully employed or engaged into (a)vocation for remuneration or not covered under CGHS or any other employer's medical / mediclaim schemes) Declaration to this effect may be required from the officer. 2. Details of health and wellness benefits applicable to officers 2.1 Mediclaim scheme: a. Coverage and premium Members Covered Officer, Spouse and 2 dependent children (less than 22 years of age) (i) 3 rd, 4 th child (less than 22 years of age) (ii) Either set of dependent parents or parents-in-law Children who are 22 years of age or above but below 25 years of age, provided they are dependent and are unmarried Officers' children with special needs (as approved by CMO) who are 25 years of age or above and are dependent Handicapped / disabled siblings (brother/sister) provided they fulfill all the below criteria: (i) They are dependent (ii) They are not married (iii) Appropriate certificate of being handicapped/disabled is produced Siblings (brother/sister) of unmarried officers provided they are dependent on the officer and both parents are deceased Premium 100% borne by the Company 50% borne by the Company For 1 st & 2 nd child - 100% borne by the Company / 3 rd & 4 th child - 50% borne by the Company 100% borne by the officer 100% borne by the officer 100% borne by the officer b. All claims should be made within 60 days from the date of discharge from the hospital failing which claim may be disallowed. c. Pre-hospitalization medical expenses incurred up to 30 days prior to hospitalization on disease / illness / injury sustained and post - hospitalization medical expenses incurred up to 60 days from the date of discharge will also be treated as part of the claim, within prevailing guidelines of the insurance provider. d. This policy covers medical treatment availed only in India. While on business travel overseas, officers need to ensure that they are covered under Foreign Travel Insurance provisions for the duration. in a sustainable way 3

4 e. Officers based in Jamshedpur availing facilities of the empanelled hospitals may opt for Mediclaim cover of ` 2,50,000 for which 50% of the premium will be paid by the Company and 50% paid by the officer. f. Enrollment: New joiners need to enter details of dependents to be covered under the mediclaim scheme, in the online system. During the course of the year, dependent details can be modified / updated through the online system. Officers in Jojobera to use the system for enrollment in the Mediclaim scheme. g. Procedure: Officers can claim Mediclaim through two methods: 1. Cashless: Officers need to print the TPA (Third Party Administrator) e-card from the online mediclaim portal and present it to the hospital cashless counter for cashless request to the TPA. A cashless facility form will be given by the hospital which needs to be filled and submitted to the hospital cashless counter. At the time of discharge, final bill and discharge card will be sent to the insurance company to release payment to the hospital. 2. Reimbursement: Officers who do not avail cashless facility can claim hospitalization expenses by submitting the original documents (including hospital bills, discharge card, cash memos, medicine bills, investigation reports etc.) from the hospital along with a duly filled Mediclaim form (available on the online portal) to the Corporate Insurance Department in Mumbai. h. Option of continuation of scheme after retirement: The coverage under the Mediclaim scheme of an officer who superannuates or retires on Voluntary Retirement on Medical Grounds (VRMG) will continue till the end of the financial year in which he/she retires and the premium for this period will be borne by the Company. Retired officers and their dependents have the option to continue with the Mediclaim scheme by paying the yearly premium at the beginning of each financial year. Exercise of this option has to be made before last working day in prescribed format. Officers once discontinued from the scheme will not be able to join the scheme. 2.2 Mediclaim Top- up cover a. Top-up cover is applicable after the sum insured in the Mediclaim policy is exhausted. b. All conditions in the Mediclaim policy claim shall be applicable to the top up policy claim. c. The top-up cover is purely voluntary and shall be available to the officers after payment of the additional premium. This scheme is extended by the insurance company on their discretion. The insurance company may withdraw or extend the scheme and Company shall only facilitate the issuance of the policy. d. Every year, details of the top-up coverage including applicable premium for that year will be communicated to officers and option may be exercised. 2.3 Medical Fund Scheme a. This is a contributory scheme to provide aid in medical treatment to officer and covered nominees under specified conditions. Apart from officers, the Company also contributes in a sustainable way 4

5 to the fund. Deduction is made in salary on a quarterly basis. Officers are required to contribute to the scheme until separation. b. Family members not covered under the Mediclaim Scheme will not be eligible for aid from the Medical Fund Scheme. Parents-in-law, even if covered in the Mediclaim scheme are not eligible for coverage under the Medical Fund Scheme. c. Procedure: To avail benefit under this scheme, the officer has to submit an application on the online system and submit a print of the application form along with original documents to the nominated official of the scheme. Upon verification and as per extant rules of the scheme, the committee will sanction the eligible amount for payment. 2.4 Monetary Advance in case of hospitalization a. Procedure: To avail this facility, officers need to fill up the application form in Annexure 1 along with an estimate for the treatment, from doctor / surgeon and submit it to concerned Business HR for verification and onward transmission to Corporate Insurance Department. Corporate Insurance will verify the eligibility and send the request to CMO. CMO will examine all relevant details of the request and recommend (or otherwise) sanction of advance to the approving authority. Advance amount will be released subsequent to approval. b. Within 60 days from the date of discharge from the hospital, the officer needs to submit the application for Mediclaim. The claim amount received will be adjusted against the advance disbursed. In case the hospitalization expenses are in excess of the eligibility under Mediclaim scheme, differential amount will be recovered from the officer's salary in maximum 6 or 12 or 24 equal monthly installments. In case there is an admissibility under Medical Fund Scheme, the same may be applied for separately which will be processed as per provisions of the scheme. In case the expenses incurred are less than the advance taken, the balance needs to be returned within 2 weeks of discharge from the hospital. c. Officers can avail a maximum advance of 6 months of monthly basic salary or up to base mediclaim coverage / sum insured (excluding any top-up coverage availed by officer), whichever is higher. The concerned officer, processing officials and approving authority will exercise due discretion in deciding the amount of advance as per need and nature of the ailment and treatment. Recovery of monetary advance will be as follows: Amount to be recovered Number of months Less than 4 times of Basic Salary 6 4 times - 6 times of Basic Salary 12 More than 6 times of Basic Salary (where sum 24 insured is higher than 6 times of basic salary) In case an officer does not submit the mediclaim application within 90 days of availing the monetary advance or within 60 days of discharge from the hospital, whichever is earlier, the recovery of the monetary advance will start from the officer's next payable monthly salary as per provisions in Clause 2.4 [c]. in a sustainable way 5

6 2.5 OPD (Outdoor Patient department) facilities: OPD facilities are extended to officers, spouse and dependent children / parents through one or more of the following means depending on the location/division of posting: a. Company Medical Centre b. Tie up with nearby hospitals / clinics in specific locations c. Pre-defined reimbursable limits for consultation and investigation charges While OPD is extended to officers and their family members exclusively in Company facilities at the locations having company medical establishments, in other places tie-up with reputed clinics/hospitals is made from time to time and limits for reimbursement of consultation charges are prescribed / approved (by CMO and CHRO) based on local conditions, distance and availability of medical facilities. These provisions will be standardized within the limitations of diversity of operating locations. Reimbursement of cost of OPD treatment (or availing of company paid tie- up of OPD treatment) is permissible only in case of spouse, dependent children/parents are staying with the officer in the place of posting. The OPD facilities cover only acute curative treatment and not chronic treatment. It excludes the following treatment: a. Vaccinations, Vitamins and Tonics b. Non-allopathic treatment c. Pregnancy related treatment d. Dental treatment e. Spectacles & Contact Lenses f. Physiotherapy not related to operation 2.6 Disbursement of medicines for chronic illness a. Illnesses covered: In order to support officers and their families who are affected by chronic illnesses, the Company dispenses generic medicines (within available budget) for the following illnesses, as applicable. The list of illness is reviewed periodically and suitable amends by way of additions/ deletion of ailments is made. Sl Illness Covered Applicability 1 Hypertension Officers, currently in 2 Diabetes (Tablets) service of the Company 3 Ischemic Heart Disease 4 Cancer Chemotherapy not admissible under Officers, currently Mediclaim service of the Company in 5 Immuno- modulating medicines for transplants, etc. 6 Insulin for Diabetes Spouse, dependent 7 Dyslipidemia children and dependent 8 TB & Leprosy parents of officers 9 Ulcerative Colitis currently in service of the 10 Epilepsy & Parkinsonism Company b. The generic medicines for the above mentioned chronic illnesses are available at Medical Centre, Carnac and the same can be obtained based on need. c. Medicine bills are not reimbursed under the scheme. in a sustainable way 6

7 d. Procedure: To avail this facility, officers need to fill the application form in Annexure 2 and send it to the CMO along with the copy of the prescription signed by a certified doctor/divisional Medical Officer. Once verified, suitable action will be taken by Medical Centre, Carnac. 2.7 Executive Health Checkup (EHC) a. Statutory EHC: Frequency of Statutory EHC will be in line with legal statutes specific to the location / state, as applicable. b. Wellness EHC: An officer working in non-statutory area can avail the facility of EHC, as per the table below: Age / Work Level Frequency Less than 40 years Once in three years years Once in two years More than 50 years As per CMO's advice Every year 3. Roles and Responsibilities Roles Responsibilities (i) Enter details of dependents they want to cover under the medical scheme, in the online Mediclaim system (ii) Submit Mediclaim request within 60 days of date of discharge from hospital (iii) Return unused monetary advance within 2 weeks of discharge from Officers hospital (iv) Submit application along with original supporting documents for Medical Fund Scheme, if required (v) Submit application along with medical prescription for availing Medicines for Chronic Illness (i) Facilitate the Mediclaim process through the TPA (ii) Facilitate the Mediclaim top up cover every year Corporate (iii) Follow up on the Mediclaim application to be submitted by officers who Insurance avail monetary advance Team (iv) Inform Payroll on amount of monetary advance to be recovered from any officer (i) Verify details of the officer who applies for the Medical Fund Scheme SBU HR and forward it to the Corporate Insurance Department Accounts Team Shared Services Payroll Team Chief Medical Officer Chief - HR (ii) Release monetary advance amount upon approval (iii) Every week, send the list of officers who have availed monetary advance, to the Insurance and Payroll Team (i) Deduction of Mediclaim top - up premium for eligible officers (ii) Recover medical advance amount from the officer's salary in equal installments (i) Review all documents and recommend/reject application for Medical Fund Scheme (ii) Review all documents and recommend/reject monetary advance (iii) Final approval for dispensing of medicines for chronic illness Overall process and policy ownership in a sustainable way 7

8 Annexure 1 REQUISITION FOR MEDICAL ADVANCE Division Date 1. Name Employee No. 2. Designation Grade 3. Please sanction medical advance, as per details below : a) Amount: `. (In words) b) Name of the patient : c) Relationship : Self/ spouse/ dependent children/ dependent parents d) Details of the sickness/ hospitalization : i) Suffering from ii) Name of hospital where patient is undergoing treatment iii) Date of hospitalization/estimated duration of stay iv) Name of the attending doctor v) Estimate from the doctor/ surgeon - Enclose the estimate 1) Kindly adjust the amount against the Mediclaim amount received from the insurance company/amount released through Medical Fund Scheme and the balance, if any may be recovered from my salary as per Company policy. 2) The amount of advance, if unutilized, will be returned to the Company immediately. Name & Signature of SBU HR Head: (Signature of the applicant) (To be filled in by Office) Details of advance, if any, availed earlier: Amount: `. Balance, if any: Reasons for availing the advance (state type of illness/ hospitalization/ surgery, etc.) Recommendations of Divisional Head: Name, Designation & Signature: Name of Chief Medical Officer Signature Verified the documents/estimate: Recommended amount of advance: *` (in figures & words) Recommendation: MA = ` 2,50,000; WL MB = ` 1,00,000 Name: Designation Signature Approval limits: CHRO: Upto ` 2,50,000 CEO & MD / COO & ED: More than ` 2,50,000 In case the employee's spouse/ dependent children make the request application, the SBU HR should verify before disbursement of the advance amount. Cc: Head - Medical/ Insurance Dept. / Shared Services Payroll Team

9 Annexure 2 APPLICATION FORM FOR MEDICINES FOR CHRONIC ILLNESSES 1. Name of Employee: 2. Employee No: 3. Division/Department: Photograph of patient 4. Name of Patient: 5. Details of patient A) Relationship: B) Age: C) Illness: 6. Date from which Patient is being treated: 7. Medical history of the patient : (To be filled in by the Divisional Medical Officer) I hereby certify that the details given above are correct and should any discrepancies arise in the factual statements, the companies may at their sole discretion withdraw any facility and also recover from my salary the amount incurred of the said medicines. At the same time I shall be liable for punishment as deemed fit by the companies including termination. Date: Signature of Employee: Signature of Divisional Medical Officer Signature of Divisional/ Department Head Endorsement of Chief Medical Officer