HEALTH INSURANCE SCHEME OF IBA.

Transcription

1 ALL INDIA SYNDICATE BANK RETIREES FEDERATION (Affiliated to ALL INDIA BANK RETIREES FEDERATION) (Recognized by the Management as the representative body of retirees) No. 43, 2 nd Floor, 2 nd Main Road, Sheshadripuram, Bangalore contact@sbra.co.in Web : Cir.No.4/AISBRF/ /03/2016. Dear Comrades, HEALTH INSURANCE SCHEME OF IBA. We hope that by now, majority of the pensioners/family pensioners have opted for the health policy of IBA. However, if anybody has not opted so far, he/she may opt for it before 31/03/2016. Please note that all categories of retirees are eligible to be covered under the Health Policy, except those, who were dismissed from the service. PLEASE ENSURE THAT NO WILLING PERSON WILL MISS THIS LAST OPPORTUNITY. It may please be noted that the Bank has issued the following circulars in this regard. 33/2015/CYC dt.24/08/ /2015/CYC dt.10/09/ /2015/CYC dt.01/10/ /2015/CYC dt.30/11/ /2016/CVC dt.01/01/ /2016/CYC dt.03/02/ /2015/BC dt (Regarding claim procedures along with the related annexures) The captioned circulars are available in Bank s site, ( under the menu, Announcements and sub-menu, For Syndicate Ex-staff only. You may visit our site viz. for important circulars and also the Group Medical Insurance Policy, issued in the name of the Bank. Please note that no individual policy is issued by the insurer, viz. The United India Insurance Co. Based on Annexure-II submitted by you, the HO: SWD has already furnished the particulars to the Ins. Co./the TPA, viz. Vidal Health and those, who had given their mail id might have received the soft copy of the Health Card, in the name of the optee and his/her spouse, directly from the TPA. Others may be guided by the procedure already communicated vide our Cir.No.03/ For the benefit of our members, we give here below, the procedure involved for claims under CASHLESS FACILITY / REIMBURSEMENT FACILITY: 1. CASHLESS PROCESS AT NETWORK HOSPITAL: Cashless facility can be availed at the Vidal health TPA network hospitals. (Pl. visit Vidal Health website viz. for the list of network hospitals)

2 The procedure mentioned below needs to be followed while availing Cashless facility at such hospitals. Show TPA ID card along with valid Photo identity card and collect Pre-Authorization form from the hospital. Insurance coordinator in the Network hospital will give assistance during hospitalization. Fill up personal details and the rest to be filled up by the hospital treating doctor along with contact number. Hospital will send the fax/ to TPA. The TPA shall process the claim as per policy terms and conditions and send anapproval letter to the hospital. Get admitted, take treatment and get discharged without payment of bill exceptfor non-payable items. Please ensure claim form is filled and duly signed and final bill is signed, before discharge. An SMS will be sent to the insured by TPA. Payment will be made to the Hospital/Nursing Home directly by TPA 2. REIMBURSEMENT (WHERE CASHLESS FACILITY IS NOT AVAILED/ TREATMENT IS AVAILED IN A NON-NETWORK HOSPITAL). Reimbursement of the hospitalization expenses can be claimed where Cashless Hospitalization facility is not availed or treatment is availed in a Non-network Hospital. The Insured have to settle the hospital bill, collect all original hospitalization documents and submit the documents totpa for scrutinizing the same in terms of the policy and check the admissibility or otherwise of the claim/ expenses. I. Reimbursement claims may be filed in the following circumstances: a) Hospitalization at a non-network hospital b) Post-hospitalization and pre-hospitalization expenses c) Denial of pre-authorization on application for cashless facility at a network hospital II. Claim Intimation : To be given (Telephonically/ /fax/online intimation) prior to the hospitalization or in case of emergencies immediately upon hospitalization but prior todischarge. (iii).the documents to be submitted for a hospitalization reimbursement claim are: a) Original hospital final bill b) Pre-Numbered / Printed Receipts for payments made to the hospital c) Complete break-up of the hospital bill d) Original Detailed Discharge Summary e) All Investigation reports f) All medicine bills with relevant prescriptions g) Operation Theatre Notes in the event of a surgery performed

3 h) Sticker for the Implant, if any, used during surgery i) A copy of the Invoice for the implant, if any, used during surgery performed. j) Original duly completed and signed claim form A. k) Duly completed and signed Medical Practitioner s Form B. l) ECS form for National Electronic Fund Transfer (NEFT) m) Copy of TPA ID card and Photo ID card n) Documents for National Electronic Fund Transfer (NEFT) (iv). The documents to be submitted for post-hospitalization/pre-hospitalization claim: a. Copy of the discharge summary of the corresponding hospitalization b. All relevant doctors prescriptions for investigations and medication c. All bills for investigations done with the respective reports d. All bills for medicines supported by relevant prescriptions (v). Submission of claim documents: All claim documents should be submitted within 30 days from the date of discharge to: Dr. Shankar / Jayanth, Vidal Health, TPA Pvt., Ltd.,Tower 2, 1st Floor, SJRI Part, Plot No.13, 14, 15 EPIP Area, Whitefield, Bengaluru, Ph (Extn.386)/ , - Jayanth.c@vidalhealthtpa.com Toll free No Vidal Health help desk is set up at H.O.Manipal and manned by 1. Ms.Kavyashree (Mob.No ) 2. Mr. Kishore (Mob.No ). Clarifications : 1. What are Pre-Hospitalization & Post-Hospitalization Expenses? When one falls sick, one usually consults a family physician and gets relevant investigations done. On the advice of the physician, one gets hospitalized for further management of the disease if required. Such medical expenses incurred before hospitalization are called Pre-Hospitalization expenses.during hospitalization, a major part of the treatment is completed, but some part of the treatment extends beyond the hospitalization. It may involve follow-up visits to the doctor, medicines to be taken or further investigations to be done. Such medical expenses are called Post- Hospitalization expenses. There is provision to claim these expenses through your health insurance policy. These expenses are payable for a policy-defined period. Both pre-hospitalization and post hospitalization expenses can be claimed only after the settlement of the main hospitalization claim. The claim submission process for prehospitalization expenses and post hospitalization expenses is the same as Reimbursement.

4 2. Non-Medical Expenses Your health insurance policy pays for reasonable and necessary medical expenditure. There are several items billed during hospitalization by some hospitals but notadmissible under an insurance contract. These items will not be payable and expenditure towards such items will have to be borne by you. For Example: Gloves, documentation charges, cost of spectacle, etc. However, registration /admission charges are admissible. 3. Period of Hospitalization: A minimum of 24 hours admission to the hospital is necessary for admission of a claim. Insurers define a hospital as a centre with more than 15 inpatient beds, with a fully equipped operation theatre, fully qualified nurses and fully qualified medical practitioners available round the clock. 4. Systems of Medicine covered by Health Insurance: The systems of Allopathy, Ayurveda, Homeopathy and Unani are covered. 5. Sum Insured: The sum insured will be the maximum payable amount. 6. Domiciliary Treatment You may be aware that expenses incurred for domiciliary treatment (which do not involve hospitalization) is not admissible generally. However, there are some exceptions like expenses incurred for dialysis/chemotherapy, which are re-imbursed. Dental treatment in general is not eligible: but, dental treatment, necessitated by an accidental injury is admissible. AIBRF CENTRAL COMMITTEE MEMBERS OF AISBRF We are pleased to inform that the following office bearers of our organization have been nominated to Central Committee of AIBRF, constituted in the recently concluded 4 th Triennial National conference held at Thrissur. You may also be aware that Com. N T Hegde our beloved president is already elected as an Organizing Secretary of AIBRF in the same conference. Sl.No Name Position held in our organization 1 Com. K Umesh Nayak Vice President 2 Com. K Y Nagaiah Vice President 3 Com. P Raghavendra Rao Vice President 4 Com. U Abdul Jaleel General Secretary 5 Com. M S Bhat Dy.General Secretary 6 Com. T S Anjaneya Sastry Dy.General Secretary 7 Com. R Ganapathi Dy.General Secretary 8 Com. Gopala Krishnan Nair General Secretary-SBRA,Kerala affiliate Unit 9 Com. S A Yadnopavit General Secretary-SBRA,Pune affiliate Unit INAUGURATION OF A.P. STATE COMMITTEE FOUNDATION CONFERENCE.

5 Consequent upon the bifurcation of the erstwhile Andhra Pradesh into Telangana and A.P. a new committee exclusively for A.P. became a necessity and accordingly, a new State Committee was set up at Vijayawada on 07/02/2016, in a beautifully organised function. The event was attended by a large gathering of more than 150 members. The conference was inaugurated by our President Com. N T Hegde who, also presided over the event. Sri. Chandrashekar, Dy. Gen. Manager of Vijayawada Region, was the Chief Guest of the Conference. Sri. S H V Ramaraju, AGM of Vijayawada Region was the Guest of Honour of the conference. Following were elected as Office Bearers of the newly formed State Committee. Sl. No Name Position 1. Com. A V V Sathyanarayana Chairman 2. Com. N V Rao Vice Chairman 3. Com. A K Murthy Vice Chairman 4. Com. S V B Rama Sarma State Secretary 5. Com. K V S S N S Sarma Asst.State Secretary 6. Com.K V Krishna Reddy Asst.State Secretary 7. Com. N Devadas Asst.State Secretary 8. Com. P L Kantha Rao State Treasurer Besides the election of the above office bearers 11 State Committee members were also elected. The members of the newly formed state committee deserve all the kudos for the nice arrangements made for the conference. We wish them all success in their endeavour to reach greater heights. MASSIVE SHOW OF SOLIDARITY. In response to the call given by AIBRF (Karnataka), a demonstration was held in front of Gandhi Statue, Race course road, Bangalore, on 19/02/2016, which was attended by nearly 1000 retirees, drawn from various banks. This was a part of the action programme, chalked out by our Apex Body, for resolution of various long pending demands of the retirees. The gathering was addressed by Shri. S C Jain, General Secretary, AIBRF. The event preceded the inaugural ceremony of the 4 th National Conference of Vijaya Bank Retirees Association. We thank all our members, who responded to the call of the organisation. PARLIAMENTARYCOMMITTEE HEADED BY DR.NACHIAPPAN. The Parliamentary Committee on Personnel, Public Grievances, Law and Justice was met at Delhi on 8/02/2016, to discuss the pending issues of bank retirees, based on the charter of demands and the memorandum submitted by AIBRF/IOB Retirees Association. AIBRF and IOB Retirees Association were represented by Dr. B. Ramji and Shri. Chandramouli respectively. The IBA was represented by its Chairman and CEO. Officers from the Dept. Of Financial Services also participated. Taking a sympathetic view of the issues of the retirees, the committee directed IBA/DFS to discuss the pending issues of the retirees within 2 months. W.P. filed by Resignees in the High Court Of Karnataka.

6 The High Court took up the hearing of the W.P.No /2014 filed by the resignees, seeking pension option on 04/03/2016. The arguments were held for 2 hours and it was adjourned for further hearing to 18/03/2016. Unauthenticated views/rumours in social media For some times now, many rumours/unwarranted information on retirees issues are being spread by some over-enthusiastic individuals in the social media, which create confusion among the retirees. We advise the members, not to be guided by such unauthentic information. With warm greetings, Comradely Yours, ALL INDIA SYNDICATE BANK RETIREES FEDERATION ALL INDIA BANK RETIREES FEDERATION BANK RETIREES UNITY ZINDABAD ZINDABAD ZINDABAD RESTORATION OF COMMUTED PORTION OF PENSION IS AUTOMATIC. There are many queries about the restoration of commuted portion of pension, on the expiry of 15 years from the date of release of commuted value of pension (CVP). Please note that these dates are fed into the computer and the restoration of the commuted portion takes place exactly on the due date, without any reminder /representation from your end. As such, you may wait till the date of release of pension for the month following the due date. The date of restoration of the commuted portion of pension is mentioned in your PPO.