Date: 18 th November 2010

Transcription

1 The Chairman General Insurer Public Sector Association of India (GIPSA) Jeevan Vihar, 3 rd Floor (Rear Portion) Sansad Marg New Delhi Dear Sir, Date: 18 th November 2010 Reg: Health care -Group Mediclaim Insurance for Employees. Employees and Retired Ref: - our letters dt.23 rd Nov 09,5 th Feb 10, 1 st May 10,& 29 th July 10 to Gipsa & companies. We are glad and thankful to the management for successfully completing the phase of wage revision of all class of employees. We are sure now that the management can spare sometime out of their busy schedule to think over the issues of Retired Employees specifically covering their Health Care. With the hope we approach your kind self to please give considered and helpful thought on the following issues. We are also thankful to the management for providing unlimited Free Medical facility to their Directors and Ex-Directors which includes domiciliary treatment too.this covers eligible dependents also. We are also grateful to the management that all the companies have allowed the facility of cashless treatment to retired employees by providing the authority letter to the nursing home and nomination facility under the policy. Health care coverage and access of all class of employees and retired employees inclusive of General Manager to lowest rung is the welfare measure and should be viewed as other staff amenities and benefits to class I II III and IV account. It should not be taken as COST. We quote the Supreme Court Judgment in one of the case number (C) NO. 206 OF 1986 (A I R 95 Vol. 82 page-922) Para 27 We therefore hold that right to medical aid to protect the health and vigor of a worker while in service or post retirement is fundamental right under article-21 read with the article-39(c),41,43,48a and all the related articles and fundamental human rights to make the life of a workmen meaningful and purposeful with dignity of person. The National policy on older person 1999 recognizes the problem of health and associated problems of all senior citizens. 1

2 The VI pay commission of government of India too realized that with the advancement of the age particularly in higher group of age there is much necessity of healthcare and the same required more financial expenses towards medical cost. Pay commission recommended to cover the increased expenses upward payment of pension of 20% (over and above the regular pension) starting from the age of 80 years to 100% increase in pension on reaching the age of 100 years. The government of India graciously accepted the recommendations of pay commissions. Keeping in view of the above sentiments LIC Of India marched ahead to provide the 75% subsidy in the premium to the retired employees.the premium paid to the New India Company has been debited under the head Other staff amenities and benefit to class I II III AND IV account.the said account is used to make various payments towards employees benefits. We expect from our management to fall in line at least with development in the Nationalized Life Insurance Sector to achieve the goal of creating and sustaining good affordable health services for health care. We give below our submissions point wise for your sympathic consideration: 1. Health care of retirees at par with the serving employees Please refer our letters dated 23 rd November 09 and 29 th July 10 on the subject. As mentioned above the LIC in its board meeting held on had approved that corporation will bear ¾ of the premium of mediclaim uniformly for retired employees for the basic sum insured. Being social security and welfare measure we request for positive and sympathetic consideration for sharing of premium to retired employees of public sector general insurance companies to take their health care for life time and also after death for the bereaved family. The calculation of premium under group mediclaim policy as applicable in the companies to the class II III and IV employees to arrive out the final premium chargeable from the class II III and IV is to be extended to the retired employees also covering GENERAL MANAGER to downward.this system of sharing the premium is ¼ borne by the working employees and ¾ by the companies for the class II III IV and P.T. Employees. 2. High cost treatment for specific diseases ex-gratia payment. At present a sum upto Rs. 5, 00,000 is reimbursed to the working employees 2 times during the entire service period. Looking to the inflationary trend of the specialized treatment cost of the heart, cardiac, cancer, kidney, etc. the limit of Rs. 5 lakh is not appears to be sufficient to cover the expenses.we urge to raise the ex-gratia limits up to Rs. 10 lakhs and to remove the two times bars during service period. The same facilities should also be extended to the retired employees to cover the high cost treatment as they are in much need in the old age. 2

3 We have made the analyzed survey that not more than 1% has availed the facility and on an average not more than 2 lakhs has been reimbursed over and above the payment under group mediclaim policy. We feel if the limit is raised to 10 lakhs, no bar to avail the facility and lastly extended to the retired employees no extra burden will come on the companies and the cost will be within the existing budget. We understand the above is also under consideration of LIC. 3. To increase the eligible sum insured for employees and Retired Employees Please refer our letters dt: 23 rd November 09 & 1 st May 2010 in this regard.the present limit of eligible sum insured is Rs 70,000, Rs 1 lakh & Rs 1,55,00. It is being observed that there is very much high trend of inflation and specifically in food items.naturally it has impact on cost of medicine, life saving drugs, doctor fees, nursing home/hospitalization expenses & pathological test, etc. The cost of health care has gone up tremendously.with the present limit of the eligible sum insured it is almost impossible to get the treatment, what to talk of specialized treatment.even for the normal disease admission and treatment in the good nursing home ordinarily costs round about minimum of Rs. 3 lakhs even if life support devices are not used. We therefore request you to increase the eligible sum insured at least to Rs 3 lakhs in the current high inflationary scenario for the working employees and the Retired Employees. 4. Coverage of diagnostic tests without hospitalization (though covered under hospitalization) Please refer our letters dt: 23 rd November 09, 1 st May2010 &29 th July We had approached to extend the facility to all inclusive of all General Managers and downwards and to the Retired Employees. We again approach to your good self to give the positive consideration on the issue.the LIC has already extended the facility for the last so many years to their all class of Employees and Retired Employees. In earlier days when the technology was not so much advance the diagnostic tests required admission in the hospital and also there was no much references for test.nowadays doctors normally advice the diagnostic test of latest technology such as MRI, CT scan, Sonography,Ultrasound and Biopsy,etc. which does not require hospitalization of 24 hours in the nursing home. The test is of high value. The Employees and Retired Employees on the advice of the doctor get themselves admitted in the nursing home to carry the test for more than 24 hrs for coverage under hospitalization scheme. After examination tests show presence of ailment but not of serious nature which required stay generally in the hospital. We therefore suggest, on the lines of LIC, to allow the diagnostic test without hospitalization though covered under hospitalization scheme.we are of the considered view instead of increasing the cost it will decrease the cost as the hospitalization expenses will not be required.it may be treated at par with some treatment viz. cataract operation etc. where hospitalization of 24hrs is not needed. 3

4 5. Cashless service We are grateful to the companies that they have very kindly agreed to issue authority letter to nursing home giving under taking the payment will be made by the companies. The National Company offered one more facility in case the authority letter is not acceptable by the nursing home 50% cash of the estimate /sum insured will be advanced. In our country the rising cost of health care poses major challenge to the sustainability of out of pocket spending. Emergency medical treatment or major hospitalization often means financial ruin for families because the cost of such health care often far exceeds the average family s ability to pay or borrow. During our interaction with members we feel major portion of their total annual household is spent on health care. A large percentage of families with a hospitalized member fell into bankruptcy after that hospitalization.we have seen some of our members died as they were not having the sufficient fund to get the admission in the nursing home. To ward off such eventualities the companies have come forward to issue authority letters to retired employees but looking to the difficulties of acceptance of authority letters we suggest as under helping the employees and Retired employees. a. All the public sector general insurance companies have entered into agreement with hospitals/nursing home in regard to charges of operation/room charges/doctors fees etc. through out India named as PREFERRED PROVIDER CENTRE. The employees and Retired employees should be allowed to take the treatment from such preferred provider centers without making any payment from their pocket up to the limit of policy. b. The national insurance company pattern be allowed 50% cash advance to retired employees of Oriental, United India and New India in case the authority letter is not accepted by the nursing home. 6. To give one time option to allow coverage under Group mediclaim policy wef from Leaving microscopic number of persons who have opted out the scheme on account of increase in premium under group mediclaim policy the large number of retirees including widows could not get the coverage. They could not deposit the premium in March in earlier years on account of ignorance, not present at head quarters, residing in the village side etc. They need your sympathy and helpful positive approach to get the coverage under group mediclaim policy.we feel they are the genuine group of Retied Employees who needs the shelter of group mediclaim policy umbrella. Please allow such persons to enter into scheme with effect from

5 7. Domiciliary Treatment We are thankful to the management that cash medical benefit (per annum) ranging from Rs 4,000-12,000 has been provided to III IV II & I for domiciliary treatment.with the advancement of age the need is more for OPD treatment.it is just like sometime hospitalization.old persons are more likely to experience than other age group frailty, ailment and disability. Primary health care is helpful to avoid hospitalization.we feel a system may be evolved to pay cash medical benefit to retired persons.it will ensure to meet the health care needs of older retired persons. Ultimately it will reduce the cost of hospitalization expenses. Even in the banking sector the facility is available viz.rbi, SBI etc. In government it is too provided through CGHS, Railway etc. We therefore appeal to you to please provide the cash medical benefit to pensioners. 8. Ambulance Charges The present policy does not provide reimbursement of the charges for ambulance van while LIC is reimbursing such expenses. We request to make the provision minimum of Rs. 5000/- from the next renewal date. The All India Retired Insurance Employees Federation has also made similar request in regard to the above points. We are quite confident that our managements will provide help for health care of their senior citizen employees and our submissions will find favor with effect from the next renewal date of policy. We are requesting you to take up these issues in the Governing Body of GIPSA urgently. Thanks Yours Faithfully K. S. Samant General Secretary 5