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Medical Facilities to Staff


As per the 10th Bipartite Settlement/Joint Note dated 25.05.2015 signed between Unions/Associations of employees/officers and IBA on behalf of Bank’s Management, a new Medical Insurance Scheme for officers and award staff has been implemented with effect from 01.10.2015 for reimbursement of medical expenses in place of the hospitalization scheme. In case of retired staff, the scheme is effective from 01.11.2015 subject to payment of stipulated premium by them. For full content of Scheme Please Click Here for Joint Notes (Annexure IV- Medical Insurance Scheme) indicating the detailed guidelines in this regard

In all Banks the Insurer for the scheme is M/s National Insurance Company Limited (NICL). Below are the downloadable PDF link of Bank of Baroda insurance policies (2019-20) for retirees and serving staff:

The content of insurance policy of the member banks are same as per IBA direction and therefore above policies may be used by all the banks staff for reference



Third Part Administrator (TPA):

TPA is an intermediary company between an insured and insurer. It provides a supporting role to the insurer in terms of claim settlement. This body obtains a license from IRDA in order to function in the insurance industry.

Third Party Administrator (TPA) allotted to reach bank is different. Further the TPAs are subject to change on every renewal of Medical Insurance Policy. Some of the popular TPAs are:




Definition of Family

The Scheme covers Employee + Spouse + Dependent Children + any two of the dependent Parents /Parents-in-law.

  • No age limit for dependent children (including step children and legally adopted children).
  • A child would be considered dependent if his/her monthly income does not exceed ₹18,000/- per month;
  • Widowed Daughter and dependent divorced / separated daughters, sisters including unmarried / divorced / abandoned or separated from husband/ widowed sisters and Crippled Child shall be considered as dependent for the purpose of this policy.
  • Physically challenged Brother / Sister with 40% or more disability shall also be covered as Dependent.
  • No Age Limits for Dependent Parents. Any two, i.e. either dependent parents or parents-in-law will be covered as dependent.
  • Parents  would  be  considered  dependent  if  their  monthly  income  does  not  exceed ₹18,000/- per month or as revised by Indian Bank's Association in due course, and wholly dependent on the employee as defined in this scheme.




Sum Insured


Hospitalization and Domiciliary Treatment coverage as defined in the scheme per year

Cadre

Sum Assured

Officer

₹400000

Award Staff

₹300000





Policy Period


Status

Duration

Serving Staff

1st November to 31st October

Ex-Staff/Retired Staff

1st November to 31st October




Network Hospital

As already mentioned above, different bank has been allotted different Third Party Administrator (TPA). These TPAs has tieup arrangement with hospitals in every part of the country. All these Network hospitals provide Cashless treatment to the policy holder through TPA. For sample List of Network Hospitals of Raksha Health Insurance TPA Pvt. Ltd. (Raksha TPA) Click Here 




Other Bullet Point

  1. All New Officers / employees to be covered from the date of joining as per their appointment letter. For additions /deletions during policy period, premium to be charged /refunded on pro-rata basis.
  2. Continuity benefits coverage to officers / employees on retirement and also to the Retired Officers /employees, who may be inducted in the Scheme.
  3. Room and Boarding expenses as provided by the Hospital/Nursing Home not exceeding Rs. 5000 per day or the actual amount whichever is less. Intensive Care Unit (ICU) expenses not exceeding Rs. 7500 per day or actual amount whichever is less.
  4. Pre and Post Hospitalization expenses payable in respect of each hospitalization shall be the actual expenses incurred subject to 30 days prior to hospitalization and 90 days after discharge.
  5. The hospitalization expenses in respect of the new born child can be covered within the Mother’s Maternity expenses. The maximum benefit allowable under this clause will be up to Rs. 50000/- for Normal Delivery and Rs. 75,000/- for Caesarean Section.
  6. Baby Day one Cover: New born baby is covered from day one. All expenses incurred on the new born baby during maternity will be covered in addition to the maternity limit up to Rs, 20000/-. However if the baby contacts any illness the same shall be considered in the Sum Insured + Corporate buffer. Baby to be taken as an additional member within the normal family floater.
  7. Ambulance Charges: Ambulance charges are payable up to Rs 2500/- per trip to hospital and / or transfer to another hospital or transfer from hospital to home if medically advised. Taxi and Auto expenses in actual maximum up to Rs750/- per trip. Ambulance charges actually incurred on transfer from one center to another center due to Non availability of medical services/ medical complication shall be payable in full.
  8. Pre- Existing Diseases / Ailments: Pre-existing diseases are covered under the scheme.
  9. The scheme covers hospitalization as well as domiciliary treatment.
  10. The scheme provide cashless treatment in Network hospital of allotted TPA.


References: IBA website, Joint Notes 2015, Bank of Baroda website

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