Banking News

Medical Reimbursement scheme for Bank Officers/Employees under 10th BPS


The new medical reimbursement scheme scheme covers all the existing employees/officers in the bank service and same would also be continued beyond their retirement/superannuation/ resignation etc., subject to payment of stipulated premium by them. New recruits will be covered from their  date of joining to the bank.  The scheme also includes the benefit of cashless treatment facility in hospitals covered by the scheme. The officers / employees need not be required to share the cost of such benefits under the new scheme.

The new Scheme would also cover the officers/employees retiring from the banks after the scheme is introduced as well the existing retired officers/employees of the Banks and dependent spouse subject to payment of stipulated premium by them.  The quantum of coverage for ex-officers is Rs. 4 lakh and ex-award staff is Rs.3 lakh. The quantum of contribution towards premium payable by the retired/designed staff will be decided by the individual banks. Till the new scheme is made effective and gets implemented, the existing provisions as per Bipartite Settlement dated 27.4.2010 will continue to operate.

Salient features of the Scheme

  1.  The Scheme covers Employee + Spouse + Dependents + any two of the dependent Parents /Parents-in-law.
  2. Hospitalization / domiciliary hospitalization and domiciliary treatment expenses will be reimbursed.
  3. No age limit for dependent children (including step children and legally adopted children.
  4. A child/parents/parents in law would be considered dependent if monthly income does not exceed Rs.10,000 /- per month.(Employees/officers, spouse, dependent children and two dependent parents or in-laws will be beneficiaries. Parents would be considered dependent if their monthly income does not exceed Rs.10000/- per month.
    If the income of one of the parents exceeds Rs.10000/-p.m or the aggrgate income of both the parents exceeds Rs.10000/-p.m, both the parents shall not be considered as wholly dependent on the employee
  5. Widowed Daughter and divorced / separated daughters, sisters including unmarried / divorced / abandoned or separated from husband/widowed sisters.(viii) Physically/mentally challenged Brother / Sister with 40% or more disability shall also be covered as Dependent.
  6. Reimbursement shall cover Room and Boarding expenses as provided by the Hospital/Nursing Home not exceeding Rs. 5000 per day or the actual amount whichever is less.
  7. Reimbursement shall cover Intensive Care Unit (ICU) expenses not exceeding Rs. 7500 /- per day or actual amount whichever is less.
  8. Reimbursement shall cover Surgeon, team of surgeons, Assistant surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists fee, nursing charges, Service Charges, Administration Charges, Nebulization Charges, RMO charges, Anaesthetic, Blood, Oxygen,Operation Theatre Charges, surgical appliances, OT consumables ,Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Cost of artificial Limbs, cost of prosthetic devices implanted during surgical
  9. procedure like pacemaker, defibrillator, ventilator, orthopaedic implants, Cochlear Implant, any other implant, Intra-Occular Lenses, infra cardiac valve replacements, vascular stents, any other valve replacement, laboratory/ diagnostic tests, X-ray CT Scan, MRI, any other scan, scopies and such similar expenses that are medically  necessary or incurred during hospitalization as per the advice of the attending doctor.
  10. Hospitalization expenses (excluding cost of organ) incurred on donor in respect of organ transplant to officers/ employee/dependent would also be covered for reimbursement. 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.
  11. Alternative systems of treatments other than treatment under Allopathy or modern medicine shall include Ayurveda, Unani, Siddha, Homeopathy and Naturopathy for Hospitalization and Domiciliary treatment.
  12. Day care Treatments shall be covered under the scheme.
  13. Domiciliary  Hospitalization shall be covered under this scheme and would mean medical treatment for an illness/disease/injury which in the normal course would require care
  14. and treatment at a hospital but is actually taken while confined at home under any of the following circumstances :
  • (i) The condition of the patient is such that he/she is not in a condition to be removed to a hospital or (ii) the patient takes treatment at home on account of non-availability of room in a hospital. (iii) Treatment taken for specified diseases which may or may not require. (iv) Domiciliary Hospitalization / Domiciliary Treatment : Medical expenses incurred in case of the following diseases which need Domiciliary Hospitalization /domiciliary treatment as may be certified by the recognized hospital authorities and bank’s ’medical officer shall be deemed as hospitalization expenses and reimbursed to the extent of 100%.

(78) Comments

  1. narendra singh rana

    I m retd employee and willing to contribute under the scheme. I tried to contact some friends/ branches but they have denied for any such scheme in force. May I request to let us know the progress on the subject. Forms in other banks are being filled now-a-days, some source informed.

    1. Surendra NaikSurendra Naik - Post author

      Sir, IBA has signed new hospitalization scheme for all bank's existing and all retirees staff. Some banks like BOB have sent the option letter to each and every retiree staff at home address. However, retirees of many banks are still waiting for their bank's circular/communication.You may therefore, contact retirees' association of your bank or the association/ union where you were a member during your service period, to collect the information. If nobody is available to you, contact your head office (PAD/retirees cell). Regards- Surendra Naik

  2. r v mangrulkar

    sir, many thanks for information. please let me know implementation date of this scheme? what will be premium employee will have to bear for this scheme?

    1. Surendra NaikSurendra Naik - Post author

      The terms of reference to the scheme has been elaborately dealt with in the BPS which is applicable to all the banks. More so a master policy is issued in the name of IBA covering all the members. Hence, the only variable component could be funding pattern of the premium. Some of the banks have already issued circulars regarding premium payable by the retirees and some banks are on the process of issuing circular. please keep in touch with your bank for the effective date of the scheme. I understand that the scheme is effective from 1st November 2015.

      1. GOUTAM SHAW

        My father pension amount is rs 1500. But i and my father have fd which interest my father is getting more than rs 10000 per month. So my question is can i show my father is dependent on me.

        1. Surendra NaikSurendra Naik - Post author

          If you show that Rs.10000 interest as your father's income, he is not eligible under the scheme. If it is the earning of joint account, you need not worry about it. You can apply apply for medical reimursement.

  3. abhi

    Hello sir, Private banks like laxmi vilas bank which comes under the IBA norms covers under the medical insurance scheme or reimbursement scheme...

  4. Sarath s

    Sir I am working in central bank of India as a clerk. My father working as ED post master with salary 12000. He is not a permenant staff. Is it possible to add my father as a dependent..

    1. Surendra NaikSurendra Naik - Post author

      Parents would be considered dependent at present only if their monthly income does not exceed Rs. 10,000/- per month. You have mentioned that your father is not in permanent job. If your father does not have regular income, there may not be any problem in showing him as your dependent.

      1. Sarath s

        Sir Father working last 30 years as ED Postmaster and also have four more years for retirement. He also have consistent income. But tomorrow they can send him out. He don't have any right like central government employees. He don't have any incentives like PF, Gratuity, ESI. Then Is it possible to add my father as a dependent..

        1. Surendra NaikSurendra Naik - Post author

          I'm not sure of correct position in this situation. According to my perception, currently, he is in a job and earning more than Rs.10000/- per month, he is not eligible as per the definition. Once he is out of job, he becomes your dependent. You may consult your top union leaders in this respect, as they are people coming to your rescue if there is any problem. Since,Insurance claim is settled by the insurance company, not the bank, your bank management may not be serious in this issue.

  5. K Emmanuel

    Sir thank u for your valuable information , my son hospitalized and recovered within network hospital How much time to will take to pay bills , Working in Kotak MAHINDRA bank IBA employee .

    1. Surendra NaikSurendra Naik - Post author

      If the hospital is in the list of network hospitals, they will claim the amount and get the money immediately. If the hospital is not a network hospital, you will have to claim through TPA who take time to settle the claim. It depends upon claimant luck if they settle early.If there is inordinate delay in settlement of claim you may have to contact the bank's liaison officer for early settlement.

  6. Harshida

    Sir, I would like to know, what insurance United Bank of India provides for their employees who are in officer designation. Will it cover parents/parents in law also ? What is the total amount for the insurance ? Will it be cashless or reimbursement ?

    1. Surendra NaikSurendra Naik - Post author

      The scheme is same as earlier scheme of bank reimbursing the claim amount. Now Bank has covered all their staff for certain limit. If the claim amount is more than the insured amount bank will consider the excess amount claimed by the member for reimbursement.The Scheme covers Employee + Spouse + Dependent children including step children and legally adopted children + any two of the dependent Parents (i.e. Parennts or Parents-in-law.).A child/parents/parents in law would be considered dependent if monthly income does not exceed Rs.10,000 /- per month. Widowed Daughter and divorced / separated daughters, sisters including unmarried / divorced / abandoned or separated from husband/widowed sisters, step children, adapted children,Physically/mentally challenged Brother / Sister with 40% or more disability shall also be covered as Dependent.

  7. ankit batra

    my father is 67 yrs old retired from obc bank,he is not covered any medical scheme right now.can he join any scheme now if yes then please suggest me the way how can he will take,or is there any other option for him in any insurance or reimbursement scheme please reply as soon as posible.

    1. Surendra NaikSurendra Naik - Post author

      Health insurance for retirees is done through the respective employer bank. The existing master policy of United India Insurance was expired on 31.10.2017 and premium amount collection for the period November 2017 to October 2018 is closed by all the banks on 31.10.2017. Your father may contact the OBC bank head office (PAD) and cheque up whether he can join the scheme now. I understand other insurance companies Appollo Munich and others are covering senior citizens at very low premium, you may search in google for the same.

    2. Surendra NaikSurendra Naik - Post author

      The period for submitting top up option/renewal/joining the IBA group health Insurance for Retirees with premium to the respective bank is extended by United India Insurance by 1 month from 01/11/2017. The premium coverage will be from 01/12/2017 till the group policy expires i.e.31.10.2018.You may immediately contact the bank for payment of required premium.

  8. Aswathy p s

    Sir,My husband working in canarabank officer post... my parents income not more than 10000. Will it cover parents law also? Or only for eligible in women employees?

    1. Surendra NaikSurendra Naik - Post author

      I'm not sure about medical reimbursement for baritric surgery. Usually hospitalization charges are reimbursed when the patient is admitted to hospital on the recommendation of Registered Medical practitioner.

  9. deepak kumar

    Dear sir my wife is a GOVT TEACHER & her salary is more than 10000 P.M. can I show her dependent on me and take the benifit of hospitalization schemes.

    1. Surendra NaikSurendra Naik - Post author

      Your wife is entitled for medical reimbursement along with you irrespective of her personal income. The dependents clause is applicable to your parents or parents-in-law.

  10. HABEEB

    My wife gave birth to child recently. My bills rejected before delivery by the reason Prenatal and after delivery by the reason Normal Delivery ( Epidural). My approximate expenses on this is Rs. 2,00,000/-. Not a single rupee reimbursement given by a doctor in our panel.

  11. Poonam kumari

    Sir, Is there child care (ccl)leave facility in idbi bank for female staff.or any other option for long leave to take care of child.kindly suggest.

    1. Surendra NaikSurendra Naik - Post author

      Bank Unions have been agitating to grant CCL on the pattern of CCL granted to Govt. Employees. The Public Sector Banks have a policy on granting Sebatical Leave to women Employees.However, sabbatical leave is being extended without pay and without any other benefit to the women employees in the Banks. Thus women employees in the Banks are discriminated as against Government employees. I don't have idea about IDBI bank CCL policy. You may check up from their HRD portal or write to them regarding leave facilities available to women employees.

    1. Surendra NaikSurendra Naik - Post author

      Read the guidelines given by the HRD of your bank. You have to furnish the details of your family like spouse, children, dependent brothers/sisters and parents or parent-in-law, to the bank in the format given by the bank/online.

  12. Rekha

    Sir i m sbi employee. My father is going to retiree from railwayin july my mother lives with me she has no income can she be dependent on me or i can add her under medical insurance scheme

    1. Surendra NaikSurendra Naik - Post author

      Employees/officers, spouse, dependent children and two dependent parents or in-laws will be beneficiaries. Parents would be considered dependent if their monthly income does not exceed Rs.10000/- per month. If the income of one of the parents exceeds Rs.10000/-p.m or the aggrgate income of both the parents exceeds Rs.10000/-p.m, both the parents shall not be considered as wholly dependent on the employee

  13. Raman batra

    Thanks for info . Sir one imp question . As on now officers are eligible for rs 4 lac family flotter plan . Wt if any of family member fell I'll and cost of the hospitalisation is more then 4 lac ..Then only 4 lac will be reimbursed or the rest of the amount will be disbursed by bank through some some staff welfare fund ?

    1. Surendra NaikSurendra Naik - Post author

      The Banks have renewed the Top up Medical policy for serving and retired employees wef 01.04.2017. As per the scheme, after exhausting the coverage under the primary policy of United India Insurance Company Limited, all the working employees and retired employees will be eligible for additional coverage of Rs.5.00 Lacs under “Top up Medical Insurance Scheme for reimbursement of Hospitalization Expenses for the year 2017-18 with Cashless facility.

  14. Sneha Aggarwal

    Sir, is dental comes under this policy. If yes then what is the criteria for it ? What is the maximum limit upto which claim can be settled ?

    1. Surendra NaikSurendra Naik - Post author

      United India health insurance policies exclude dental treatment in their list of common exclusions. However dental surgery and treatment would definitely be covered under certain policies if the same requires a minimum of 24 hours hospitalization and especially if the same is caused by an accident.

  15. MUKESH KUMAR

    Sir my father work in bank , every month they take medicine from hospital. Is there any method to claim that money .. Medicine are toI costly

    1. Surendra NaikSurendra Naik - Post author

      He is eligible for domicilliary treatment provided along with medical bill he has to submit doctor's prescription (originali/photo copy of the prescription) with every claim. If your father has any doubt on procedure for claiming reimbursement, let him contact HR department or Personnel Administration Department of the bank and get clarification from them. Alternatively he can discuss with his colleagues to know the procedure of claiming reimbursement for domiciallery treatment.

  16. Abhineet

    Sir, my father retired from psu and his pension amt is 10000+. My sister is unmarried and having some mental problem, Can i declare her as a dependent or not.. I work with Canara Bank..

        1. Surendra NaikSurendra Naik - Post author

          If the bank or insurance company asks for your father's income then you may provide the father's income. What's the problem in it? If your sister is not eligible under the provisions they will intimate the same to you.

  17. Kavita

    Hi, Sir, My father is retired from Bank of Maharashtra, Delhi in Year 2010. Can he enroll himself in group medical insurance? If yes, what is the process. Regards, Kavita

    1. Surendra NaikSurendra Naik - Post author

      He is eligible, but why he has not subscribed when bank has called all the retirees to apply for health insurance. I donot whether he can join the scheme now.Probably bank will be able to include him in the scheme during October 2018 when existing policies are due for renewal. Please check up from HRD of Bank or from the serving /retired employees association who may guide you properly in the matter.

  18. Rashmi C J

    Hi sir. I am working in Canara bank Kolar district near Bangalore.i am married and my husband works for PSU. can I add my parents as dependents?. And I have elder brother who is married and have no income. If so can we claim one day treatment expenses or we have any recognised hospitals we can directly get treatment.i have no idea about list of approved hospitals I am

    1. Surendra NaikSurendra Naik - Post author

      You can include either your parents or parents-in-law as your dependents provided their income is less than Rs.10000/- per month as per present rule. The TPA sends you the list of hospitals where you can have cashless treatment.

  19. Deep Madhav

    Sir, I have a simple question that If I take OPD (Domiciliary) Homeopathic treatment from any Registered practitioner from a clinic will that amount (Consultation+Medicine) be reimbursable to me? I am an officer in BOI.

  20. Khum Singh Chouhan

    As per latest circular with bank of Maharashtra, how can i know that my policy expanses limit is how much and can apply for Cashless facility?

    1. Surendra NaikSurendra Naik - Post author

      You must have received health cards issued by United India by this time. In my case, they have issued 4 cards two in my name and two for my wife.One card for basic limit and another one for top-up policy.If you have not received the card you may contact the Retirees cell of your bank/United Insurance/TPA. You may also contact office bearers of your erstwhile association or the retirees association who would help you in the matter.

  21. John Devadoss

    I am a scale IV Officer. While in abroad on personal visit, I fell ill and hospitalised there. I incurred USD 6000. I am a cardiac patient underwent angioplasty. As the plan was for a short tenure no insurance cover was taken. When claimed the bank denied the claim on the ground that the treatment abroad do not fall under the eligiblity. I have not gone abroad for treatment but it so happened. Is there no remedy?

  22. Ashu

    Sir, My father is an insurance agent and he has no fixed income....Like in some months its less than 10000 and in some other more than 10000....will he be a dependent?

  23. ARUNDHATI DASH

    Sir can I include my unmarried sister as my dependent family member. I am working with SBI and my father is a retired school teacher.

    1. Surendra NaikSurendra Naik - Post author

      Yes. You can include her as dependent family member for the purposes of claiming medical reimbursement. If the income of one of the parents exceeds Rs.10000/-p.m or the aggregate income of both the parents exceeds Rs.10000/-p.m, both the parents shall not be considered as wholly dependent on the employee

  24. Deepak

    Dear sir, my father is manager PNB and he is in state of comma since last 3 years, please confirm can bank recover loan instalment from medical reimbursement, if not then please provide any circular regarding this. Thaks email id - deepak.jarodia1989@gmail.com whats app no 9416437655

    1. Surendra NaikSurendra Naik - Post author

      I'm sorry to know about the plight of your father and your family. It is harsh, inhuman and bad in law to recover a loan installment from the amount which was credited to the staff's account for reimbursement for medical treatment. Contact or write to GM of PAD or CMD of the bank and apprise them the position and ask them to help you in the matter. You can also contact the principal office bearers of Officers association like GS or president of the association and seek their help in the matter. Lest as a last resort you may have to initiate cumbersome legal proceedings against them, which ordinarily not recommended, in view of money and time to be spent.

  25. Shrikant

    Sir, My Father is retired from SBI in 2012 and is getting pension and does not have any medical insurance scheme. Do pensioners can be dependent on employee as I m also a officer in SBI. As my mother is suffering from deadly disease. All my and father's salary is consumed in disease. Please give me suggestions how can I add my mother as dependents

  26. Rohit shrivastava

    Sir pls tell me there is reimbursement for ivf test tube baby. I m working in state bank of india as a scale 1 officer.sir pls advise me

    1. Surendra NaikSurendra Naik - Post author

      An order has been released by the Ministry of Health & Family Welfare that both the CGHS beneficiaries and beneficiaries under CS (MA) Rule 1944 will get medical reimbursement for In-Vitro Fertilisation (Test Tube Baby) of an amount not exceeding Rs.65,000/- or the actual cost, whichever is lower. Karnataka Government has also passed a similar order for the similar amount. I am not aware whether bank employees are covered under an insurance scheme for the same. You may check up from the Head Office of your bank.

  27. Sajeev D

    Sir, I have few doubts 1. can we apply for cashless treatment for a same disease for second time in an year? 2. If two persons in a family are employed in bank, can they add one parent each as dependant?

    1. Surendra NaikSurendra Naik - Post author

      1. You can apply for cashless treatment for the same disease any number of times till the amount of insurance cover exhaust. 2. Both of you can declare both the parents (or the parents-in-law) as dependents provided their monthly income is less than Rs.10000/-. Only thing is that both the employees cannot claim reimbursement on the same medical treatment at the same time.

  28. vikas kumar

    my parents is dependent on me. can my unmarried sister also dependent ? what is contradictory in following 1. physically challenged brother/sister with more than 40% disabilty

    1. Surendra NaikSurendra Naik - Post author

      Widowed Daughter and divorced/separated daughters, sisters including unmarried/ divorced/abandoned or separated from husband/widowed sisters are covered as dependents under the scheme. Physically/mentally challenged Brother / Sister with 40% or more disability shall also be covered as Dependent.

  29. vikas kumar

    Sir, but our bank has not agreed. that unmarried sister is dependent. please give the solution. official says, only brother/Sister with 40% or more disability can dependent.

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