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.
  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%.

(20) 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.

  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.

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