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RBI-Medical Assistance Fund Scheme (MAFS)-GMP (2016-17) for RBI retirees renewed with United India Insurance co.

17 Aug

The earlier cashless Medi claim policy with the private sector company – IFFCO TOKIO– expired on August 14, 2016. RBI has ,now, renewed the policy for a period of one year (15-8-16 to 14-8-17)  with United India Insurance Co. Ltd.(UIIC).
There is a change in the Grade-wise limit for ICU, room/bed charges, sum  insured per hospitalization.
There is no change in the Third Party Administrators (TPAs) View/download the list.
Following enhancements/additions have been made:

I.  Ayurveda treatment at CGHS empaneled Ayurvedic hospitals.
II.  EECP (Enhanced external counter pulsation) to be included under the policy on OPD basis up to the per hospitalization limit. Settlement of claim to be done on reimbursement basis only after completion of full treatment.
III. Donor Medical expenses in case of transplants like kidney, liver etc. to be covered within the sum insured (Organ cost not covered under policy)
IV. The day care list will also be inclusive of day care Medical Treatment undertaken due to advancement of technology. The additions to the current list of 140+ day care treatment are:
(a) Cost of CRF/CKD treatment including the cost of injection
Erythropoietin/Cyclosporine/Sandimmune up to admissible per hospitalization limit on cumulative basis .

Other Operations / Procedure
(b) Cystoscopy
(c) All types of angiography covered
(d) Photo dynamic laser therapy covered under ARMD treatment
The names, contact numbers and e-mail id of the designated TPAs and representatives of the Insurance Consultants are listed here.

New TPA cards will be issued to MAF members in due course. Till such time the existing MAFS ID card issued by the Bank as well as existing ID cards issued by the TPA will be valid for admission to the hospital.

As members’ have unhappy past experience with the TPAs regarding issue of new ID cards, and as  the Bank has not prescribed any time limit  for issue of new ID cards, retirees may remain vigilant, and in case they do not receive new ID cards within 3 weeks, they should contact the Relationship Managers  concerned for immediate issue of ID cards along with details of Hospitals empanelled. 

Your may view complete List of Salient Features /Bank’s forwarding letter dated 12-8-16.

LIC pensioners case-SC judgment

9 Apr

LIC court case

LIC court case – at a glance- events till 2013.

Events thereafter:
Despite the SC orders to deposit the amounts in courts for payment to the petitioners, LIC plays foul, uses dilatory tricks, seeks repeated adjournments , feigns non-availability of counsels on due dates to drag the suits to all possible extents. Needless to say, these skills are an inseparable part of our Democratic Justice Delivery System.

LIC deposited amounts in courts based on  DR anomaly only by excluding element of consequent revision of Pension. This resulted in more appeals, notices, rejoinders and dates and more dates consuming a period of more than 2 years without any visible result.

Accumulation of appeals and further hearings in Supreme Court led to an order dated 7-5-15 by SC, which directed that as an ad-interim measure, LIC shall release 20% of the amount as per the impugned judgments pertaining to the High Court, in favor of the respondent employees within six weeks hence, subject to final result in the appeals.The next hearing  was fixed for 23rd Sept15. In the background of these sequence of events, SC pronounced the latest verdict on 31st March 16.

Important directions of the latest Supreme court decisions are:
  1. Set aside the orders passed by the HCs of Rajasthan, Delhi and P&H  and transfer  the writ petitions from the High Courts of Rajasthan and Punjab & Haryana to the High Court of Delhi,
  2. HC of Delhi  to decide the constitutional validity of Para 3A of the Appendix to the Rules, by Aug. 31,16.
  3. Directed LIC to pay IR 40% ( which was  20% earlier ) as per Para 3A of the Appendix  within six weeks and shall file an affidavit to the said effect.
  4. Orders reg item 3 applicable to the ‘similarly placed persons’.
  5.  SC observed the resolution passed by LIC board could not have been given effect to without framing a rule by the Central Government.

Nevertheless, Supreme Court judgment of 31-3-16 is evoking mixed responses. There is a lurking fear that courts may or may not  uphold the arbitrary and hyper technical authority of M/o  Finance, in the name of rules and acts.

It is high time that Government of India  considers sympathetically the  plight of the pensioners in financial institutions owned by them. The moot point for consideration ought to  be whether pension updation as being done for decades in case of  Central Government employees whose scheme of pension is also linked with CPI is valid in principle, and if so, there should be  no reason to deny the same to other similarly placed persons. Why refuse to allow others what you  get by virtue of  proximity to the system and authority to  invoke and frame technical rules. We are also suffering the same fate and game plans at the hands of M/o finance .

The constant fighting spirit of the septuagenarians is exemplary and praiseworthy. This long drawn battle by LIC Pensioners may conclude by Sept. 16, all other things remaining the same. We salute their resolve to fight till end.

Let us wait and see where the fight initiated by a single LIC retiree in 1998 leads to. We hope and pray that the result will be a shot in the arm not only for the LIC pensioners but all ‘similarly placed persons’ in other financial institutions.

Wishing A Victory for the LIC pensioners!

Pension Calculator for RBI Pensioners (Feb16 to July 16)

5 Feb

Violations by IFFCO TOKIO General Insurance Co. Ltd.-Group Mediclaim Policy 2015-16

3 Feb

We have come to know from the retired  members of MAFS that the present Insurance company -IFFCO Tokio- with whom the GMP contract for the period 2015/16  has been renewed-  has initiated  restrictive practices regarding settlement of their pre-authorisation  bills with Network Hospitals. Some other  unauthorised practices have also been observed in cases relating to   planned hospitalisation such as, Cataract Surgery and other procedures where  hospitalisation under a package  are agreed to  by the retiree members. In this connection, we emailed  to central office members’  concern in the matter. Some extracts form the emailed letter are given below.

“Earlier where treatment of cataract surgery was planned, the TPA
(under United India Insurance co.) used to provide for the entire admissible  amount in one instalment capped at  RS 40000/- on submission of the required case papers  by the  hospital…”

“Our  members who have undergone cataract surgery in the  network hospitals have reported  that the amount estimated  by the hospitals is not being released by the TPA in one go as was being done by the same TPA under  earlier Insurance company. In a recent case (details in Annexure I), where the TPA (Medi Assist, Noida) approved the pre estimated amount as conveyed to them in 3 instalments, that too 60% of the amount claimed by the hospital. The balance amount was sanctioned 5 hours after the surgery was performed. Till then the  patient remained stuck in the hospital. He was thus  forced to expose himself to the avoidable risk of aggravation/infection. It is well known in Health Care Industry that  the cataract treatment is a fixed package where the cost of lens and surgery charges, as a rule, are pre-fixed, and there is little  scope for  any subsequent changes in the estimates.”

We have also reports and papers which prove that United India Insurance is a better rated company by the Health Care Industry and enjoys a higher credit limit than the present insurance company.Our members are also at a loss to  understand  the favour bestowed upon a Company in Private Sector and all love lost for Public sector Company owned by the nation, when  generally the beneficiary employees were satisfied by the implementation of the policy by the Public sector Company since the inception of the scheme. 

As per the  guidelines issued by Insurance company to TPA, under the pretext of  Package System, TPA has reduced the Cashless Facility and the Hospitalisation limit of the retirees to a farce . In fact,  by  disallowing  the genuine claims of the retiree including that of medicines and investigation charges etc. the Insurance company is  violating  the provisions in the policy. Who has authorised the company to  sanction the pre-authorisation amount  on the basis of  the room rent below the  eligibility of the member concerned?

The difference in the amount between the eligible amount and actual paid amount for Room Rent/ICU/ICCU is also payable by Regional Office in accordance with the para.No.7 of C.O. Circular C.O.HRDD.No.G.100/4241/18.03.00/2010-11 dated November 1, 2010.

However, We have come across many cases where the members have not claimed the room rent difference from the Bank as they are not aware of the same. The instructions relating to retirees  are not well circulated, although central office invariably advises regional offices to bring the contents of such  circulars to the retirees’ associations. It is not being done as no retirees’ association is on the mailing list of  the Bank. Instructions remain  confined to a few in the Bank and the Medical Desk.

Or some times, the members who are coping with the prolonged  sickness are required to approach bank at different times  for settlement of the bills and  trivial objections involved.  Some consider it better to  avoid the hassles in representing and then fearing for the negative response.  They thank God for whatever amount is paid by the Insurance company. But this approach makes the Insurance company richer due to  their grace rather than God’s.

In the circumstances, retiree members who have undergone hospitalisation may note to  first  obtain the full itemised details of rejections along with reasons /summary of the settlement from the TPA. TPA is bound to provide the same as per Regulatory Authority’s guidelines. Then they should  represent each and every deduction /wrong settlement of their bills first to the TPA, and if rejected or not replied to within 3 weeks , to Central Office through their local office. We should also bring all such information about MAFS to the notice of  retirees in Class IV and Class III who are  already suffering due to very low room rent admissible to them.





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