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.
The dearness relief rates for family pensioners are same as
applicable to those who retired on 1-11-2007.
DR rates for ex-gratia recipients: 928.62% of ex-gratia
United forum of Reserve Bank Officers and Employees has issued a press statement calling for mass casual leave by 17000 RBI staff, including very senior officers on 19th November 15, to protest against the government moves to cripple functions and working of RBI. The protest is also aimed at the dilatory tactics being used by the Ministry of Finance regarding revision of Pension in respect of RBI Retirees .
Unions in RBI have long been pursuing for reasonable improvements in pension, as the basic pension once fixed in RBI is never revised, although the pension scheme in RBI is analogous to Pension Scheme in Central Government. In respect of about 50 lakh Central Government pensioners , the periodic revision is done with every pay revision. Moreover, the Pension in RBI was once revised by Central Board and implemented for pre-2002 retirees, but was later withdrawn on account of unjustified and unilateral orders by M/o finance. Retirees concerned had to approach Mumbai High court to get the unilateral orders stayed. The issue of not updating pension is hanging for about a decade and ministry is keeping the employees genuine demands in limbo. Fed up with the Government’s tactics, the present RBI Governor included the problem with Government in para x.28 of the RBI Annual report 2015, which no earlier governor liked to do.
The proposed protest is also to Save RBI from the transparent agenda of GOI to cripple RBI, despite cautionary signals from the economists of fame. Rigidity by M/o Finance in the above issues is a matter of deep concern for the RBI staff. ” If very reasonable demand of improvement in Pension is not met as demanded by the staff, the agitation will be further escalated in the coming days” says the press release.
AIRBIOPF fully supports the demands of the retirees and working employees and advises all the members to participate in the programme on 19th November 15 at their offices of RBI.