1)Though in the 10th Bipartite Wage Settlement
for Banks with IBA ,Group Medi claim policy details in full are enumerated from
Page 33 –56.
While the 32 pages, as is customary,are exhaustive presentations in several Paras & Clauses
& Subclauses,I concentrate on last 3 pages ,Page 54,55 & 56 as above[ FOR THIS SEE EARLIER POST:Ed.]
For convenience, I have highlighted in different colours, to
lay emphasis,to easily grasp the fundamentals,& to understand &
appreciate the Rules & Procedures laid down, to enable us to compare with
LIC Group MediClaim practices & under Select items to enhance & improve
our practices.This does not, in any way,compromises the FFPolicy conditions
& privileges but only salutary mechanisms Banks are endeavouring to install
to make lives happier for all employees ,for medical treatment & hospitalization
& to reap the fruits of the negotiations without hassles or any murmur.
2)Para 1 ,c)itself commences with a positive empathetic
note, ‘the collection of data of dependent family members at the
initial stage may take long time. In such cases claims
pertaining to dependent family members of employees pending collection of data
may be settled on certification and recommendation of the appropriate authority
of the respective bank. ’
3)Para 6 mentions about allocation & use of
Corporate buffer & nicely portrays “The unutilized
Corporate Buffer of the member banks would now be proportionately available to
the member banks whose Corporate Buffer has been totally utilized. This would
be one of the major benefits of the Group underwriting of all the member banks
under one policy and at the same time individual underwriting of each member
banks for data processing, servicing and claims.”—heartening to the Banks
4)Paras 8 & 9 are crucial,well laid down, pinpoints
TPA role correctly & forcefully.In LIC ,TPA so far is invisible.For the
fabulous premium LIC pays to New India,this role of TPA must be insisted
upon.RBI Chief GM, HRD holds regular sessions of pensioners with TPA &
jointly discuss problems ,issues & grievances & so are more prone &
sensitive to urges & demands.Obviously, solutions also are reached quickly
LIC must aim to
have same identical role for TPA “The Third Party Administrator, appointed by the lead insure viz
United India Insurance Co. Ltd. will station their representative at the banks
regional/ nodal offices from where these banks have been settling medical
claims of their employees.
The Third Party Administrator, would have a
Dedicated Office, Server and a 24 X 7 Call Centre for the Member Banks of the
Indian Banks’ Association. ”
5)Paras 10 & 11 must be the be-all &
end-all for LIC to draw polite attention of our TPAs & ensure right now
such full participation of TPAs in daylight presence to empathise & fully
cooperate with LIC Offices to settle claims, which takes unduly long time.If
one reads these paras,one can realize how much behind we are & how LIC
hesitates to book TPAs & command them to enhance efficiency to help
ailingpersons to, afterall, get their claims settled vey expeditiously
6)Read “The employees would submit
the claims to the same regional / nodal offices where they have been submitting
in the past and the
Third Party Administrator representative will be the backup support and ensure
claim settlement is completed in thirty minutes.
(The Third Party Administrator should ensure
placement of representative in all the regional/nodal offices of
the member banks where the employees have been submitting their claims in the
past)
What more is required,if this aim is fulfilled,that will be a
great day for such real good practice to percolate to all TPAs & fulfilling
abundantly the CORE PROBLEM for all coming under Mediclaim scheme
7)Para 12 is exemplary,as without rhyme or reason,rejections
taking place ,can be avoided.It is gratifying that IBA & Bank Unions have
virtually installed a built-in Ombudsman.
“No claims
would be rejected by the insurance company/ Third Party Administrator unless
the same is rejected by the committee
comprising of the Bank management, Insurance Company, Third Party Administrator
and K. M. Dastur Reinsurance Brokers Pvt Ltd.
8)Para 13 is a polite reminder to
LIC to put in place a mechanism for Cashless Service ,with full cooperation of
TPA & Hospital authorities.How much time it is taking, even to get an Ecard
from TPA.Golden hour palpitation troubles our mind, family is disturbed,no
proper velvet guidance to smoothen matters.But here “In case the employee or his family member gets admitted in
any of the preferred Provider Network of hospitals on production of ID card,
the hospital authority in turn shall notify by fax / mail the details of
hospitalisation along with ID card number and Name of the employee to the Third
Party Administrator, who would again revert by fax / mail a confirmation to the
hospital to proceed with the claim. This would even enable them to claim from
anywhere in India and they would be able to admit themselves in hospitals
anywhere in India by merely calling the dedicated call centres of the Third
Party Administrator, which would be working on a 24x7 basis. The Third
Party Administrator, would even be able to advise the employees on the nearest
hospital available in their area. In case of an emergency admission to a
hospital which is not in PP Network, the employees also have a benefit to get
himself admitted on a cashless basis by intimating the Third Party
Administrator, call centre number, mentioning his ID card No and name. The
hospital authority would fax / mail the details of hospitalisation to the Third
Party Administrator, who would again revert by fax / mail a confirmation to the
hospital to proceed with the claim. ”
Here, all the nuances
& variable circumstances which can arise in such Emergency situations, have
been ably thought of, discussed & codified for the benfit of all parties
for a complete understanding of this Vital & important issue ,for Cashless
service.We pray LIC rises to the occasion & installs a hassle-free
procedure without any detriment to the insured.
9)In LIC, neither Employees nor Pensioners have availed
cashless service,is the talk of the town.That situation must disappear, all
because Cashless Facility to be availed must contain such roots&
essence inscribed in Bank deal with TPA
skillfully
This is echoed brightly in their
Para 14, “Most
of the claims would be cashless; which would be paid directly to the hospital
concerned. ”
It is LIC’s duty to get transformed to make this a reality.
10)Para 16 is another
eye-opener.Read : “Wherever the hospitals are not in
the approved list of Third Party Administrator, the Third Party Administrator
should take necessary action for addition of those hospitals on their network
hospital list in consultation with bank. In an emergency the claim
payment would be paid to the hospital account and empanelment of the hospital
would be considered.”
What more is required,so liberal,
maximum empathy & consideration ,indeed needs emulation & practice in
LIC too
11)Para 17 also demonstrates
flexibility “All the addition and deletion of the
employees and dependents of the various member banks would be done on a monthly
basis. A newly recruited employee would automatically be admitted in the
medical scheme from the date of his appointment letter “
12)Para 18 hits the bulls eye as it pertains to Id Card.We are
clamouring ever since LIC CO circular of 31 March 2015 & 14 April, 2015.
We appeal &
entreat to LIC to implement such salutary & liberal practices ,without any
further delay.
“ID cards will be prepared within 10 working days from the
date of receipt of data. These cards can be couriered to the respective branch
office in which the employee is located. The cards can be distributed by at the
branch office by the bank’s branch manager / any other person who is made
responsible for the same. Corrections in cards, if any can be e-mailed to an
exclusive id which will be exclusive for cards correction errors. This cards
will be corrected and resent within 2 working days from the receipt of
correction mail.
”
Please go through
& help the insured to experience
contentment & happiness,even when dire need forces him for
hospitalization by making considerable improvements right from now on, to
educate & enforce discipline amongst TPAs.Please also implement various
provisions so correctly incorporated in Bank mediclaim agreement &
certainly LIC must outwit banks with a democratic practice & calling us
representatives alongwith TPAs to sort out issues & problems for a happy
tomorrow
Greetings
R.B.KISHORE
VP,AIRIEF
