New Med Claim Policy Introduction

Dear friends,
Our request for improvements in the new medclaim floater policy along with the Unions and Associations have forced the Management to defer the introduction of the same till Septembers 2013. The GM's of all the four companies will consult and finalise the improvements. Let us wait. Pensioners who have already given the cheques can get back the same from the respective offices.
with regards
nagarajan
GENL SECTY. 

NEW STAFF GROUP MEDICLAIM POLICY

Dear friends,
We are happy to inform you that a new Floater policy is introduced from July 1st of 2013.
The above policy has got some advantages and also the Premium rate is higher. The policy cover is increased to 20 lakhs but on floater basis. Our EC has discussed the for and against points yesterday and we are sending letters to GIPSA and all the four companies regarding the above policy. The main features of the present policy compared with the new policy is given down below. for your perusal. Please opt for a higher sum insured before June 30th.

Revision in Group Mediclaim Policy for Serving & Retired

Employees of our Company w.e.f 1^st July 2013

The Group Mediclaim Policy (GMC Policy) covering our serving and retired employees and their family members which is

in force now, has undergone modifications with effect from 1.07.2013. For ready reference, some important features

are outlined below :-

Current Provision	Revised Provision
Company’s Contribution towards Premium in case of Serving Employees (for employee, spouse & two dependent children) :- Class I – 2/3rd premium + loading, if any, -       up to Eligible S.I + Service Tax Class II/III/IV- 3/4th premium + loading, if any, -        up to Eligible S.I + Service Tax	Company’s Contribution towards Premium in case of Serving Employees (for employee, spouse & two dependent children) :- 75% of the premium payable (including loading on account of applicable TPA fees and Service Tax) - up to the Eligible Sum Insured.
Company’s Contribution towards Premium :- For Retired Employees :- -       Loading portion of premium up to Eligible S.I + Service Tax For Spouse of Deceased Employee/ Spouse of Retired & Deceased Employee :- -       Loading portion of premium up to Eligible S.I + Service Tax	Company’s Contribution towards Premium :- For Retired Employees :- - 75% of the premium payable for retired employee &   spouse (including loading on account of applicable TPA fees & Service Tax) - up to the Eligible Sum Insured. For Spouse of Deceased Employee/ Spouse of Retired & Deceased Employee :- - 75% of the premium payable for spouse (including loading on account of applicable TPA fees & Service Tax)                        - up to the Eligible Sum Insured.
Employees’ Contribution towards Premium in case of Serving Employees :- For employee, spouse & two dependent children :- Class I – 1/3rd premium + loading, if any, -       up to Eligible S.I + Service Tax -       the entire differential premium for differential higher Sum Insured opted by Employee over & above the Eligible Sum Insured + Service Tax Class II/III/IV- 1/4th premium + loading, if any, -        up to Eligible S.I + Service Tax -       the entire differential premium for differential higher Sum Insured opted by Employee over & above the Eligible Sum Insured + Service Tax For dependent ineligible children/dependent parents/ dependent parents-in-law/independent children & their family members :- -       the entire cost of premium for opted Sum Insured + Service Tax	Employees’ Contribution towards Premium in case of Serving Employees :- (Class I/II/III/IV) – For employee, spouse & two dependent children :- - 25% of the premium payable + TPA fees + Service Tax                                 - up to the Eligible Sum Insured. - the entire cost of premium payable for dependent   ineligible children and dependent parents + TPA Fees +   Service Tax - the entire cost of premium payable for dependent   parents-in-law, independent children and their family   members, in the applicable cases + TPA Fees +   Service Tax - the entire differential premium payable for differential    higher Sum Insured opted by Employee over & above    the Eligible Sum Insured for self, spouse & two    dependent children + TPA Fees + Service Tax

                                                                                                                                                                

Current Provision	Revised Provision
Employees’ Contribution towards Premium in case of Retired Employees :- For self, spouse & two dependent children :- -the entire cost of premium for opted Sum Insured + Service Tax (except Loading portion of premium up to Eligible S.I + Service Tax) For dependent ineligible children/independent children & their family members :- -the entire cost of premium for opted Sum Insured + Service Tax Premium Contribution by Spouse in case of Spouse of Deceased Employee/ Spouse of Retired & Deceased Employee :- -the entire cost of premium for opted Sum Insured + Service Tax (except Loading portion of premium up to Eligible S.I + Service Tax)	Employees’ Contribution towards Premium in case of Retired  Employees :- For self & spouse :- - 25% of the premium payable + TPA fees + Service Tax                                 - up to the Eligible Sum Insured. - the entire differential premium for differential higher Sum Insured opted by Employee over & above the Eligible Sum Insured for self & spouse + TPA Fees + Service Tax For dependent children/ dependent parents :- -the entire cost of premium payable for opted Sum Insured   +TPA Fees + Service Tax Premium Contribution by Spouse in case of Spouse of Deceased Employee/ Spouse of Retired & Deceased Employee :- - 25% of the premium payable for spouse + TPA fees    + Service Tax - up to the Eligible Sum Insured. - the entire differential premium for differential higher Sum   Insured opted over & above the Eligible Sum Insured +   TPA Fees + Service Tax
Eligible Sum Insured :- Basic less than – Rs.22,731         -  Rs.   70,000/- Between Rs. 22,731 & Rs. 29,000 - Rs. 1,00,000/- Rs. 29,001 & above                   –  Rs. 1,55,000/-	Eligible Sum Insured :- Basic less than – Rs.22,731         -  Rs. 3,00,000/- Between Rs. 22,731 & Rs. 29,000 - Rs. 4,00,000/- Rs. 29,001 & above                   –  Rs. 5,00,000/-
Maximum Optional Sum Insured :- Rs. 5,00,000/- per member	Maximum Optional Sum Insured :- Rs. 20,00,000/- on floater basis
Who can be covered :- Serving Employees :- Spouse, Dependent Children Dependent ineligible children Dependent Parents/ Parents-in-law Independent Children/their family members Retired Employees :- Spouse, Dependent Children Independent Children/their family members	Who can be covered :- Serving Employees :- Spouse, Dependent Children Dependent ineligible children Dependent Parents Independent Children/their family members & Parents-in-law can be continued to be covered provided they are already covered – but no fresh inclusion from 1.04.2013. Retired Employees :- Spouse, Dependent Children Dependent Parents
Other provisions :- Ambulance Charges – Not payable	Other provisions :- Ambulance Charges (cumulative actual charges                                           per policy period) – Distance up to 50 Km.   - Rs. 1,500/- maximum Distance beyond 50 Km.- Rs. 3,000/- maximum          (payable against hospitalization claim only)

                                                              

Current Provision	Revised Provision
Other provisions :- Room rent Charges – no sub-limits No Medical Check-up facility Cover to Infant-after 3 months from date of birth Pre-existing diseases -  covered Maternity Benefits (for two living children) – -        Rs. 50,000/- maximum	Other provisions :- Room rent charges – Actual room rent charges per day shall be limited to an amount which is equal to the sum of :- -1% of S.I. up to Rs. 5 lacs + 0.5% of S.I.> Rs. 5 lacs which shall not exceed - 7,000/- per day maximum in Metro/ A Class Cities 4,500/- per day maximum in B Class Cities 4,000/- per day maximum in C Class Cities Stay in ICU/CCU :- Maximum reimbursement limit per day shall be double that of above room rent entitlement. Medical Check-up facility- Once in 04 claim-free years (w.e.f 1.07.2013) :-                                    - Rs. 5,000/- maximum Cover to Infant -  from Day 1. Pre-existing diseases clause  - stands waived. Maternity Benefits (for two living children) - Rs.25,000/- maximum per child for normal delivery Rs.50,000/-maximum per child for caesarian delivery
Being a single master policy for all the employees (serving & retired) along with all the covered members, data relating to collection of premium and claims paid are kept collectively for Class I to Class IV. Percentage of loading of premium was decided on the basis of Incurred Claim Ratio as a whole.	Now, policies shall be underwritten separately for – a)Class I, b) Class II and c) Class III & IV. Therefore, data relating to collection of premium and claims paid should be kept from 1.07.2013 on the basis of the above classes separately and send the class-wise data to HO Fund Department on quarterly basis.

the above points will guide you about the policy. we are also giving you the method of calculation of premium with some examples down below.

Main Details of the Policy.

Existing                                               Revised                        Co's Contribution
Eligible S.I.                                         Eligible S.I.                  75% of Premium Payable

70,000                                                  3,00,000                       up to Eligible Sum Insured

1,00,000                                                4,00,000                      ( for employee &spouse )

1,55,000                                                5,00,000                      plus TPA Fees &Service Tax

                                               If you take Sum insured for 10 lacs

                                               

Members                      Relation                       Age (Years)                  Amount

(Rs.)

A                                  Self                              63                                 17,358

B                                  Spouse                        55                                  6,702

C                                  Dep.Child 1                  24                                 3,003

D                                  Dep.Parent                   85                                 14,792

Yearly Premium-                      Total :              41,855
                                                     (plus TPA Fees &S/Tax)

                                                Eligible S.I. - 3 lakh                             

Members                      Relation                       Age (Years)      Amount         
                                                                                                 (Rs.)            Co's Contribution

A                                  Self                              63                     8,274

B                                  Spouse                        55                     3,205           75% of PremiumPayable

C                                  Dep.Child 1                  24                     1,408           up to EligibleSumInsured

D                                  Dep.Parent                   85                     6,769          (for employee &spouse)

             19,656  plus TPA Fees &ServiceTax

   

Co's Contbn.-      75% of 11,479 

             (i.e 75%of A & B)               8,609

Emp's Contbn.-                                    Yearly -                        11,047         ( For S.I.-Rs. 3 lakh)

                 
                  (19,656 - 8,609)

                 (plus TPA Fees & S/Tax)

Emp's Contbn.-                                    Yearly -                        33,246          (For S.I. - Rs. 10 lakh)                                                                              

       (41,855 - 8,609)

(plus TPA Fees & S/Tax)

RETIRED EMPLOYEE

Example for Calculation of Premium underStaff Mediclaim Policy on Floater Basis 

Sum Insured - Rs. 10 lak

 Eligible sum ins.4 lakh

Members          Relation           Age (Years)                  Amount(Rs.)                 Co's Contribution

A                      Self                   63                                11,292

B                      Spouse             55                                4,365                75% of Premium Payable

C                      Dep.Child 1       24                                1,913                up to Eligible Sum Insured

D                      Dep.Parent       85                                  9,213               ( for employee & spouse )

26,783 plus TPA Fees & Service Tax

Co's Contbn.-               75% of 15,657

(i.e 75%of A & B)          11,743

Emp's Contbn.-            Yearly -                        15,040.00              ( For S.I.-Rs. 4 lakh)

        (26,783-11,743)

  (plus TPA Fees & S/Tax)

Emp's Contbn.-            Yearly -                        30,112                   (For S.I. - Rs. 10 lakh)

        (41,855 - 11,743)

   (plus TPA Fees & S/Tax)

                                            IF YOU TAKE 10 LAKHS AND ELIGIBLE SUM INSURED 

                                                                      5LAKHS

Members          Relation           Age (Years)                  Amount(Rs.)                 Co's Contribution

A                      Self                  63                                 13,446

B                      Spouse            55                                 5,192                75% of Premium Payable

C                      Dep.Child 1      24                                 2,327                up to Eligible Sum Insured

D                      Dep.Parent       85                                 11,459              ( for employee & spouse )

            

32,424  plus TPA Fees & Service Tax

Co's Contbn.-               75% of 18,638

(i.e 75%of A & B)          13,978

Emp's Contbn.-            Yearly -                        18,446.00            ( For S.I.-Rs. 5 lakh)

       

          (32,424-13,978)

          (plus TPA Fees &ServiceTax)

Emp's Contbn.-            Yearly -                        27,877                 (For S.I. - Rs. 10 lakh)

          (41,855 - 13,978)

          (plus TPA Fees & ServiceTax)