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)

Friends, 


We met the officers at GIPSA and the following are the excerpts of our discussion.


1) Companies are seriously considering to introduce Floater type policy in our Group Mediclaim and there will be increase in basic premium also as per the IRDA regulations. 


2) One more option for pension is in the pipeline and the companies are finalising their recommendations in this regard and the consolidated opinion will be forwarded to Ministry shortly. We feel some positive signs as the unions are also pressing for this. 


3) There is also a favorable thinking interms of Ex Gratia Pension as given to the Pre 1986 retirees to those who have opted for pension and did not complete the 20yrs clause but left with nothing. 


4)National has retained the 90% loading and the premium will be on the same line as before but for the service tax as it is to be adviced by Govt. after the budget. 


5) While implementing the floater type policy the companies may allow increase in coverage to all (only for those who are in the Staff Group Medi claim.) 


6) We have represented with the CEO to extend the facility of increase in coverage to United india and Oriental as they have done to New India and National. 

Our Case in Supreme court is to be listed and we are crossing fingers and waiting for the date.

We are again requesting each and every one of you to strengthen our finance as the case may come at any time by  paying the legal fund due and as well the subs.due.


with regards


NAGARAJAN
GENERAL SECRETARY

Dear Friends,
It is long time we have published any news.But the Association is active and going all over india to gather suppport for the cause financially and morally. We had been to Kanpur and Ludhiana in the North and in south almost all the places we have toured to garner support for us to fight the Case in Supreme Court. We have lot of positive news coming in from decisions taken in the Supreme Court on cases fought by the Pensioers. It is really encouraging the the Apex Court is giving positive verdicts especially on the cases of Pensioners. One such thing came recently in one of the cases against the Tamil Nadu Government, where it is decided that the pension should be enhanced and revised on par with the others. In Lic also the case has come to Supreme Court and sooner it will be heard and decided.
It is also encouraging that the Management of General Insurance Public Sector industry has taken a positive view of  one more option for Pension in the industry. We may come up with some good news later.
Our case is still not listed and we are checking up every day with the Registrar at Supreme court. Nothing can be done by us but for waiting for the case to be listed before the Bench.
We are now concentrating in building good finance to fight the case at the highest level and are happy to inform you that all the members are responding positively and slowly we are gaining funds to fight our final battle.
In Maduai Our Assn. has impleaded ourselves as a party and it is also coming up for hearing any time.

Our D A has increased by another 67 slabs and there is a proposal by the Management to improve the medical facility for the Pensioners also.
Nothing more to add,

V.A.NAGARAJAN
GENERAL SECRETARY

Dear friends,

The most expected time has come, and  our case is now sent for listing on 12th Sep,2012 and we were informed by our Cousels that all the formalities are over and we may get our date of trial within 3 months. The battle is almost over and we are in the final stages. 

What next?

We all should get together and fight the case with all our might and strength to match the Government and the management. Yes friends, we are facing a very mighty and powerful opponent.  We should match them in all fields especially in the appointment of Advocate/Advocates. For this, we should have the financial strength since the fees charged by the Senior Counsels are exorbitant.  Hence we all should shed our differences and join the fight led by NISVRREA by joining our Assn and contributing for the Legal fund. The time is too short and every one of our SVR optees should contact NISVRREA through E Mail or contact the following numbers over phone to join the Association. Our Email ID is gokul_van@yahoo.co.in and the numbers to be contacted are given below: 

V.A.Nagarajan General Secretary - 09444321613 

Dr.E.Rajagopalan Joint Secretary - 09840787850

We also met CEO of GIPSA on 11th of September 2012, and discussed with him all the pending points including the case with which we have clearly emphasised that we are the only litigants and any thing concerned with the case should be discussed only with us. Also we stressed the point of one more option for pension in the industry and other problems faced by the Retirees on Mediclaim reimbursement. 

The talks went on a positive note and we were adviced to make the same representation to the individual Companies. 

Last but not the least we again APPEAL to all the existing members to contact the SVR optees who did not join us to join now and take this final opportunity to participate in the fight for justice and pay the dues of subscription including the present request for the second additional legal fund of Rs. 1000/- and also donate liberally for the Association to fight the case. JUSTICE NEVER FAILS. 

with regards

GENERAL SECRETARY