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.
(19,656 - 8,609)
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 1st 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
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)
(plus TPA Fees &S/Tax)
Eligible S.I. - 3 lakh
Members
Relation Age (Years) Amount
(Rs.) Co's Contribution
(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)
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