A health insurance scheme proposed for bank employees under the 10{+t}{+h} bipartite settlement seeks to take away ‘the role of the third party administrator from the picture’ as requested by the unions.

This replaces the system of reimbursement of hospitalisation expenses/domiciliary treatment currently operated by individual banks.

KM Dastur, insurance and reinsurance brokers, has proposed to Indian Banks’ Association (IBA) the new system under which medical claims of bank employees will be settled by the company.

But employees will deal directly with the bank as is the position at present, the company wrote to the IBA in response to their concerns about dealing with a third party administrator.

Support system

Claims settlements too will be continued to be managed at bank locations, said the communication from the company which Business Line has access to.

The insurance company will set up a help desk as a support system for claims administration.

A customer relationship executive will be present at the desk to reply to any queries raised by employees and ensure smooth service. Other members of the desk include a data entry executive who will enter the claims into the insurance company’s software and a doctor for processing of claims.

Also, there will be a dedicated 24x7 call centre as a support system for queries, registration of claims and claims settlement.

Fresh policy

The policy has been categorised as a ‘Group health policy — family floater’. Employees, spouse, dependent children and two dependent parents or in-laws will be beneficiaries.

The total number of employees covered at the inception will be 7,43,832. The sum insured will be: ₹4 lakh for officers (3,04,090 in number); ₹3 lakh for clerical staff (3,08,175); and ₹2 lakh for sub staff (1,31,567).

Addition/deletion of mid joiners/leavers will be treated on a pro rata basis. Additions to cover will be provided from date of joining as mentioned in the appointment letter subject to a cash deposit account.

Change in sum insured after commencement of the policy is possible in case of promotion.

Expenses on new born will be covered under the family floater scheme. The policy also offers of coverage to employees on retirement.

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