Medical Insurance Scheme for Retired Officers/Employees Hospitalization
Mr. S. Ramamchandran has sent a letter dated 29th July, 2016 addressed to Shri P.S.Jayakumar, MD & CEO of Bank of Baroda on the subject of non-reimbursement of medical bills submitted as per banks circular, which was issued by the bank as per MoU arrived between the bank & UFBU & IBA. Mr. Ramachandran states that it is a matter of regret, that it appears that the United India Insurance Co. has reneged on its earlier contract, and if that is the case, then it is for the IBA to sort out the issue without putting the retirees through the difficulty. The IBA was in the forefront while dealing with the Insurance Co. and, therefore they should take up the responsibility.
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He further states that neither IBA is taking the responsibility nor the Bank management of BoB, which has issued the Circular No. BCC/BR/107/555 dated 10th November,2015, is taking the responsibility and settling the medical claims, though nearly more than eight months have passed from the date of issuing the insurance policy and banks circular and the retirees are put to financial difficulty and mental agony.
We hereby provide you the details of the letter, and hope that the readers can express their views accordingly below:
RE:- REMEDICAL INSURANCE SCHEME FOR RETIRED OFFICERS/EMPLOYEES;PROCEDURE FOR HOSPITALIZATION –DOMICILIARY TREATMENT-MY PENDING CLAIMS OVER Rs. 93000/- SUBMITTED TO THE BANK
Thanks for Mr Jani, DGM HR OPERATION e mail of 18th July 2016 on the issue of reimbursement of my various bills relating to domiciliary treatment.
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At the outset, I am amazed at the similarity in the reply sent by him now with that of the reply received from the Executive Director Mr. Joshi, vide his letter No. BCC/HRM/108/i-21/2058 sent way back on 25th February 2016. Both have emphasized that the issue regarding reimbursement of claims under domiciliary treatment is "under discussion between IBA and Insurance Company". I am unable to understand the rationale for the inordinate and inexplicable delay in settling an important matter concerning the retirees especially when everything is in black and white. In fact the Executive Director has in unequivocal terms admitted that "the medical insurance policy for retired employees circulated by the Bank is arrived at by IBA with United India Insurance co. Ltd. In the policy which the bank is referring for, the aspect of coverage of domiciliary treatments even for retired employees were crystal clear. Even in the presentation made to the IBA and the UFBU, the domiciliary treatment was covered for retirees. It is only after an after-thought, the insurance company has reneged from their contractual obligation. It is because of this, the UFBU who are one of the signatory to the insurance contract has been racking up this issue time and again. Since, the domiciliary treatment was covered in the MOU the Bank has issued the circular and is now taking up with the IBA.
Even during my meeting with you on 14th March,2016 at Pune, you promised me that on going back to Mumbai, you would take up the matter with Mr. Tankasale - CEO OF IBA AND THE CHAIRMAN OF UNITED INSURANCE CO in the matter and resolve the matter with in a period of one month and in the worst scenario you would pay the bills to the debit of the banks profit and loss account. This assurance given by you was confirmed by me to you vide my email dated 15th April,2016.
Apart from the above it may be noted that I had sent several emails to you such as dated 18-11-2015, 7-1-2016, 27-1-2016, 6-2-2016, 7-3-2016 and 14-7-2016 on the above subject but regret to state that you preferred to remain silent in spite of the fact that bank was deficient in services as assumed in the banks circular dated 10th November,2015.
By end of October, the one year term of the policy is coming to an end and hence it is necessary that the issue is sorted out without further procrastination. Banks' reply sounds as if it is Indo- Pak dialogue which is lingering for ages.
To recapitulate, I have to state that the Bank has issued the circular No. BCC/BR/107.555 dated 10th November, 2015 which was published on its website wherein it is categorically stated that domiciliary treatment is covered. The bank has issued this circular based on a copy of the memorandum of understanding of IBA and the Insurers. Hence, everything is in black and white. We therefore do not see any rationale in prolonging the discussion. The contract of Health Insurance cannot be rescinded arbitrarily. If the insurance company has reneged on its earlier contract, it is for the IBA to sort out the issue but without putting the retirees to difficulty. The IBA was in the forefront while dealing with the Insurance Company and therefore, they should take up the responsibility. It is for this reason, we have been shouting from the roof top to stop accepting the advice of IBA which is an un-registered and non – professional body without any responsibility and accountability.
The presentation made by the insurers clearly and categorically showed that domiciliary treatment is covered both for the serving and retired employees. The same was incorporated in the MOU. It is ironical that the coverage for retirees have been stealthily deleted which is against all cannons of justice and fair play. The Bank should have immediately taken up the issue in the IBA Managing committee meetings and forced for an immediate resolution of the issue. Strong arm tactics of the insurers should have been highlighted to the top management of the insurers including their Board which would have given positive results.
Since in the circular issued by the Bank, there is no ambiguity as far as coverage of domiciliary treatment is concerned, it is necessary that the bank should reimburse the amount and claim the same from the insurance company or the IBA.
In this context, I REQUEST YOUR ATTENTION TO THE PROVISIONS OF “CONSUMER PROTECTION ACT 1986. ACCORDINGLY I AM CONSUMER OF THE BANK FOR WHICH I HAVE PAID THE PREMIUM/FEES IN PURSUANCE OF BANKS CIRCULAR NO BCC:BR:107:555 DATED 10TH NOVEMBER,2015 FOR AVAILING THE SERVICES OF HEALTH INSURANCE POLICY.
It is crystal clear in spite of compliances of all the formalities by the undersigned as a consumer ,by not sanctioning my claims bank is deficient in services as assumed in the above banks circular no BCC:BR:107:555 DATED 10TH NOVEMBER,2015.
In view of the above I request you to sanction and release ally my claims within 30 days from the receipt of my this communication and also order the head office to pay my future bills that I will be submitting for treatment of self and my wife till the expiry of policy on 31-10-2016.
About the Author: (Mr. S Ramachandran is a former GM, BoB & is a Pensioner)
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