punjab national bank no. 509 21.01.2009 hrd ... - Pnbnet.net.in

PUNJAB NATIONAL BANKHUMAN RESOURCES DEVELOPMENT DIVISIONHO : 7, Bhikhiji Cama Place, New Delhi – 110066HRDD CIR.NO. 50921.01.2009TO ALL OFFICESHRD DIVISION CIRCULAR NO. 509REG: INTRODUCTION OF NEW PNB MEDICLAIMINSURANCE SCHEME FOR RETIRED EMPLOYEES 2009-10We have been receiving representations from variousassociations of retired employees/officers demanding formulation ofsuitable scheme for retired employees under Staff Welfare.Accordingly, Board in its meeting dated 14.01.2009 has approved ascheme ,to be named as, ‘’New PNB Mediclaim Insurance Schemefor Retired Employees 2009-10’’, for providing subsidy @ Rs.2500/- to retired employee on being member of the scheme, detailsof which has been given in Annexure I.2. A PNB Medi-Claim Insurance Scheme for Retired Employeesthrough the New India Assurance Co. Ltd. as circulated vide HRDDCircular No. 220 dated 14.09.2004, is in operation which is beingrenewed on calendar year basis i.e. 1st January to 31 st Decemberevery year. At present, the scheme has been renewed for the year2009.3. As per decision of the Board, Bank shall reimburse a sum ofRs.2500/- as subsidy to each member of the existing scheme i.e.PNB Mediclaim Insurance Scheme for Retired Employees, which are1384 at present.1

4. In order to provide subsidy to the new members/entrants, ithas been decided to introduce a new scheme named ‘’New PNBMediclaim Insurance Scheme For Retired employees 2009-10’’to be effective from 1 st April 2009 to 31 st March 2010 for those retiredemployees who are not member of the PNB Mediclaim InsuranceScheme for Retired Employees 2009 and who will be retiring upto31 st March 2009.5. The terms and conditions as applicable to the existingscheme and , as circulated vide HRDD Circular 504 dated12.12.2008 shall also be applicable to the new scheme named as ‘’New PNB Mediclaim Insurance Scheme for Retired Employees2009-10’’.6. The premium payable under the New PNB MediclaimInsurance Scheme for Retired Employees 2009-10, afteradjustment of subsidy @Rs.2500/- per member shall be as under:SumInsuredPremiumUpto 70 yrsPremiumAbove 70 &upto 80 yrs(Rs.)PremiumAbove80 yrs(Rs.)(Rs.)Rs. 1 lac 1,973 2,420 2,868Rs. 2 lacs 6,196 7,066 7,935Rs. 3 lacs 10,024 11,276 12,5297. The Salient features of the Scheme are as under:‣ All the members shall have the option to opt for the sumassured i.e. Rs. 1 lac, Rs. 2 lacs and Rs.3 lacs irrespective oftheir scales/cadres.‣ This option shall be One Time and Irrevocable. The schemewill be on First Come First Serve Basis. The details of thenew scheme are given in Annexure I of this Circular.‣ Mid term inclusion to the membership of the scheme isapplicable in case of retiring employees only any time duringthe year, on the payment of pro rata premium on half yearly2

asis. In such cases insurance coverage would be availableupto 31 st March during the currency of the scheme.8. The retired employees who are desirous of becoming memberof the above scheme are requested to submit their duly filledapplication in the format (Annexure II) latest by 1st March 2009alongwith prescribed yearly premium in the form of CBS cheque orDD payable at CDPC, Delhi favouring “New PNB MediclaimInsurance Scheme for Retired Employees 2009-10” to Asstt.General Manager, HRD Division, HO: 7 Bhikhaji Cama Place NewDelhi 110066. Applications received without necessary amount andprescribed format will not be entertained.9. The amount of subsidy for the next year shall be reviewed afterassessing the response of the employees vis-à-vis funds available.10. All claims under the above scheme are to be submitted to theTPA i.e. M/s Raksha TPA Pvt. Ltd., 15/5 Mathura Road, Faridabad –121003 directly and under no circumstances the same will be routedthrough the bank.11. Copy of this circular is available on website “pnbnet.net.in”12. All the branches are advised to get this circular noted from theretired employees who are drawing their pension from that branch. Acopy of this circular be also displayed on their Notice Board.ASSTT. GENERAL MANAGER3

ANNEXURE INew PNB Mediclaim Insurance Scheme for Retired Employees 2009-10.1. TITLE :The Scheme shall be called New PNB Mediclaim Insurance Scheme forRetired Employees 2009-10.2. ELIGIBILITY :a) Officers and employees retired from the Bank’s servicei. On attaining the age of superannuationii. Under the bank’s voluntary retirement scheme.b) Employees retired on medical ground are not eligible.c) Retiring officers and employees can opt for the scheme at the timeof their retirement.d) In case of the death of an employee during his/her service period orafter his/her retirement, the option to join the membership of the PNBMedi-claim Insurance Scheme for Retired Employees shall remain openfor the spouse of the said employee.e) Officers/employees who have been discharged/ dismissed/ removedfrom service/ compulsorily retired or terminated on grounds ofmisconduct will NOT be eligible.f) The scheme shall on First Come First Serve Basis3. WHEN TO OPT FOR THE SCHEMEMembership to the scheme is optional subject to the fulfillment of theeligibility criteria stated under point no. 2 above.Membership is permitted only at the time of renewal of the scheme eachyear which is valid separately for each calendar year.4

Membership to the scheme cannot be opted for during the currency of apolicy during the year, except for those employees who retire during thatyear and opt for membership of the scheme for the remaining part of theyear.4. PERSONS COVERED UNDER THE SCHEMEThe benefits of the scheme is allowable only to the ex employees and his/herspouse.5. AGE LIMITThere is no lower / upper age limit for joining the scheme. However, thepremium required to be paid for membership to the scheme is related to theage of the beneficiaries.6. OBJECTIVE :The scheme has been floated with a view to provide assistance to the retiredemployees of the Bank and their spouses, which makes them eligible to seekreimbursement of hospitalisation expenses incurred anywhere in India atany time during the currency of the scheme. Beneficiaries under the schemeare covered for incidents/eventualities that may result in injury or disease/illness leading to hospitalisation including admission to a nursing home.Expenses with respect to pre-hospitalisation and post hospitalization arealso covered under the scheme as per details below.7. OPERATION OF THE SCHEMEThe medical insurance cover under the scheme shall commence from 1 stApril 2009 and would be valid upto 31 st March 2010. Details of thepremium to be paid is available at point no. 10 .8. DEFINITIONSThe following words, terms or expressions wherever they may appear inthis Scheme or even otherwise shall be deemed to have meaning expressedhereunder:-a) Member : Shall mean a member of PNB Mediclaim Insurance Schemefor Retired Employees.5

) Hospital/Nursing Home : Would mean any institution in IndiaEstablished for Indoor care and treatment of sickness and injuries andwhich has been registered as a Hospital or Nursing Home with the localauthorities and is under supervision of a Registered and qualified MedicalPractitioner. The Hospital or Nursing Home shall not include anestablishment which is a place of rest, a place for the aged, a place fordrug-addicts or place of alcoholics, a hotel or a similar place.c) Surgical Operation : Would mean manual and / or operative proceduresfor correction of deformities and defects, repair of injuries, diagnosis andcure of disease, relief of suffering and prolongation of life.d) Minimum Period : Shall mean Expenses on Hospitalisation for minimumperiod of 24 hours are admissible. However, this time limit is not appliedto specific treatments i.e. Dialysis, Chemotheraphy, Radio therapy, EyeSurgery, Lithotripsy (Kidney stone removal), D & C. Tonsillectomy, iftaken in the Hospital/Nursing Home and the Insured is discharged on thesame day; the treatment will be considered to be taken underHospitalisation Benefit.d) Period of Hospitalisation : Shall include a maximum period of 7 daysas pre-hospitalisation and maximum period of 7 days as posthospitalization period.e) Disease : Shall mean any illness, disease or injury requiringhospitalisation.The following diseases/surgical measures are to be treated as specialoperations:i. Nephritis of any Aetiology plus Bacterial renal failure requiring KidneyTransplantation and / or Dialysis.ii. Cerebral or Vascular Strokes.iii. Open and Close Heart Surgery (inclusive of C.A.B.G. inclusive cost ofvalves, PTCA, Heart Failure.iv. Malignancy disease which were confirmed on Histopathological report.v. Encephalitis (Viral)vi. Neuro Surgeryvii. Total Replacement of joints.viii. Liver disorder (Hepatitis B & C) associated with complications likeCirrhosis of liver (excluding caused by Alcohol).6

ix.Grievous injury including multiple fracture of long bones, head-injuryleading to unconsciousness, burns of more than 40%, injury requiringartificial ventilatory support plus Vertebral Column injury.9. Domiciliary and Non Hospitalisation : Not covered(Except Chemotherphy/Radiotherphy/Dialysis)10. PREMIUM The premium payable under the New PNB MediclaimInsurance Scheme for Retired Employees after adjustment of subsidy@Rs.2500/- per member shall be as under:SumInsuredPremiumUpto 70 yrsPremiumAbove 70 &upto 80 yrs(Rs.)PremiumAbove80 yrs(Rs.)(Rs.)Rs. 1 lac 1,973 2,420 2,868Rs. 2 lacs 6,196 7,066 7,935Rs. 3 lacs 10,024 11,276 12,529The above premium amounts is inclusive of Service Tax.The amount of premium shall be negotiated afresh each year and may varyfrom year to year. Also, the amount of subsidy for the next year shall bereviewed after assessing the response of the employees vis-a-vis fundavailable.11. COVERAGE UNDER THE SCHEME :11.1 A member can opt for any sum insured i.e. Rs. 1 lac, Rs.2 lacs andRs.3 lacs irrespective of his/her cadre of retirement. This offer shall be‘One Time Option and Irrevocable’.11.2 The employees and officers has to specifically mention in their requestletter/ application form the amount of “ Sum Assured”.11.3 The Scheme which covers the member and his/her spouse provides asunder:7

Rs. 1 lac on floater cover basis for the member and his/her spousesubject to a maximum ceiling as under:‣ Hospitalization expenses for treatment of special ailments asindoor patient as specified in the scheme on production oforiginal bills/cash memos etc. – Max. Rs. 70000/-‣ Non surgical hospitalization expenses as indoor patient onproduction of original bills/cash memos etc. – Max. Rs.10000/.‣ Hospitalisation expenses for surgical interference as indoorpatient on production of original bills/cash memos etc. –Max. Rs.20000/- (including the cost of any surgicalimplant)‣ However, this sub limit in case of cataract operationincluding I.O.L. is maximum of Rs.5000/- only.‣ In case of cataract operation, sticker of lens used must beaccompanied with claims.‣ The sub limits enumerated would be applicable directly inproportion to the sum insured in multiples of Rs. 1 lac.‣ 7 days pre hospitalization and 7 days post hospitalizationexpenses are covered.‣ Pre existing disease allowed.‣ Hospitalisation / Admission on or after the date ofcommencement of the scheme is permissible. Personsalready admitted at the time of commencement of thescheme/policy, especially for that particular illness shall notbe covered.11.4. SUB LIMITS(Amt. in Rs.)Sum Insured 1,00,000 2,00,000 3,00,000Room Rent500 750 1000Maximum Per dayICU1500 2000 2500(Maximum Per day)Cataract Operation 5000 7500 1000011.5 Package charges for specialized treatment subject to insurance cover withdetails.8

12. EXCLUSIONS :The Company shall not be liable to make any payment under this policy inrespect of any expenses whatsoever incurred by any Insured Persons inconnection with or in respect of:a) Injury or Disease directly or indirectly caused by or arising from orattributable to War, Invasion, Act of Foreign Enemy, War likeoperations (whether war be declared or not).b) Circumcision unless necessary for treatment of a disease not excludedhereunder or as may be necessitated due to an accident, vaccination orinoculation or change of life or cosmetic or aesthetic treatment of anydescription, plastic surgery other than as may be necessitated due toan accident or as a part of any illness.c) Cost of spectacles and contact lenses, hearing aids.d) Any dental treatment or surgery which is a corrective cosmetic oraesthetic procedure, including wear and tear, unless arising fromdisease or injury and which requires hospitalization for treatment.e) Convalescence, general debility, “Run-down” condition or rest cure,congenital external disease or defects or anomalies, sterility, venerealdisease, intentional self-injury and use of intoxicating drugs/alcohol.f) All expenses arising out of any condition directly or indirectly causedto or associated with Human T – Cell Lymphotropic Virus type III(HTLB-III) or Lymphadinopathy Associated Virus (LAV) or theMutants Derivative or Variations Deficiency Syndrome or anySyndrome or condition of a similar kind commonly referred to asAIDS.g) Charges incurred at Hospital or Nursing Home primarily fordiagnostic, X –ray or laboratory examinations not consistent with orincidental to the diagnosis and treatment of the positive existence orpresence of any ailment, sickness or injury, for which confinement isrequired at a Hospital/Nursing Home.h) Expenses on vitamins and tonics unless forming part of treatment forinjury or disease as certified by the attending Physician.i) Injury or Disease directly or indirectly caused by or contributed to bynuclear weapons/material.9

j) Treatment arising from or traceable to pregnancy childbirth,miscarriage, abortion or complications of any of this, includingcaesarian section.k) Naturopathy treatment.13. PROCEDURE FOR MEMBERSHIPa) The eligible retired employees and officers as well as their spousesdesirous to become member of the scheme shall submit their duly filledapplication in the format (Annexure II) latest by 1 st March’2009alongwith a prescribed yearly premium in the form of CBS cheque orDD payable at CDPC, Delhi favouring “New PNB MediclaimInsurance Scheme for Retired Employees”. Applications receivedwithout necessary amount and prescribed format duly filled in andsigned will not be entertained. Those who are retiring they must sendtheir application alongwith prescribed yearly premium immediately ontheir retirement.b) Annual insurance premium for the subsequent years as per theprescribed rate to be decided by the Bank in negotiation with insurancecompany will continue to be paid in advance every year.14. MODE OF SETTLEMENT OF CLAIMa) Settlement of claims lodged by the members will be made by theInsurance Company through M/s Raksha TPA on the basis of claimsmade by the retired officers and retired employees/legal heirs as thecase may be, whose decision is final and binding. All claims shall besettled by the Insurance Company through its office as The New IndiaAssurance Co. Ltd., Divisional Office 311100, Bhandari House, 3 rdFloor, 91, Nehru Place, New Delhi – 110019.b) The application/enrolment forms for membership will be available atHRD Division, HO New Delhi besides being available at all Circle/Branch Offices of the Bank and can also be downloaded from bank’swebsite.All claims must be accompanied by Discharge Certificate and details/ breakup of hospitalization expenses.10

15. FALSE CLAIM / INFORMATION:In case any false claim / information is found to have been submitted by anymember at any stage, his/her membership shall be cancelled for all times andhe/she shall not be eligible for re-enrollment. Subscription paid willautomatically be forfeited and claim preferred if any will not be reimbursed. Insuch cases, any reimbursement already received by the member under the schemewill have to be refunded to the insurance company.16. GENERALa) The operation of the Scheme subject to availability of minimum requirednumber of retired officers and employees. The Bank has discretion todiscontinue the scheme at any point of time.b) Mid term inclusion to the membership of the scheme is applicable in case ofretiring employees only any time during the year, on the payment of pro ratapremium on half yearly basis. In such cases insurance coverage would beavailable upto 31 st March during the currency of the scheme.c) Modification/Amendment to the scheme is the sole discretion of the bank.11

ANNEXURE IIAPPLICATION/ENROLMENT FORM FOR NEW PNB MEDI CLAIMINSURANCE SCHEME FOR RETIRED EMPLOYEES 2009-10(To be sent latest by 01.03.2009 in case of retired employees and or immediately atthe time of retirement for retiring employees.The Asstt. General Manager,Punjab National Bank, HRD DivisionHead Office, 7 Bhikhaiji Cama Place,New Delhi.-110066For Office use onlyEnrolment No., _____Dear Sir/Madam, Please affix jointphotograph of self andspousePlease enrol me as Member of the above scheme to which I hereby opt. I have gonethrough the rules and regulations of the scheme and agree to abide by the rules andregulations of the same as may be modified / amended from time to time . Particularsabout myself and my spouse are given below:1. Name of Officer/Employee ________________________ 2. P.F No.____________(In Block Letters)3. Name of Spouse _________________________4. PPO No. _____________ 5. Name of the Pension Paying Branch _______________6. Father's/Husband 's Name_____________________________________________(In Block Letters)7. Date of Birth a) Self ______________ b) Spouse___________8. Date of retirement ___________________9. Office from which retired _____________________________Under CO/HO____________________________(Write the name)10. Designation & Scale at the time of Retirement _________________11. Sum Insured opted :12

12. Address for Communication : _________________________________________________________________________________________________13. Telephone No. _______________ Mobile No. ________________14. Type of retirement : (i) Superannuation (iii) Medical Ground (iii) Dismissed (iv)Compulsorily retired (v) Voluntarily retired under Officers’ Service Regulation (vi)Voluntarily retired under Pension Regulations) (viii) Any other(Attach documentary proof)15. I am enclosing herewith a CBS Cheque/ Draft No.__________________dated__________for Rs __________only favouring New PNBMediclaim Insurance Scheme for Retired Employees 2009-10 issued by the BO___________________ _ (D. No _________ ) drawn on Delhi. being my premium to theScheme . My CBS account no. is _____________________________. (16 digit)16. DECLARATION(i) I have read and understood the New PNB Mediclaim Insurance Scheme forRetired Employees 2009-10 and agree to abide by the terms and conditionsmentioned therein.(ii) The information given above by me is true to the best of my knowledge.(iii). I also undertake that if at any point of time, during the currency of mymembership of the scheme, the information submitted by me, either in relationto application form or hospitalisation claim preferred by me, is found to befalse/misleading, my membership to the scheme will be terminated without anynotice to me. The amount deposited by me towards my subscription of thescheme will stand forfeited and I will not be eligible to become member of thescheme again.(iv) I will inform the change of my address to the Bank immediately by RegisteredPost.v) Discrepancy/query reported after 30 days from the date of receipt ofsanction/rejection will not be entertained.Place_____________NOTE:_____________SIGNATURE OFRETIRED EMPLOYEE_______________SIGNATURE /T.I .OFSPOUSE1. Application form complete in all respects, must be sent to HO directly.2. Strike off whichever is not applicable.13