Medical Reimbursement scheme for Bank Officers/Employees under 10th BPS

The new medical reimbursement scheme scheme covers all the existing employees/officers in the bank service and same would also be continued beyond their retirement/superannuation/ resignation etc., subject to payment of stipulated premium by them. New recruits will be covered from their  date of joining to the bank.  The scheme also includes the benefit of cashless treatment facility in hospitals covered by the scheme. The officers / employees need not be required to share the cost of such benefits under the new scheme.

The new Scheme would also cover the officers/employees retiring from the banks after the scheme is introduced as well the existing retired officers/employees of the Banks and dependent spouse subject to payment of stipulated premium by them.  The quantum of coverage for ex-officers is Rs. 4 lakh and ex-award staff is Rs.3 lakh. The quantum of contribution towards premium payable by the retired/designed staff will be decided by the individual banks. Till the new scheme is made effective and gets implemented, the existing provisions as per Bipartite Settlement dated 27.4.2010 will continue to operate.

Salient features of the Scheme

1.  The Scheme covers Employee + Spouse + Dependents + any two of the dependent Parents /Parents-in-law.
2. Hospitalization / domiciliary hospitalization and domiciliary treatment expenses will be reimbursed.
3. No age limit for dependent children (including step children and legally adopted children.
4. A child/parents/parents in law would be considered dependent if monthly income does not exceed Rs.10,000 /- per month.(Employees/officers, spouse, dependent children and two dependent parents or in-laws will be beneficiaries. Parents would be considered dependent if their monthly income does not exceed Rs.10000/- per month.
   If the income of one of the parents exceeds Rs.10000/-p.m or the aggrgate income of both the parents exceeds Rs.10000/-p.m, both the parents shall not be considered as wholly dependent on the employee
5. Widowed Daughter and divorced / separated daughters, sisters including unmarried / divorced / abandoned or separated from husband/widowed sisters.(viii) Physically/mentally challenged Brother / Sister with 40% or more disability shall also be covered as Dependent.
6. Reimbursement shall cover Room and Boarding expenses as provided by the Hospital/Nursing Home not exceeding Rs. 5000 per day or the actual amount whichever is less.
7. Reimbursement shall cover Intensive Care Unit (ICU) expenses not exceeding Rs. 7500 /- per day or actual amount whichever is less.
8. Reimbursement shall cover Surgeon, team of surgeons, Assistant surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists fee, nursing charges, Service Charges, Administration Charges, Nebulization Charges, RMO charges, Anaesthetic, Blood, Oxygen,Operation Theatre Charges, surgical appliances, OT consumables ,Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Cost of artificial Limbs, cost of prosthetic devices implanted during surgical
9. procedure like pacemaker, defibrillator, ventilator, orthopaedic implants, Cochlear Implant, any other implant, Intra-Occular Lenses, infra cardiac valve replacements, vascular stents, any other valve replacement, laboratory/ diagnostic tests, X-ray CT Scan, MRI, any other scan, scopies and such similar expenses that are medically  necessary or incurred during hospitalization as per the advice of the attending doctor.
10. Hospitalization expenses (excluding cost of organ) incurred on donor in respect of organ transplant to officers/ employee/dependent would also be covered for reimbursement. Pre- and Post- Hospitalization expenses payable in respect of each hospitalization shall be the actual expenses incurred subject to 30 days prior to hospitalization and 90 days after discharge.
11. Alternative systems of treatments other than treatment under Allopathy or modern medicine shall include Ayurveda, Unani, Siddha, Homeopathy and Naturopathy for Hospitalization and Domiciliary treatment.
12. Day care Treatments shall be covered under the scheme.
13. Domiciliary  Hospitalization shall be covered under this scheme and would mean medical treatment for an illness/disease/injury which in the normal course would require care
14. and treatment at a hospital but is actually taken while confined at home under any of the following circumstances :

• (i) The condition of the patient is such that he/she is not in a condition to be removed to a hospital or (ii) the patient takes treatment at home on account of non-availability of room in a hospital. (iii) Treatment taken for specified diseases which may or may not require. (iv) Domiciliary Hospitalization / Domiciliary Treatment : Medical expenses incurred in case of the following diseases which need Domiciliary Hospitalization /domiciliary treatment as may be certified by the recognized hospital authorities and bank’s ’medical officer shall be deemed as hospitalization expenses and reimbursed to the extent of 100%.