TIME TO CARE FOR YOURSELF & YOUR FAMILY

     In our day to day routine life, we have lost so many dear friends and colleagues due to some untoward incidents as well as stress in our office life. During the crisis time or emergency it is our friends and savings that come to our rescue for immediate relief. But many a times, there are instances where in the long run, we are unable to meet the large expenditures on account of medical treatments, either of self or for a family member.  

       When crisis occurs everybody expects the organisation in which we serve to take care of our needs, which unfortunately do not have the flexibility/funds at the right time to meet these emergency needs, and we bear the brunt. 

       Many times, close friends and colleagues come forward to give help and support, both financial and physical and many are not lucky enough to have both. In the recent past many incidents have occurred which compelled CESA, Mumbai, to intervene to provide basic protection to the staff. After due deliberations CESA, Mumbai wants to lead and launch a Group Medical Insurance scheme for all the staff working in the Department, as a staff welfare measure.

       If you would like to participate in the Scheme, the salient features are given below. Kindly go through the same and fill up the online form with your & family details on or before 07-Sept-2015, so that the data can be forwarded to M/s. ICICI-Lombard for further process.

Proposal for Group Medical Insurance Scheme

General information

     In view of some of the untoward incidents of emergency hospitalization in respect of some colleagues in the recent past and the bad experience in respect of Supdt. Late Shri Kori, it is high time now that each one of us should be covered under a Mediclaim policy for meeting such exigencies.

 
2. For the benefit of all Superintendents, Inspectors and other willing staff members working in Central Excise & Service Tax, CESA, Mumbai, is planning to obtain a Group Medical Insurance Scheme from M/s. ICICI-Lombard for Rs. 3 to 5 Lakhs + an additional amount of Rs. 3 to 5 Lakhs per family per annum for Inspectors and Superintendents, respectively, covering the family members.

3. The benefits of a Group Medical Insurance from M/s. ICICI-Lombard are
as follows :-
     a. Largest network of CASHLESS Hospitals
     b. No claim intimation required.
     c. Best Online support.
     d. In House TPA to service the claims in better way.

4. Normally, the premium amount for Individual Policies (taken by individuals covering their family Policy (2 adults+2 children) for sum insured of Rs. 5 Lakhs are as shown 

Policy Type                         Premium for Individual

Age Band 35-45                             15,169/-

Age Band 46-50                             20,166/-

Age Band 51-55                             25,240/-

Age Band 56-60                             30,253/-

5. The following are the proposed Coverages in the Group policy as compared to an Individual policy :-
a) No Medical Check-up is required in GROUP Policy.
b) Pre-Existing Diseases are covered from day 1 in GROUP Policy where as in INDIVIDUAL there is waiting period of 2 Years.
c) Disease-wise limit is prescribed in INDIVIDUAL Policy where as in GROUP there is no such limit. For ex. Cataract.
d) Larger the group, more will be the discounting on premium, in GROUP Insurance. However, in INDIVIDUAL policy premium is fixed.
e) At the time of renewal, GROUP premium is calculated on claim experience, whereas in INDIVIDUAL Policy, premiums are fixed for a particular age band.
f) No Capping on ROOM RENT in GROUP Policy.
g) There is no waiting period in GROUP Policy, where as in INDIVIDUAL Policy waiting period of 30 days is applicable - once policy is in place, person can claim only after 30 days.

6. For those who are already covered by CGHS and / or already covered by an individual Mediclaim Policy, this can be an additional medical insurance policy which can be claimed over and above the individual Mediclaim policy, if the need arises.

7. This Group Medical Insurance scheme will be valid for one year, tentatively scheduled to begin coverage from the 01-Oct-2015 and will be valid upto 30-Sept-2016.

8. The only exclusion is that the Group Medical Insurance will not cover parents of the officers. Family only includes self, spouse, un-married daughters and sons upto the age of 25 years.

9. Another point of caution is that if any officer does not submit his existing spouse/family details at the time of joining the Group Medical Insurance scheme, the same cannot be added during the tenure of the current policy, i.e. upto 30-Sept-2016. However, if an officer gets married during the validity of the policy, the name of the spouse can be included in the Group Medical Insurance policy. The same principle applies to children born during the validity of the Group Medical Insurance policy.

10. Also note, the amount paid as premium for the Group Medical Insurance to CESA, Mumbai, cannot be claimed for deduction/abatement under Income Tax.

11. If an officer retires on superannuation or opts for VRS during the validity of the Group Medical Insurance policy, the period of cover will extend till the expiry of the group policy.

12. This Group Medical Insurance will be available to all the Superintendents / Inspectors at an annual cost of Rs.12,000/- to Rs.15,000/- approximately (amount to be finalized by M/s. ICICI-Lombard after submission of details/data of family of willing members), as against the cost of Rs.25,000/- to Rs.30,000/- for a family of four when taken on an individual basis. The total amount of premium will depend on the number of members in the group. Higher the number of members in the group, lesser will be the premium to be paid by each family.

13. The manner of collection of the premium amount can be done through submission of a cheque, favouring CESA, Mumbai. In future, if the majority of the members are willing, the amount can be deducted from their salaries on a monthly basis through standing instructions to the CAO of the respective Commissionerates, for credit to the CESA, Mumbai, bank account, or yearly submission through cheque will continue. 

14. It may be noted that the Insurance company, namely M/s. ICICI-Lombard, will not deal with individual officers/staff of the Department for the collection of premium amount, but will deal only with the employees’ association, namely CESA, Mumbai. A single cheque for the total premium will have to be issued by CESA, Mumbai, to the insuring company, for the commencement of the Group Medical Insurance scheme. 

15. It may also be noted that all claims for re-imbursement of medical expenses are to be directly submitted to M/s. ICICI-Lombard, whose decision will be final. CESA, Mumbai, has no role to play in the submission, processing or finalizing of medical claims.

16. Another aspect that requires attention is that if the total re-imbursement of claims by the members of the group during the insurance period is more than the total premium paid for the Group Medical Insurance, then next years’ premium amount to be paid by the officers will proportionately increase. 

17. Important :- All those who are interested in availing the said Group Medical Insurance scheme from M/s. ICICI-Lombard, may kindly submit their details online by accessing the form available on the Mumbai Service Tax website (www.servicetaxmumbai.gov.in) as shown below :-

Website of Service Tax Mumbai Commissionerate
    - then select “Service Tax-I Mumbai Commissionerate”
    - then select “Departmental Officer”
    - then select “Associations”
    - Proposal for Group Medical Insurance - Gen. Information
    - Form for submission of Officers’ Details.

18.  If this scheme is a success, then CESA, Mumbai will plan to obtain a Group Medical Insurance policy for all the retirees and their spouses, who are residing in and around Mumbai, the details of which shall be informed later. 

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