TAILORMADE GROUP MEDICLAIM POLICY (RETIREES) ISSUED BY UNITED INDIA INSURANCE COMPANY LIMITED FOR THE PERIOD

01.11.2016 TO 31.10.2017

We are pleased to inform all our members that under instructions from Indian Banks Association, United India Insurance Co. Ltd. communicated to our Bank regarding renewal of Group Insurance Policy for retired employees for the period 01.11.2016 to 31.10.2017 (both days inclusive) with following two options:

1. Renewal WITHOUT DOMICILIARY TREATMENT COVER.2. Renewal WITH DOMICILIARY TREATMENT COVER ( a separate list

containing name of diseases covered is put at Annexure 1)

The premium amount is as under:

WITHOUT COVERAGE OF DOMICILIARY TREATMENT : (POLICY NO.5001002816P112955673)

COVERAGE PREMIUM SERVICE TAX TOTAL

RETIRED OFFICERS / SPOUSE OFRETIRED OFFICERS

Sum InsuredRs. 4 Lacs Rs. 13935/- Rs. 2090/- Rs. 16025/-

WITH COVERAGE OF DOMICILIARY TREATMENT : POLICY NO.5001002816P112960858 – with Domiciliary

COVERAGE PREMIUM SERVICE TAX TOTAL

RETIRED OFFICERS / SPOUSE OFRETIRED OFFICERS

Sum InsuredRs. 4 Lacs Rs. 17400/- Rs.2610/- Rs. 20010/-

Please note that the retirees covered under the policy for 01.11.2015 to 31.10.2016 were only eligible to renew the policy.

It was also clarified that those desirous to renew the policy WITHOUT coverage of DOMICILIARY TREATMENT need not have to submit any separate option form but those desirous of opting for WITH COVERAGE OF DOMICILIARY TREATMENT HAVE TO SUBMIT OPTION FORM TO Medical Insurance Cell, HO Mandvi, Baroda. If no option is submitted within the stipulated time (i.e. 15-12-2016), it would be presumed that they are not willing to opt for coverage of domiciliary treatment and accordingly their premium was debited.

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Once the option is submitted change of option will not be allowed during the policy period.

The domiciliary expenses ceiling will be Rs.40,000/- for Officers and their spouses which will be under the overall ceiling of Rs.4,00,000/-.

THE MODALITIES/ RECEIVED FROM INSURANCE COMPANY FOR SUBMISSION OF CLAIMS FOR DOMICILIARY TREATMENT

1. OUR BANK HAS TAKEN A DECISION THAT ALL CLAIMS OF RETIREES TO BE SUBMITTED TO MEDICAL INSURANCE CELL, HEAD OFFICE, MANDVI, BARODA.

2. In any case, the claim form and documents SHOULD NOT be submitted to local office/representative of DHS or our Pension Paying Branch.

3. United India Insurance Company Limited has advised that claims for domiciliary treatment should be submitted on MONTHLY BASIS and the same should be submitted by 15th of the succeeding month.

4. The cover containing the claim form and documents for domiciliary treatment should be superscribed “CLAIM FOR REIMBURSEMENT OF DOMICILIARY TREATMENT – RETIREE”.

Form to be used- Only Part A of the form for hospitalisation (appearing on Page 38-39 of our Member’s Handbook covering Insurance Schemes)) is to be used.

Please write on the top of the form ‘Claim for Domiciliary Treatment (Retiree).’

Positively mention your EC Number alongside.

Documents to be attached –

1. Copy of the ID card issued by United India Insurance Company Limited through Dedicated Healthcare Services TPA (India) Private Limited (DHS). We understand that DHS is not sending new cards this year. While last year’s card is valid subject to renewal for the period 1-11-2016 to 31-10-2017, we recommend that officers should download the card for the period 1-11-2016 to 31-10-2017 from the website following the instructions given in the attached annexure-II.

2. Original prescription should be attached with the claim form. Name of the disease should be mentioned in the prescription. If no period has been mentioned in the prescription, it will be valid maximum for 3 months only. In case the prescription is valid for more than 3 months, the Doctor’s certificate mentioning the disease and treatment required for life time on continuous basis is a must for submission with each claim. Such certificate will be valid only for 1 year from the date of issue.

3. In case of continuous treatment beyond 1 month, the claim for the second month onwards should be accompanied by self attested Xerox copies of prescription and certificate. On these Xerox copies it should be mentioned that the originals were submitted to DHS on a particular date of the first claim during the validity of the policy period.

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4. For continuous and life long treatment, the Doctor’s certificate should clearly indicate name of the patient, name of the diseases and that it requires long term follow up and treatment on regular basis. This certificate should be signed by the attending Doctor and his rubber stamp should be affixed.

5. Every pathological or investigative report (Blood test, x-ray, CT Scan, etc) should be supported by the Doctor’s advice to undergo the tests. The Doctor’s advice for undergoing test, the test reports and films/CDs should be submitted in original with the claim. If these papers are required back after settlement of the claim for your record, a request to that effect should be submitted in writing with the claim.

6. Original Pharmacy bills for medicines purchased should be in printed format complete in all respects.

7. Original receipts for (1) Consultation Fees paid to the Doctor and (2) laboratory/investigations should be submitted in printed form having serial number.

8. A cancelled cheque of the account from which premium was deducted.

DOMICILIARY TREATMENT REIMBURSEMENT FOR THE PERIOD 01.11.2015 TO 31.10.2016

As in the First year of policy domiciliary expenses were not reimbursed by the Insurance co. The matter was placed before Bank's Board and it was decided to reimburse domiciliary treatment expenses for the period 1.11.2015 to 31.10.2016 only on humanitarian and sympathetic grounds. There will not be any precedence or liability on Bank for future domiciliary or hospitalisation expenses and the same shall only rest with the Insurance co. as per the policy in vogue.

Procedure for claiming the reimbursement of domiciliary treatment undertaken during 01.11.2015 to 31.10.2016

1. Claim form for Hospitalization Part A is to be used even for Domiciliary Treatment claims. Claims under Domiciliary treatment. Mention EC Number on the top right hand corner of the claim form.

2. Original prescription of the Doctor.3. Bills for the medicines purchased.4. Consulting Doctor’s original consultation fees receipt.5. Pathological and other tests if done, the original reports and original

receipts for the payment made. It is advisable to retain photocopies of the papers submitted to the Bank for reimbursement.

Claim for Domiciliary treatment undertaken during the period 01.11.2015 to 31.10.2016 is to be submitted to Bank of Baroda, Medical Insurance Cell, Head Office, Mandvi, Baroda.

It is also decided that an amount of Rs.3,000/- on full / prorata basis per annum shall be reimbursed towards medical insurance paid by such Retired(Superannuated),/ Voluntary Retired Employees/ spouse of deceased employees from the Bank's Staff Welfare Fund and the same is reimbursed directly in the account of Policy holder on 28.12.2016.

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Our Bank's Board has further approved that the said amount of Rs.3000/- will also be reimbursed to eligible retirees / spouse of deceased employees mentioned above who have taken ANY OTHER MEDICAL INSURANCE POLICY FROM ANY OTHER INSURANCE COMPANY. However, in any case, the reimbursement would be restricted to Rs.3000/- per eligible retiree/ spouse of deceased employee.

Those who opt to take any medical Insurance policy from any other Insurance Company may submit their claims for reimbursement DIRECTLY to Head Office in the proforma attached as per Annexure A.

Checking Claim Status –

The status of the claims submitted can be checked from the website of IBA.DHS-India (iba.dhs-india.com). Generally, it takes around 30 days to settle the claim. Any query on your claim will be uploaded by the TPA on the above website and one can see the query by logging to the website using Login ID “BOB***** (***** stands for your EC No) and password as ‘BOB*****’ (***** stands for your EC Number). Reply to query should be submitted with documents wherever necessary to Medical Insurance Cell, Head Office, Mandvi, Baroda.

CLAIMING REIMBURSEMENT OF HOSPITALISATION EXPENSES FROM TWO OR MORE INSURANCE COMPANIES:

In case the limit of insurance policy under IBA Medical Insurance Scheme is insufficient to cover expenses incurred on hospitalisation, the excess paid can be claimed from other insurance company if the officer has another insurance policy covering medical expenses. The officer has to send intimation of hospitalisation to both – DHS as well as other insurance company. The officer has to submit all original papers, after retaining a copy of the entire set, to DHS TPA and inform them that the excess will be claimed from other insurance company. On settlement of the claim within the limit, the officer should obtain a certificate of settlement of claim and amount rejected as it exceeded the insurance amount from the DHS. Thereafter, another claim form in the format prescribed by the other insurance company should be submitted to the TPA of that company with the set of Xerox copies and the original certificate of settlement of claim by DHS.

CASHLESS HOSPITALISATION

Cashless hospitalisation is preferred as the reimbursement procedure will be completed by the hospital concerned. The network hospital should be advised to send proper intimation of your cashless hospitalisation to DHS.

The list of network hospitals as appearing in the kit provided by DHS is not final and this list keeps changing. It is advisable to check the latest list of network hospitals from IBA-DHS website.

GIPSA HOSPITALS:

There are two types of NETWORK HOSPITALS. One is GIPSA PPN (i.e. GENERAL INSURANCE PUBLIC SECTOR ASSOCIATION, PREFERRED PROVIDED NETWORK) and other one is NON GIPSA NETWORK HOSPITALS.

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GIPSA NETWORK HOSPITALS provide treatment based on rate schedule contracted with all the Insurance Companies, whereas NON GIPSA Network Hospitals DO NOT follow the said rate schedule but are registered as Network Hospital to provide CASHLESS TREATMENT to Policy Holders. Generally, charges of GIPSA network hospitals are comparatively lesser than non-GIPSA hospitals.

It is therefore advisable to prefer GIPSA network hospitals, wherever available and possible as their bills will consume lesser amount from your total insurance limit. This will also go a long way in maintaining lower claim ratio and hence the rise in premium in future will be less.

The list of GIPSA network hospitals will be put up shortly on IBA-DHS website (www.iba.dhs-india.com). Meanwhile, our Head Office has sent the list to all the branches. This list will also be uploaded on our Association’s website.

OTHER HEALTH INSURANCE POLICIES:

In case you have another health insurance (mediclaim) policy, it is advisable to continue the same as cost of medical treatment is rising rapidly.

(This note is updated up to 6th January 2017)_______________________________________________________________________________

ANNEXURE I

LIST CONTAINING NAMES OF DISEAES COVERED FOR DOMICILIARY TREATMENT

Cancer , Leukaemia, Thalassemia, Tuberculosis, Paralysis, Cardiac Ailments , Pleurisy , Leprosy, Kidney Ailment , All Seizure disorders, Parkinson’s diseases, Psychiatric disorder including schizophrenia and psychotherapy , Diabetes and its complications, hypertension, Hepatitis –B , Hepatitis - C, Haemophilia, Myasthenia gravis, Wilson’s disease, Ulcerative Colitis , Epidermolysis bullosa, Venous Thrombosis (not caused by smoking) Aplastic Anaemia, Psoriasis, Third Degree burns, Arthritis , Hypothyroidism , Hyperthyroidism expenses incurred on radiotherapy and chemotherapy in the treatment of cancer and leukaemia, Glaucoma, Tumor, Diptheria, Malaria, Non-Alcoholic Cirrhosis of Liver, Purpura, Typhoid, Accidents of Serious Nature , Cerebral Palsy, , Polio, All Strokes Leading to Paralysis, Haemorrhages caused by accidents, All animal/reptile/insect bite or sting , chronic pancreatitis, Immuno suppressants, multiple sclerosis / motorneuron disease, status asthamaticus, sequalea of meningitis, osteoporosis, muscular dystrophies, sleep apnea syndrome(not related to obesity), any organ related (chronic) condition, sickle cell disease, systemic lupus erythematous (SLE), any connective tissue disorder, varicose veins, thrombo embolism venous thrombosis/venous thrombo embolism (VTE)], growth disorders, Graves’ disease, Chronic obstructive Pulmonary Disease, Chronic Bronchitis, Asthma, Physiotherapy and swine flu shall be considered for reimbursement under domiciliary treatment.

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ANNEXURE-II

DHS – IDENTITY CARD

DHS is not sending Identity Cards for the Insurance period 01.11.2016 to 31.10.2017. DHS Identity Card Number remains the same for this year also as it was for the Insurance period 01.11.2015 to 31.10.2016 but validity will be from 01.11.2016 to 31.10.2017.

However such cards are uploaded by Dedicated Healthcare Services TPA (India) Pvt. Ltd. (DHS) on their website www.iba.dhs-india.com members can download the same.

Procedure for down loading Identity Cardo Go through Internet Explorero Open website www.iba.dhs-india.como Click on DHS INDIA WEBSITEo Click on Insured Logino Insert User ID as BOB***** (***** stands for your Employee Code Number)o Insert Password as BOB***** (***** sands for your Employee Code

Number)o (In short User Id and Password will be same)o Click on Print All E-cards togethero Click on Print Now option to get your Identity Cardo In case some members are not familiar with computer, they can either

take help of their friends or can approach Cyber Cafe and get their cards printed with normal charges.

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