Draft on Health Insurance!

NATIONAL CO-ORDINATION COMMITTEE

OF PENSIONERS ASSOCIATIONS..

Website: nccpahq.blogspot.in.

E mail: nccpahq@gmail.com.

13.c Feroze Shah Road,

 New Delhi. 110 001

PRESIDENT:       COM.SHIV GOPAL MISHRA.(97176 47594)

SECy. GENERAL:          COM.K.K.N.KUTTY. (98110 483030)

Dated: 2^nd December, 2019

To

All the National Secretariat members of NCCPA.

Dear Comrades,

              

As discussed at the last conference held at Jaipur, we are circulating a draft health insurance proposal for discussion at the National Sectt. meeting to be held at Delhi on 15^th December, 2019.  We are placing this on the website and SMS will be sent to all.  The members may cause a discussion with the experts in the field and  at the respective organisational fora before 15^th. 

With greetings,

yours fraternally,  

KKN Kutty.

Secy, General.

The 7^thCPC, in line  with all its earlier Commissions had recommended the need to have health insurance scheme for pensioners either as a supplementary benefit or as one in replacement of the existing one. The CGHS with all its ailments and deficiencies are looked upon by the beneficiaries with affection. The large number of the present beneficiaries, consider it as a scheme, beneficial and not to be replaced.   However, large number of pensioners is beyond the pale of CGHS. The insurance scheme is recommended as an alternative, for the Government as an employer can escape from its responsibility and the exchequer will be freed of financial outflow on health care related issues. In the absence of any scheme, the pensioners who are covered by CS (MA) Rules, are virtually left out of  health care. They are presently entitled for a pittance of allowance which satisfied none.   The following is a proposal that has emanated from the discussions we had with pensioners, who stay in non CGHS areas and are not covered even by the CS(MA) Rules.  In the longer run, we feel that even the CGHS beneficiaries will either opt for this or opt as an additional benefit. 

The proposed scheme covers only for in-patient treatment and the pensioner will have to eke out from his pocket for out-patient treatment.

1.   1.                      Govt. will float a tender for the insurance companies to part-take in the scheme.

2.                      The annual premium, a pensioner/ an employee as the case may be will be equivalent to 75% of the fixed medical allowances.

3.                      In the case of pensioners who opt for the schemes the Govt. might deduct the premium from the FMA and will remit the same to the Insurance Company.

4.                      There will not be any age bar for the policy holders.

5.                      The insurance coverage will be similar to a group Insurance scheme. The more the number in the group less will be the premium.  Therefore there will have to be a clause for reduction of premium when the group coverage increases.

6.                      In the case of pensioners who opt for the scheme shall not be treated as a defaulter for non receipt of the premium on account of administrative lapses on the part of the concerned government offices. The insurance company may think in terms of penal clauses whereby the employer will have to pay compensation to the company in case of default

7.                      The sum assured has to be Rs 15 Lakhs for a premium of Rs 9000 per annum.

8.                      The assured amount can be increased depending upon the number of pensioners registered in the group.

9.                      The insurance company while offering the tender shall indicate the name and address of the hospital in each town/city with whom they will enter into the agreement.

10.                  All policy holders shall be given identity cards by the Insurance Company showing of which must enable them to get admission and in-patient treatment in the hospital.

11.                  The scheme must have a residency period initially for 5 years and renewed thereafter on fresh terms and conditions.

12.                  The Insurance premium will get automatically increased as and when the FMA quantum is increased by the Govt.

13.                  The insurance company may offer higher coverage and higher premium for chronic diseases.

14.                  In the case of patients suffering from chronic diseases a scheme may be drawn out where by the patient might get the post hospitalization medicines at cost price.

15.                  For the working employees the scheme may be optional and for pensioners outside the ambit of CGHS mandatory.

16.                  The Govt as the employer will function as regulator and shall co-ordinate with a view to bring in larger number policy holders in the group

17.                  Since the premium is related to FMA which is constant in the case of all pensioners, the policy coverage will have to be the same for all beneficiaries.

18.                  The conference/ National Executive, as and when it is found the proposal is worth considering shall appoint a  committee to finalize the scheme with in-puts from the experts in the Insurance industry

* All affiliates are requested to respond and approve this draft together with any modifications before 31.12.2019. - KKN.