West Bengal State Electricity Distribution Co' Ltd'
(A Govt. of West Bengal Enterprise)
(lomorate Human Resource Department
twfotL
oF!-rcE oRDER NO.
P
DATED:
l32
19
-c6-20trt
introduce a Group Medical lnsurance Scheme lor its retired
with sum
*to tru. op,Ja fo-, th. sa*e, with united lndia Insurance company Limited
with
per
member
benefit)
(hospitalization
of IPD
".ptoy."r,
insured of Rs.1,56,0001 per annum in respect
functioning
policy
will
start
The
f""iU,V *'ith his,trer spouse with Floater Type operation
"irill"g
;;.;. ii trr, Z0l+. Detaits u,ili be available in the website of the Company i.e. rvrvu'-*'bsedcl'in.
WBSEDCL is going
to
MedicalReliefdrarvingbythePensioners/FamilyPensioners'whohaveoptedand
200/- per month along with their pension will be
considered for the Scheme. u*ointing to Rs.
pension payable from the morrh ol Ju11"2014
;;il;J as premium of rhe Scherne'from their
amount to be deposited to WBSEDCL account by the
onr.r,ards for 12 (hvelve) ,rortt,. ittt deducted
mav be
iollorving month. Necessary.Account code for this transaction
;irri" si(
;;;;i;;.i
accounts
WBSEDCL
and
"i,rr.
for Trust
by the both pension Trust und- Corporut" Compilation
""",J
"respectivelY.
RetiredemployeeswhowerenotundertheDeathCumRetirementBenefitRegulationl985
Scheme will be considered l'or this Scheme
of wBSEDCL but opt"i fo, tn" broup Medical Insurance
(. rupees two thousand four hundred only)
rv.e.f. l', october. 2014 subject to deposilion of Rs.24001
in-advance at the Corporate Cash Section at
;";;r;r; or on pro-raB basis L'y il" August'2014
Bankers cheque payable in favour of "west Bengal
i#;;;;;ilr'o".-o
St#
oruni
eu,y
ordiri
f,t..tri.ity Iiisrribution Company Limited" payable at Kolkata'
oj.th:
Scheme a
In order to facilitate services to retired employees after implementatign
.Help Desk; t.,u, U""n for."O una ii functioning at Vidyut Bhavan, 5'h floor, 'D' Block under the
controlofCMo,WBSEDCLlvherecompanyoffi"iul..alongwithlepresentativesoflnsurance
employees for satisfuing
be availabte io, lnt.ru"tion and guidance ro the rerired
;;;;.),[pt;ilt
.Help Desk' will receive subsequenr options from retired
qr".ii,r, ir"^v, and settle ,t"i, "iui*r- rni,
and such oprees will be included in
;;;i;t;", Iaiest by 30 auy. o"r-"'"o*rencement ofeach Quarter
pensioners will submit options only after
the Scheme from next quartei oriwards. Pensioners/family
and non-pensioners and their spouse (in case
issuance of pension/ family p"n.ion puy*.n, order ^(PPO)
with
option after release of their CPF/ Final payments along
of death of retired
cash section.
"*ptoy""ry'*itl-ri,U*it
be applicible at corporate
payment ofrequisite premium amount in advance as may
MemoNo.cfi( lqsEG>laot+l
t
ta
oated:
19- O6-.1-O1/l
Distribution:
Office:-Vidyut Bhavan, Block-DJ,Sector-ll' Bidhannagar' Kolkata-700091
c",p,i,:"i. ra""i,r, Numue4ctNl-u+019?wI2-091199111413'Y:b:15 -*"T';lbsedcr'in
1
i.i.p-r,"". n,i",luers_2 -t5q- I 923. 23 59- I 906, 23tg-7342, Fax N umber-23 59- 954
n"gl**a
West Bengal State Eecfl'cify Disfiibtltion Company Ed'
(A Govt. of West Bengal Enterprise)
WfIITL
Memo No. WBSEDCL/Gr. Mediclaim/20L4'151
{
Dt: /9.fr '14/,
To
The sr. Divisional Manager
Divisional Office ll
United lndia lnsurance Co. Ltd.
Himalaya House (6th Floor)
38- B, Jawaharlal Neheru Road
Kolkata - 700 071
sub:lnsurancecoverageforGroupMediclaimPolicy(FloaterType)infavourof
Retired Employees of W'B'S'E'D'C'LId'
.
Ref:i}lnvitationofoffersofthesamepublishedinleadingNewsPaperson
revised offers on
19.02.2014 followed by subsequent invitation of
21.03.2014 against our enquiries'
^
ii) Your revised offer dtd' Z6'O3'2of4
Dear Sir,
(LoA) with you for
above, we are placed this letter of Award
Policy (Floater Type) in favour of retired
undergoing lnsurance coverage for Group Mediclaim
with
reference
to
& conditions :employees of W.B.5.E.D.C.Ltd. as per following terms
Policv Terms & conditions:.
POLICY BENEFITS
:
1)
Class of lnsurance
2)
Sum lnsured:
3)
Period Of lnsurance
4)
Annual Premium
Group FLOATER Medical lnsurance Coverage
:
1,56,000/- of coverage in respect of l.P.D
(Hospitalization benefit) per member with clubbing
facitity under hospitalization with his / her spouse'
Rs
:
12 months w.e.f. 07,07.20!4
:
2400/- per member (including spouse, where
applicable) including Service Tax.
Rs
s) No. of primary members
(retired employees lncluding
582lllqg.(Requisite particulars in soft
coPY enclosed herewith)
Pensioners & FamilY Pensioners)
5)
Policy Coverage:
l
lncludes coverage of pre-existing disease from day
one, no age bar for entering Mediclaim
membership without any prior medical
examination. Employees who retired or intend to
join the policy during the course of operation of
policy can be included in poticy with payment of
pro-rata premium after every Quarter and carry full
amount of coverage of sum insured (floater basis)'
LT"t)-*rarq
7
Policy covers cashless facility in approved list
of hospitals / nursing homes etc' &
reimbursement of hospitalization & other
expenses for pre & post hospitallzation
treatment. Policy also covers Hospitalization
benefit on Non-PPN basis, where applicable
Hospitalization
(rPD)
a)
Room rent including diet, RMO charges' fluid'
bed
injection charges in non ICU / HDU / ITU / lCcU
will have ma*imum limit of Rs 1500/- per day'
ii)
Room rent including diet, RMO charges, fluid'
lnjection, Ventilator, infusion pump, Bi-pap' monitor'
oxygen, blood transfusion charges in lcu / HDU / ITU
per
/ riiu uea will have maximum limit of Rs 5000/day.
iii)
of
There will be no maximum limit on total amount
(i)
(ii)
above.
&
room rent in both
iv)
Claim
of room rent beyond maximum limit Per day
should be restricted to maximum limit but other
should
medical expenses as claimed in Hospitalization
rent'
room
with
related
not
be entertained in full and
b)
Surgeon, Anasthesist, consultant fees,
Nursing charges, physiotherapy charges will
have maximum limit of 25% of sum insured
per member.
c)
Hospital charges like investigation, OT
charges, consumables & disPosable,
medicine, oxygen, blood, diagnostic material,
dialysis, chemotherapy, radiotherapy, cost of
pacemaker or anY imPlant will have
maximum limlt of 75% of sum insured per
member. No capping will be allowed on individual
items like lOL, stent, orthopedic implants.
d)
All types oftreatments / procedure/
investiBations done in hospital/nursing home
including day care treatment should be
considered under hospitalization benefit (like
stitching of wounds, dialysis, chemotherapy,
radiotherapy, arthroscopy, ENT surgery,
Lithotripsy, endoscopy, angiography, eye
surgery including correction of eye sight by
laser sur8ery cataract operation, psychiatric &
psychosomatic disorder, any condition directly or
indirectly caused to or associated with HIV).
Iil
tLL.-,u
1 tuuL' '
/ barber' diet charges not
rent, expenses of vitamins'
bed
included in
tonics prescribed by atteriding doctor,
consumables like napkins/toiletries also $iill
come under hospitalization expenses'
e)
Charges of aya
fl
ooais
fees supported by separate numbered
Money receipts should be eiltertained in
full and need not be mentioned in Final bill of
Hospitalization.
7)
Pre & Post Hospitalization
a)
Pre Hosoitalization :
Relevant medical expenses incurred during
the period upto 07 days Prior to
hospitalization will be considered as part of
ctaims mentioned under hospitalization
expenses.
b)
Post HosPitalization :
Relevant medical expenses incurred during
the period upto 15 days after hosPitalization
will be considered as part of claims
mentioned under hospitalization expenses'
c)
8)
Relevant expenses as mentioned at (a)
& (b) above will include physiotherapy,
dressing charges, investigating charges, medicines,
doctor fees, aya charges, consumables,
medical equipments (like Bipap, CPAP,
nebulizer, walker, crutches, belts, collars,
Caps, Splints, Slings, braces, stockings,
diabetic footwears, glucometer etc).
claim submlssion fot
Hospltalization treatment
on cashless/re-imbursement
basis:
i)
The reimbursement claim (pre/post/lPD) to be
submitted to insurance company within 4 months
after completion of permissible post hosPitalization
treatment.
ii)
After receiving the claim concerned
iii)
Admissibte claim will be paid
insurance
company will release payments of admissible
amount of claim latest by 30 days from the date of
receipt ofthat claim.
to the Hospital (for
to the insured person (for
non cashless treatment). For this purpose the
employee and his/her spouse will be treated as
two distinct members within the same floater sum
cashless treatment) and
insured.
t\
'*,q,.Y'
9)
one authorized person of lnsurance
in a
Company will be present two days
*""k in ih" h"lp desk to be provided bv
HelP desk:
WBSEDCL at its CorPorate Office
for
interactions with the beneficiaries ofthe
schelne to settle any disputes if arises'
fully on discretion
Renewal of policy may be considered
or terminate
oiwssEoci rutt ority and may continue
merit of the
upon
t"naering depending
10)Renewal of PolicY:
ii-reh
fr"ttt
policy administration & service'
THE UNDERWRITER
5. ROTES AND RESPONSIBILITIES OF
(INSUTANCE COMDANVI
for development' implementation and overall
The Underwriter would be fully responsible
the terms and
day basis within the frame work of
management of the policy on a"y to
absolved
pu'po'" *here the risk would be underwritten &
conditions already designed
.;rri"r"i, o, tt'",
to"t'"
liability also
.tong with shouldering the post contractual
ensuring
necessary day to day policy administration'
they will
rested on the underwriter's shoulder and
The liability of risk will be solely and entirely
& when
claim from the beneficiaries as
bear the resPonsibility for honoring the
under
on cashless basis.from their listed facilities
triggered under the scope of the policy mainly
approved by
along with the HosPital & Nursing Homes
their existlng networking arrangements
members
the limit of sum insured designed for the
wBsEDcL authority on Non-PPN basis uPto
authbrity'
within group as per approw&ate of WBsEDclhave
to
nature they should have the ability
since the policy is basically of service oriented
to
orBanize
with the criticality as per their desired medical
the treatment of members in commensurate
medical
approached by them for avairing indoor
destinations on pan lndia basis as and when
for progression of treatment
the beneficiaries and to handle all types of situation
benefits by
client focused'
without any interruption and would be especially
the primary duty
to be administered by the TPA' hence it would be
and co-ordination with the respective TPA
and responsibility of the underwriter to have liaison
on a
Since the policy is poised
policy administration so that the policy may run
on day to day basis for ensuring necessary
TPA
a tab on the day to day functioning of the
successful way and accordingly they should keep
manner'
for servicing ofthe beneficiaries in a most satisfactory
ROLES
AND RESpONSlBltlTlEs TO BE PERFORMED
/
UNDERTAKEN BY THE 38o PARTY
sinceTPAistobeidentifiedandselectedbytheunderwriterandtheywouldbefunctioning
undertheaegisofthelnsuranceco.hencetheywouldbeactingasanagentontheirpart
and they would bind their
(lnsurance Co.) as mentioned in IRDA'S different orders & circulars
of the policy' ln other
principal for all the actions having been taken by them within the tenure
for all such actions by TPA
words, the underwriter will be prima-facie liable and responsible
under the scope of the contract entered into with WBSEDCL'
spouse in a most convenient
For providing a hassle free service to all retired employees & their
Help Desk is set up at the
way in tandem with the existing practice being followed, a dedicated
ll, Kolkata - 7RO 091 (5th Floor 'D'
WBSEDCL Head Quarter at Vidyut Bhaban, Salt Lake, Sec-
Brock).
Wa*"
provided
personnel from underwriters end would be
At the same time attachment of dedicated
their
locations for extending
on weekly basis based on the demand at all Prominent
policy
and religious way to ensure proper
professional services and guidance in a smooth
to provide
helpline numbers would also be ensured
administration. Besides above, dedicated
round
also need to be identified for rendering
service even at night. Dedicated tont'o O""on'
also be there
guidance' Medical Assistance helpline should
the clock professional assistance &
online/telephone'
io, proriaing i.r"diate medical advice through
7. Disputes Resolution
Process:
parties concerning the matters covered by the
any issues or disputes arises among the
on
endeavors to resolve the dispute promptly
Memorandum, the parties will use their best
lf
verifi cation of requisite documentary evidences'
8. Confidentialitv:
confidentiality about issues between the
All the parties to the Memorandum should maintain
.parties.
g. Procedures for amendment:
The Memorandum may be amended on mutualconsent
ofthe parties'
10. Termination of the Memorandum:
ThememorandummaybeterminatedbYmutualnegotiationamongthepartiesifanypartyor
Memorandum'
parties are unable to comply with the provisions of the
otherterms & conditions are Eiven here under:
u
Service Tar:
per prevailing
lncludes with requislte premium amount as
-
rate.
2l Paying Authority:
'
Bhaban
Manager (F&A) Estb' Corp w'B'S E'D'C'Ltd' Vidyut
Floor) Kolkata 700 091
3) Payment Clause:
1Oo% premium amount (includin8 service tax)
will be paid in
.
cheque in
advance on receipt of invoice from you by A"/c Payee
favour of United lndia lnsurance Co' Ltd'
Kolkata
chief Medicat officer WBSEDSL' Vidyut Bhaban (1$ F1oor)
700 091, who will certifythe invoice'
between yourself' and
Signing of Agreement :. Memorandum of Understanding
wBsEDCL authority to be executed in N'l/Stamped
4) Controlling
5)
-
(6th
officerl
100/- covering all terms and conditions as
mutually agreed upon before payment of premium amount'
(Draft copy enclosed for ready reference)
Paper worth Rs
your acceptance at earliest
Please acknowledge receipt of the LOA and convey
invoice indicating Premium amount at earliest supparted by
and issue triplicate copy of
Agreement PaPer duly completed in all respect as stated
Yours.faithfullY
il
Lu-,.,
'T le|C4t1
(A. K. Majutnder)
Adviser & GM (HR&A) CorP.
WBSEDCL
Memo No. *BSEDCUGT. Mediclaim/
zor+U
Dr ,3.61. )'ol9
f (i '- |
necesiary action please'
Copy forwarded for information &
1) Director (HR) WBSEDCL
2l GM (F&A) CorP. WBSEDCL
3) C,M.O. WBSEDCL
WBSEDCL
Benefit Scheme
4) Special Officer, Group Mediclaim
Secretary ofthe Committee
s) ir. Nranager (Hn&A) SSC & Member
WBSEDCL
6) Sr. Manager (F&A) Pension Cell,
7l 5r. Manager {F&A} MIS Cell,
WBSEDCL
8) Manager (F&A) Estb. CorP EBSEDCL
(2d
Co' Ltd' Kolkata Region' Himalaya House
e) Regional Manager, United lndia
700
ftoor) aa-e, tawatrarlal Nehru Road, Kolkata-
ttu"n""
.':
,.--
i\lL
1.2
071
N
il'LJ-<{elt
Adviser & GM'(HR&A) corP'
wBsEDcL
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