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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