In a major decision for the welfare of government employees and their family members, the State Administrative Council (SAC) headed by Governor Satya Pal Malik accorded sanction to the implementation of the Group Mediclaim Insurance Policy for all State Government employees including Employees of Public Sector Undertakings, autonomous bodies and Universities on mandatory basis.
The policy will also cover Pensioners, AIS Officers, Adhoc, Contractual, DRWs, Work charged and Contingent paid workers and their dependant family members on optional basis from October 1 for a period of one year and extendable annually for three years, based on claim settlement ratio and satisfactory performance of the insurer.
The policy will include medical insurance cover of Rs 6 lakh for individual employees up to 5 family members with a Corporate Buffer of Rs 10 crore, the cost whereof is loaded in the quoted premium.
The premium to be paid by the employee annually would be Rs 8776.84 minus Rs 3600 (Medical allowances currently admissible annually) equal to Rs 5176.84. For pensioners, this amount would be Rs 22,228 minus Rs 3600 (Medical allowances currently admissible annually) equal to Rs18,628, annually.
Further, the deduction of the annual premium will be made from the salaries of the employees in four installments, as shall be notified separately by the Finance Department.
This policy would allow treatment in almost 5000 hospitals across the country. It represents a significant step up over the previous policy in that it covers domiciliary hospitalization and day care procedures also.
There is good news for women employees too as the expense cap on maternity cover has been enhanced to Rs 30,000 within state and Rs 70,000 outside the state. Further, pensioners would not be required to undergo pre-policy tests and all their pre-existing diseases would receive immediate coverage, much to their relief. There is also a new provision for the insurance coverage of the dependent family member’s upto 100 years as compared to 80 years in the previous policy.
In what will benefit a large number of employees and pensioners, a dedicated Corporate Buffer of Rs 10 crore each will also be in place in the policy to cover the expenditures incurred by the employees and pensioners on identified illnesses over and above the expenditure coverage provided in the policy.
For the first time, the insurer will provide a Management Information System (MIS) report regarding enrolment, admission, preauthorization, claim settlement and other information about the services as required by the government on a regular basis.
Further, the website designed by the insurer will have district-wise/state-wise enrolment status, claims, treatments rendered and hospitals data. Stage wise tracking facility for claims and grievances shall also be available to the beneficiaries.
Also, for the first time, the services of a professional consultant have been hired to set up a robust grievance redressal system for employees and pensioners. The consultant has already set up grievance redressal offices in all districts and these offices can be accessed by the employees and pensioners in case they have any grievance regarding implementation of the policy.