HEALTH INSURANCE SCHEME IN THE OFFING
NCCPA DRAFT PROPOSALS FOR DISCUSSION
AIPRPA TO GIVE ITS FEED BACK BEFORE 31.12.2019
ALL STATES ARE REQUESTED TO GO THROUGH AND EMAIL YOUR SUGGESTIONS AND ANY OTHER PROPOSALS TO AIPRPA CHQ [ aiprpachq@gmail.com] FOR CONSOLIDATING AND FORWARDING TO NCCPA BEFORE DUE DATE.
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:
2nd 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 15th
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 15th.
With greetings,
yours
fraternally,
KKN
Kutty.
Secy,
General.
The 7thCPC,
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.
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.