United India Insurance has offered all existing bank retirees another option to join the group health policy without outpatient (OP) cover.
This will be considered along with renewal of group health insurance policy for retirees for 2017-18 and a new super top-up policy for both employees and retirees.
One more option will be given to all retirees to join the group medical cover policy without domiciliary (OP) cover.
Existing retirees under ‘with domiciliary (OP) policy’ will be allowed to switch over to one ‘without domiciliary cover.’ The option to switch over to ‘with domiciliary (OP)’ policy is not available.
Employees who retired during 2016-17 will be given the option to join the policy either ‘with domiciliary’ or ‘without domiciliary’ clause.
The insurer had earlier agreed to renew the employee policy and retiree policy (without OP cover) without any increase in renewal premium.
It had also offered a super top-up policy without OP cover for retirees with raised sum insured limits.
The group medical policy without domiciliary treatment cover (without OP) is being offered on the same terms, conditions and premiums as last year.
High claims ratio
The insurer, however, said that the policy with out-patient treatment (domiciliary) has been running on a high incurred claims ratio of 200 per cent.
In this background, it has been compelled to revise the premium for renewal of the same in 2017-18 (see Table 1). All terms and conditions will remain the same as that of last year, including the limit of the domiciliary cover which is 10 per cent of sum assured.
The total sum assured of ₹4 lakh and ₹3 lakh includes the 10 per cent limit for OP.
The new super top-up policy without OP cover for retirees having a base policy with/without domiciliary cover is as shown in Table 2.
OP treatment (domiciliary) is not covered under the policy. The concerned option and premium for super top-up policy shall come along with the main policy premium itself in one go from the respective banks.
However, the statement of premium for super top-up policy and main policy shall be separately prepared and the remittance shall also be made in separate amounts from the respective banks.
Terms and conditions
The commencement date of the policy is identical to the main policy and starts from November 1, 2017, and therefore the premium shall be remitted by the bank along with the main policy on or before October 31, 2017.
The policy is subject to the terms and conditions of the super top-up policy and the cover is identical to that of the IBA retiree policy without domiciliary cover.
In case of a claim, the basic policy/policies will be triggered first and only if the sum insured is exhausted, will the super top-up policy be activated.
A super top-up policy without OP cover is also available for employees on the same terms, conditions and premium as offered to retirees.