GROUP MEDICAL INSURANCE SCHEME

[Sukumaran Ramaraj]

Kindly clarify whether the following correct information or misleading one. Is the critical illness are what given in the bottom??.

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IBA circular for Medical Insurance Policy for year 2025-26- *Most Important- Page-2 para 5 g- critical illness  benefit will be available for employees only*. This means retirees can’t make claim against critical illnesses. 

///This clause was there in the previous policy too. Earlier it was apparenty available. Quietly they inserted this in the current year's policy and possibly in the policy of 2024-25. NICL has a Special National Critical Illness Policy (Max Entry age is 65 years), which lists down what they consider it as a Critical illness. One may therefore conclude that those illness may not be covered under the proposed IBA Policy. I am afraid, some of the common illnesses, like dialysis, brain surgery, etc., are included in the list. It would be better if the proposed policy specifically mentions which of the Critical illnesses are specifically excluded. OUR ASSOCIATIONS/ FEDERATIONS and IBA should insist on this requirement. In the current Policy, there is only one sentence, which says - Critical Illness benefit is not covered under this policy for retirees.///

The list of Critical Illness as per their Special Policy for Critical Illness is:

1. Cancer of Specified Severity

2. Myocardial Infarction (First Heart Attack of Specified Severity)

3. Open Chest Coronary Artery Bypass Graft Surgery (CABG)

4. Open Heart Replacement or Repair of Heart Valves

5. Coma of Specified Severity

6. Kidney Failure requiring Regular Dialysis

7. Stroke Resulting in Permanent Symptoms

8. Major Organ/Bone Marrow Transplant

9. Permanent Paralysis of Limbs

10. Motor Neurone Disease with Permanent Symptoms

11. Multiple Sclerosis with Persisting Symptoms

12. End Stage Liver Failure

13. Third Degree Burns

14. Goodpasture’s Syndrome

15. Apallic Syndrome

16. Aplastic Anaemia

17. Systemic Lupus Erythematous with Lupus Nephritis

18. Bacterial Meningitis

19. Multiple System Atrophy

20. Progressive Scleroderma

21. Aorta Graft Surgery

22. Pneumonectomy

23. Primary (Idiopathic) Pulmonary Hypertension

24. Primary Parkinson’s Disease

25. Alzheimer’s Disease

26. Benign Brain Tumour

27. Cardiomyopathy

28. End Stage Lung Failure

29. Brain Surgery

30. Progressive Supranuclear Palsy

31. Creutzfeldt-Jakob Disease (CJD)

32. Major Head Trauma

33. Encephalitis

34. Blindness

35. Deafness

36. Loss of Speech

37. Loss of Limbs

[MOHAN P]

Dear Mr Sukumar Ramraj,

Yes.IBA has stated in referred circular on current years GMIS as follows.

“5.(g).critical illness benefits as defined in settlement dated 25.05.2015 shall continue with existing terms for the employees only. Thyroid cancer shall also be included.”

It may be noted that the IBA  Group Medical Insurance scheme is devised based on settlement made between IBA and Unions, dt 25.05.2015 as quoted in IBA circular.Policies issued by Insurance Company also follow the same and list of deceases covered are specifically mentioned in policy.

Under the above settlement too on additional payment on critical illness  ,(details given there in) to employees are mentioned.

From the above it can be seen that there is no misleading information on above point.

Regards

Mohan.P

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[Ramachandran Bella]

Mohanji,

Last year for 3.00 Lacs single IBA policy

21772+3919. GST=25691

Now without GST - single -24301

Without GST means we should have reduced premium. 

Is there any increase in the premium amount?

Can this be clarified ji?

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[MOHAN P]

Dear Ramachandra Bella Ji,

As per information available right now the following are comparative premium figures from which you can gather the increase and decrease in premium amount.

Regards

Mohan.P

POLICY	PREMIUM	(without GST)
AMOUNT	2024-25	2025-26	Increase/decrease
₹3lks	24191	27001	2810
₹4 lks	34661	31001	-3660
₹5.25 lks	xx	40231	X
₹7 lks	xx	60001.	X

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[CHIRAMEL MATHEW SIMON]

Without coverage of critical illness to retirees, why one should join the scheme since the expenses for other illnesses are likely to be very low.

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[MOHAN P]

Sir,

Barring a few,all medically necessary treatment  which is defined as any treatment, tests, medication, or stay in hospital or 

part of a stay in a hospital which 

is required for the medical management of the illness or injury suffered by the insured;are covered under IBA GMIS including critical illness.Please refer the IBA GMI policy issued by National Insurance Co for further Information.

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