IBA GROUP MEDICAL INSURANCE SCHEME FOR BANK PENSIONERS

[Ramesh Pandey]

This mail is intended to inform the Blog Members  about the  harassment and inhuman treatment being meted out to the Bank Pensioners in processing medical reimbursement claims of Pensioners.

My wife was tested for Corona positive in the last week of November 2020.  She was running continuous fever and body pain for many days and when no relief was in sight, was hospitalized as per the medical exigencies on the advice of Doctor.

I submitted the medical reimbursement claim , on her discharge from hospital to M/s Heritage Health Insurance Co on  December, 24, 2020.  It is very sad that due to the callous and negligent approach of the TPA, the claim has still not been settled.  The TPA has been repeatedly raising the same query in a very robotic manner.  Each time, I have been  submitting  the documents/ doctor's certificate and Advice and a fool-proof justification of the claim to TPA.  After a pre-decided time-gap, I am once again confronted with the same oft repeated queries from M/s Heritage Health.  The procrastination by TPA has successfully reached 7th month now.

The factual details of claim case in respect of my wife are as under:

IBA’S GROUP MEDICAL INSURANCE SCHEME WITH NATIONAL INSURANCE CO – TPA , HERITAGE HEALTH INSURANCE CO. 

 

Insurance Policy No:       251100502010000329   

Patient Name : Bimla Pandey  Wife of  R C Pandey 

Treatment of :                  covid-19 positive  

I.Card No. :                      HHS1.0700322629  

Claim Amount :               128250.00   

Retiree  No:                       46482  (PNB) 

The inadequacy of service and the negative approach of TPA functionaries, shirking and not honouring the legal liability as Insurer does not appear to be ending.  There may be many more such cases where the retired bankers must be facing endless harassment.  

My aim here is to make the members aware of these grievances before they decide about renewal of the Policy for next year.   I also wish the IBA, concerned Banks to intervene in such cases to get timely justice delivered to the aggrieved Pensioners.  In the meanwhile, the Bank Unions should  take up with the IBA, during negotiations, for a more responsible, humane and time-bound reimbursement to the poor Bank pensioners. Otherwise the very purpose of the Scheme for welfare of the pensioners is defeated.     

RC PANDEY

RETIRED PNB

[bhaskara sarma]

Yes, every body talks about Insurance premium only. Nobody ever pointed about unsettled claims,Pandeyji.

We are fooled by the centralised policies.Nobody listens to the grievances of the Pensioners.This is the main reason why I opted out and got insured through the employer of my son.

With regards,

P Bhaskara Sarma.

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[Dinesh Rajvanshi]

Dear Mr. Pandey,

 

Please write to Divisional Manager, National Insurance Co., Kolkata or to Grievance Cell, NIC under copy to IRDAI giving full details.  There will be no use writing again and again to TPA.

 

Dinesh

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[Nagaraju Kakani]

Sairam, Sir Sarma Garu, I need your clarification on the below matter to the brothers of group also on your lines based on your reply. 1.Will the employer of your son, cover the condoms like age, pretty existing diseases, immediate claim eligibility,basic and super top up policy ants like us,  and premium rates are like GMIS policy of Bank Managements, IBA and the NICL. 

2. In short and in nutshell, what are the deviations ate additions to our existing GMIS Policy. 

So please clarify us. 

With regards 

Nagaraju Kakani 

Hyderabad. 

9177538847

rajag...@yahoo.com 

To view this discussion on the web visit https://groups.google.com/d/msgid/bankpensioner/CA%2BUBNxiycfkbP2iNnbf1M_yu8Mv1XAA%3D3E6KX%2BAh5YiV1cdcJw%40mail.gmail.com.

[Kalyanasundaram Subramaniam]

He can approach Insurance ombudsman also if the grievance is not settled. 

Regards.

S Kalyanasundaram 

[Debasish Mukherjee]

As far as my information goes the NIIC advised to all the Banks and IBA that it engaged a Nodal officer for all the Banks in every zone for helping particularly the retirees to assist the retirees in such matters.

Debadish Mukherjee.

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[Srirama Murti]

for this blog members

   Last year I was addmitted toVirinchi Hospitals,Banjara hills,Hyderabad in the period of pandemic kovid-19.

But the hospital did insist on cash deposit  instead of cashless. Because there was urgency our family was forced to shell 

down cash.No alternative for us . the hospital instead of kovid-19 mentioning has mentioned the cause as pnuemonia.

because the testing report always comes kovid-19 negative.

the then TPA M/s Goodhealth insurance tpa sanctioned atlast after query and query  a sum of Rs.60000 whereas the 'total bill

charged was a grand sum of Rs.312000/-. I submitted replies to their satisfaction but only a meagre sum of Rs.60,000

was passed. 

I was unable to understand the logics behind the passing of the claim amount.

BUT I AM GLAD some members in different cases , they got upto Rs.9,00,000/-. that is okay.

We have to fight for Cashless in Hyderabad Corporate hospitals in next IBA medical insurance scheme renewable from

Nov.,2021.

God bless all the insured without any hassles,

WITH REGARDS TO ALL,

S.S.R.Murthy, ex-canara bank,Hyderabad

(Singampalli Sri Rama Murthy)

ph:   +91 9391147762

To view this discussion on the web visit https://groups.google.com/d/msgid/bankpensioner/CA%2BUBNxiycfkbP2iNnbf1M_yu8Mv1XAA%3D3E6KX%2BAh5YiV1cdcJw%40mail.gmail.com.

[bhaskara sarma]

Dear Sir,

Premium is almost the same.Pre existing diseases are also covered.I wish I should not get any necessity of utilising the policy.But unfortunately if any necessity comes,my son takes care of the claim through their office.I get mad to correspond with the TPAs ,that too when I am sick and came out of Hospital.

I never gave much thought to other aspects of the policy.

With regards,

P Bhaskara Sarma.

To view this discussion on the web visit https://groups.google.com/d/msgid/bankpensioner/CAKxG0JVgN_5SXvjNuxMnqXS1h5sEzDkB3X8dFucy%2Bbv-Fdzs3w%40mail.gmail.com.

[LakshmanRao Kantamsetti]

Pandeji

There are ombudsmen for defficency of service from insurance companies .

There may be more than one. 

You have to find out who is the ombudsman for your area .

You may submit all the details to him for justice. 

Kindly let me know where do you stay and your phone number .

You may contact me if you have any questions. 

All the best.

KLRao from Gurgaon 

Mobile 8179731467

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[LakshmanRao Kantamsetti]

There is insurance samadhan 

In greterkailash part I in New Delhi 

Corp...@insurancesamadhan.com 

8448440626 toll free number .

No idea whether any charges are there or not. They are not asking card number . Simply name phone number and e mail I'd only .

You may contact  them  before approaching ombudsman. Their guidance may be of help. 

KLRao 

Gurgaon 

Mobile 8179731467

On Mon, Jul 12, 2021, 15:43 Ramesh Pandey <captp...@hotmail.com> wrote:

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