REF: HRD DIVISION CIRCULAR NO. 515 19.02.2009
INTRODUCTION OF PNB HOSPITALISATION CONTRIBUTORY BENEFIT SCHEME FOR RETIRED EMPLOYEES
In terms of HRDD, HO Circular No. 226 dated 29.10.2004a scheme of PNB
Hospitalisation Contributory Benefit Scheme for Retired Officers w.e.f. 1.1.2005
was circulated. Under the scheme, retired officers are required to pay a subscription of Rs.300/- p.a. with reimbursement limit of Rs.20000/- p.a.
2. Further, as per our Circular no. 486 dated 20.10.2008, another opportunity was given to eligible retired officers, who could not enroll as members or could not regularise their memberships, to become member of the scheme.
3. We have been receiving representations from retired workmen Unions and Officers Associations for introduction of similar contributory benefit scheme for all retired employees and for enhancement in reimbursement limit.
4. Board in its meeting held on 18.02.2009 has approved introduction of new scheme called “PNB Hospitalisation Contributory Benefit Scheme for Retired Employees” under the Staff Welfare Fund. The new scheme would also cover the retired employees both officers and workmen and the existing members of the scheme i.e. PNB Hospitalisation Contributory Benefit Scheme for Retried Officers would be replaced by this new scheme, consequent upon its coming into operation.
5. The salient features of the scheme are :
i) Objective To provide hospitalisation assistance to the eligible retired employees of the bank.
ii) Eligibility Refer Clause 2 of the Scheme placed at Annexure I.
iii) Subscription One Time subscription of Rs.5000/-.*
* New Member – Rs.5000/-
* Existing Member – Rs. 4775/- (Rs.5000-Rs.225)
iv) Reimbursement Reimbursement limit for self and spouse (put together) under the scheme shall be Rs.40000/ per annum (including charges payable under Non hospitalisation) with overall limit of Rs.2 lacs upto the age of 75 years. This limit shall be restored after the age of 75 years. The amount of reimbursement would be reviewed after one year of operation of the scheme.
v) Domiciliary Treatment Not covered
vi) Commencement of the Scheme 25th March 2009
vii) Last date for receipt of applications 15th March 2009
Details of the scheme are given in Annexure I.
5. All eligible retired and retiring employees (including officers) who are willing to opt for the aforesaid proposed scheme may give their consent on the proforma available at Annexure II, to Asstt. General Manager –HRD, Head Office, Bhikhaiji Cama Place, New Delhi on or before 15th March 2009 alongwith the subscription of Rs.5000/- by way of crossed Demand Draft in favour of PNB Hospitalisation Contributory Benefit Scheme for Retired Employees payable at CDPC, Delhi OR PNB CBS Cheque.
6. All the existing members of PNB Hospitalisation Contributory Benefit Scheme for Retired Officers who are desirous of becoming member of the new scheme shall have to remit difference amount of Rs.4775/- (Rs.5000 – Rs.225) by way of Demand Draft in favour of PNB Hospitalisation Contributory Benefit Scheme for Retired Employees payable at CDPC, Delhi OR PNB CBS Cheque. In case of any retired officer who is a regular member of the existing scheme as on 31.01.2009 but does not want to contribute the difference of Rs.4775/- shall cease to be member of the new scheme after 31.12.2009. (Those members whose one time subscription of Rs.4775/- is not received by 15.3.2009, they shall become ineligible under the new scheme w.e.f. 1.1.2010 and they shall be eligible for reimbursement limit of Rs.20000/- only upto 31.12.2009).
7. At present PNB Mediclaim Insurance Scheme for retired employees through The New India Assurance Company is also available. (Ref. HRDD Circulars No. 504 dated 12.12.2008 & 509 dated 21.01.09). If the retired employee becomes member of both the schemes, he shall have to get his claims settled first under Mediclaim Insurance Scheme and thereafter, from the PNB Hospitalisation Contributory Benefit Scheme for Retired employees, as per rules.
8. All the offices/branches are advised to get this circular noted from the retired employees who have retired from their offices or are drawing their pensions from their branches. A copy of this circular should also be displayed on the Notice Board.
ASSTT. GENERAL MANAGER
PNB Hospitalisation Contributory Benefit Scheme for Retired Employees.
1. TITLE :
The scheme shall be called PNB Hospitalisation Contributory Benefit Scheme
for Retired Employees.
2. ELIGIBILITY :
The membership to the scheme will be open subject to the following :
2.1 All officers/workmen employees retired on superannuation upto 28.02.2009 can become member of the scheme. Those retiring thereafter can opt for the scheme within three months from the date of their retirement.
2.2 All retired officers who are regular member of the existing contributory benefit scheme as on 31.01.2009 can become member by paying the difference of Rs4775/-
2.3 In case of any retired officer who is a regular member of the existing scheme as on 31.01.2009 does not want to subscribe the difference of Rs.4775/- shall cease to be member of the new scheme after 31.12.2009.
2.4 Spouse of the employee who die while in service.
2.5 Employees discharged/dismissed/removed from service/ compulsorily retired or terminated on grounds of misconduct will NOT be eligible .
2.6 Employees who have retired under PNBEVRS 2000 are not eligible.
3. OBJECTIVE :
3.1 To provide hospitalisation assistance to the eligible retired employees of the Bank and their spouse who have settled anywhere in India if at any time during the currency of the scheme, he/she and his/her spouse sustains injury or contacts
disease/illness, and if such injury/disease or illness required hospitalization in nursing home/hospital.
3.2 “Reimbursement for pre and post hospitalization expenses for 30 days each is payable within the overall annual limit of Rs.40000/- combined together for self and spouse.
4.1 One Time subscription of Rs.5000/-.
5. DEFINITIONS :
The following words, terms of expressions wherever they may appear in this Scheme or even otherwise shall be deemed to have meaning expressed hereunder:-
Member : shall mean a regular member of PNB Hospitalisation Contributory Benefit Scheme for Retired Employees as per clause 2 above.
Hospital/Nursing Home : shall deem to be an Institution with regular premises for stay and operation by a qualified physician or surgeon or a team of qualified physicians and/or surgeons with minimum qualification of MBBS for the care or treatment of disease / illness / injury and having proper facilities to keep and treat the indoor patients. The term hospital shall not include the establishment which is a place of rest, a place for aged, a place for drug addicts, a place for alcoholics or hotel. It is to be noted that reimbursement of claims is to be made only in those cases where concerned nursing home/hospital maintains proper records in respect of hospitalization i.e. date of admission of patient, date of discharge, diagnosis and treatment given and also details of the charges charged by them in their bills/ receipts, which could be verified in case of need.
Medical Practitioner : shall mean a duly qualified and registered physician or
consultant/ specialist or a general medical practitioner who is legally licensed to
practice with minimum qualification of MBBS.
Disease : Disease shall mean any illness, disease or injury requiring hospitalization.
Surgical Operation : Surgical operation shall be deemed to mean that : Cutting operation (not including any lancing operation or injection) or Any operation or treatment involving the reducing of fractures and / or Any treatment or adjustment in respect of any dislocation of joints or bones (provided this requires hospitalization), orthopedic or Neuro-Surgery or Plastic Operations ( for non beautification treatment only) by a qualified surgeon.
Period of Hospitalisation : shall include charges for hospital/nursing home
and charges required for the disease during period of hospitalization and for 30
days pre and post hospitalization (within the overall limit of Rs.40000/- p.a.) for
surgeries referred above. Further, reimbursement of same disease shall be admissible if there is gap of 45 days between the date of discharge and subsequent date of hospitalization.
6. PROCEDURE FOR ENROLMENT :
6.1 Retired employees who are eligible as per Clause 2 and are desirous of becoming a member shall apply on the prescribed proforma enclosing therewith draft/CBS Cheque for Rs.5000/- favouring PNB Hospitalisation Contributory Benefit Scheme for Retired Employees, drawn on CDPC, New Delhi latest by 15st
March 2009. No cash contribution will be accepted.
6.2 Employees retiring on or after 28.02.2009 can opt membership within 3 months of their retirement.
6.3 Application complete in all respects (with joint photograph of self and spouse affixed at the place provided for) mentioned above must be verified from Branch/Circle Office/ Head Office, from where they retired and send to HRD, HO alongwith DD/CBS Cheque.
6.4 The membership to the scheme is irrevocable and membership subscription is not refundable.
6.5 The application form can be downloaded from Bank’s Website www.pnbnet.net.in ) besides being available at all Circle Offices of the Bank.
6.6 Non receipt of difference of subscription i.e. Rs.4775/- shall make the member ineligible to lodge any claim from the year 2010 onwards and reimbursement limit in such cases shall remain Rs.20000/- only for the year 2009. Under no circumstances such member will be readmitted to the scheme.
7. BENEFITS :
Reimbursement limit for self and spouse (put together) under the scheme shall be Rs.40000/ per annum (including charges payable under Non hospitalisation) with overall life time limit of Rs.2 lacs upto the age of 75 years. After exhaustion of limit of Rs.2 lacs, this limit shall be restored
after the age of 75 years.
8. REIMBURSEMENT OF HOSPITALISATION CHARGES:
Charges for the following will be reimbursed subject to verification by bank’s CMO regarding justification of hospitalization.
a. Consultation : Consultation charges are payable as per Schedule of Charges annexed as Schedule of Charges.
b. Medicines : Reimbursement is allowed towards the cost of admissible medicines purchased and supplied by the hospitals during period of hospitalisation as per schedule.
c. Diagnostic Materials : Cost of Radiological/Pathological investigations undergone during period of hospitalisation are reimbursable as per schedule.
d. Operation Charges : Operation charges are reimbursed as per schedules prescribed by the bank from time to time. Operation charges include operation theatre charges, anaesthesia charges, Surgeon’s fees, Assistant’s Fees, Anaesthetist’s fees and medicines/materials used in operation theatre.
e. Visit Charges : During hospitalization period, charges for routine visit per day are reimbursable as per schedule.
f. Surcharge : Surcharge, if any levied by the Government/Municipal/ Trust / Charitable hospital is also reimbursable within the overall limit.
g. Intra-Ocular Lens : Cost of intra-ocular lens implanted during the cataract operation, undergone even without indoor hospitalization are reimbursable as per schedule.
h. Pace-maker/Implants/Prosthetic Valves : Cost of these is reimbursable as per schedule.
i. Non hospitalization charges payable as per Schedule of charges.
j. Routine Medical check up will not be reimbursable.
9. PROCEDURE FOR SETTLEMENT OF CLAIMS :
9.1 correspondence in relation to the scheme shall be sent to the Asstt, General Manager, Human Resources Development Division, HO, New Delhi.
9.2 claim must be accompanied by original documents such as the following:
i) All bills in original and to be verified by Hospitals/ Nursing Homes/Doctors.
ii) Discharge certificate from the concerned hospital nursing home containing date of admission, date of discharge, diagnosis, treatment given, name and nature of operation performed if any, name and qualifications of the treating surgeons / his assistant and anesthetist (this certificate is required to be got submitted from the concerned hospital / nursing home and not by the treating doctor in his individual capacity).
iii) Details and break-up of medicines, drugs, diagnostic materials, visit of the Doctor Consultant should accompany the claim.
iv) Other relevant information, if any, required by the bank.
9.3 The claim received will be put up to the CMO of the Bank for his approval after which the claim will be calculated as per the limits and sub limits given under appropriate schedule. The decision of the CMO in the matter will be final. Objections/Discrepancies in respect of settled claims will be entertained within 30 days of the receipt of sanction/rejection.
9.4 Claims complete in all respects must be sent to HRD Division, HO for reimbursement on Form No. PNB 816 within 6 weeks of date of discharge from the hospital. Claims submitted late will be liable to be rejected.
10. FALSE CLAIM/ INFORMATION :
In case false claims / information are found to have been submitted by any member at any stage, his membership will be cancelled forever and he will not be re-enrolled again. Subscription paid will automatically be forfeited and claim made if any, will not be reimbursed.
11.1 The proposed scheme shall run from 25th March 2009.
11.2 The date of admission to Hospital/ Nursing Home shall be treated as year of hospitalization.
12. THE FUND :
Fund of the Scheme shall consist of member’s contribution and also the contribution received from the bank. The fund or any contribution shall be invested in any deposit scheme of the bank. The fund shall be administered by the Committee constituted to manage the fund.
13. ADMINISTRATION OF THE SCHEME:
13.1 The administration of the Scheme will be done by HRD Division,Head Office. The following Committee will be constituted to over see the entire administration and fund management of the scheme.
1. General Manager : HRD Division
3. Chief HRD Division to be Member Secretary.
4. Senior Manager/ Manager – Hospitalisation Cell to be the Convener.
13.2 CMD is empowered to change the members of the Committee.
14. ANNUAL AUDIT :
The working of the scheme shall be audited every year by Chartered Accountant on the approved list of the Bank.
15. REVIEW/ WINDING UP OF THE SCHEME :
15.1 Progress of the scheme in the first year shall be placed before the Core Working Group on half yearly basis.
15.2 The scheme shall be improved/reviewed/discontinued with the consultation of Core Working Group after one year.
APPLICATION/ENROLMENT FORM FOR PNB HOSPITALISATION
CONTRIBUTORY BENEFIT SCHEME FOR RETIRED EMPLOYEES
(To be sent latest by 15.03.2009 in case of retired employees or 3 months from the
date of retirement from the service) .
The Asstt. General Manager,
For Office use only
Punjab National Bank, HRD Division Enrolment No._________
Head Office, 7 Bhikhaiji Cama Place,
PNBEVRS 2000 OPTEES NOT COVERED
Please affix joint
photograph of self and
Please enrol me as Member of the above scheme to which I hereby opt. I have gone
through the rules and regulations of the scheme and agree to abide by the rules and
regulations of the same as may be modified / amended from time to time . Particulars
about myself and my spouse are given below:
1. Name of Officer _______________________ 2. P.F No._______________
(In Block Letters)
3. Name of Spouse ________________________________________________
(In Block Letters)
4 Father’s/Husband’s Name________________________________________
(In Block Letters)
5. Date of Birth a) Self ______________ b) Spouse___________
6. Date of retirement ___________________
7. Type of Retirment :
(Attach documentary proof)
(i) Superannuation (ii) Medical Ground (iii) Demitted the office of GM
(iv) Dismissed (v) Compulsorily retired (vi) Voluntarily retired under Officers’ Service
Regulations (vii) Voluntarily retired under Pension Regulations)
(viii) VRS under PNBEVRS 2000 (IX) Any other
8. Office from which retired _____________________________
(Write the name) HO________________________
9. Date of joining the bank ___________________
10. Enrolment No. of old PNB Hospitalisation Contributory Benefit Scheme
for Retired Officers: _______________
11. Present Address ______________________________
(in Capital Letters) _____________________________
12. Permanent Address ___________________________
13. I am enclosing herewith a Draft No. /CBS Cheque No. _______dated __________
for Rs.5000/Rs. 4775/- only favouring PNB Hospitalisation Contributory Benefit
Scheme for Retired Employees issued by the BO ___________________ _ (D. No
_________ ) drawn on CDPC, New Delhi being my One Time Subscription to the
(i) I have read and understood the PNB Hospitalisation Contributory Benefit
Scheme for Retried Employees and agreed to abide by the terms and conditions of HRD
Circular No. 515 dated 19.02.2009.
(ii) The information given above by me is true to the best of my knowledge.
(iii). I also undertake that if at any point of time, during the currency of my
membership of the scheme, the information submitted by me, either in relation
to application form or hospitalisation claim preferred by me, is found to be
false/misleading, my membership to the scheme will be terminated without any
notice to me. The amount deposited by me towards my subscription of the
scheme will stand forfeited and I will not be eligible to become member of the
(iv) I will inform the change of my address to the Bank immediately by Registered
SIGNATURE OF SIGNATURE /T.I .OF
RETIRED OFFICER SPOUSE
15. It is certified that Shri/Smt..________________________ retired on
(date)________ from (Name of office)___________________________ as
Signature of retired officer and signature/Thumb Impression of his/her spouse given
above are hereby verified.
P.A. No. ___________
1. Application form complete in all respects, must be sent to HO directly.
2. Strike off whichever is not applicable.