Schemes ›› Medical Assistance Reimbursement Fund

OBJECTS :

The objects of “Medical Assistance Reimbursement Fund” are to provide medical assistance to Associate Member and reimbursement of medical expenses incurred by its existing members/Associate members for self in respect of all ailments; accidents and diseases which need hospitalisation and subsequent domiciliary treatment and also to extend exclusive risk coverage only to existing members in case of permanent total disability of limbs or eyes subject to fulfilling eligibility criteria laid down below in Rule No. 5.

To do all such things as are incidental or conducive to the attainment of the above stated object.

ELIGIBILITY

All the existing members of the Society whose subscription is current as on date OR members upon retirement, who opt to continue as Associate Members of the Society shall be eligible to avail the medical reimbursement benefit under the scheme.

All the existing members of the Society whose subscription is current as on date shall be eligible to avail the monetary benefit in case of permanent disablement as more fully described under Rule No. 5-8 below.

SUBSCRIPTION / RESOURCES

Each member of the fund shall contribute a monthly subscription of Rs. 60/- to the fund to be recovered through pay sheets, which shall not be refunded, in addition to the usual recoveries due to the Society.

A sum not exceeding 10% of Mutual Benefit Fund net surplus shall be transferred to the fund account at the end of each financial year. In case the M A R F Scheme is running under deficit as may be approved by the Managing Committee / General Body.

MEMBERS’ RESPONSIBILITY FOR THE REGULAR RECOVERY OF SUBSCRIPTION

It shall be the responsibility of each member to see that his monthly subscription to the fund is recovered regularly and arrange for recovery of arrears of subscription under intimation to the Secretary of the fund if the subscription is not recovered in any month for any reason.

However, arrears of subscription from members on account of loss or pay or any other reason a grace period of 90 days shall be allowed from the due date of receipt of the monthly subscription. To enable such of the members to enjoy the benefit flowing under the scheme, direct payments of dues will also be accepted by the Society.

ELIGIBILITY CRITERIA AND MODE OF PAYMENTS

Medical expenses incurred by the existing member or Associate Member (as defined at Rule No. 2 above) after the date of admission, in respect of all ailments, accidents and also deceases which need hospitalisation and subsequent domiciliary treatment, shall be reimbursed to the extent of 20% of the amount sanctioned or to the extent of admissible expenses disallowed by the Bank, whichever is lower subject to within the overall limit as under

a) Existing Member: Maximum Limit ; Rs. 50,000/-
b) Associate Members: Medical Assistance benefit maximum Rs. 400/- p.m. (depending upon the duration of membership.)

The quantum of medical assistance benefit fixed once to the Associate member shall remain unchanged for life time.

The Medical assistance benefit will be paid along with the Superannuation benefit from the month the retired member is admitted as Associate Member in accordance with the Provisions of subsidiary working rules of Superannuation Benefit Fund Scheme and Medical Assistance Benefit Fund Scheme.

The medical reimbursement benefit under the Scheme is admissible to members and only to those retirees who opt to continue as Associate Members of the Society, subject to fulfilling the eligibility criteria as stated in Rule No. 2 and Rule No. 5-1 above.

Application on the prescribed format duly filled in and certified by the Branch Manager / Head of the Department together with Xerox copies of the sanctioned note of the Bank and the supporting receipts / bills should be submitted within 60 days from the date of the amount reimbursed by the Bank.

Application for reimbursement will be placed as per seniority before the Managing Committee, which shall scrutinize the claim papers received and sanction appropriate quantum of reimbursement subject to availability of funds. The decision of the Managing Committee is the matter shall be final and binding on all concerned.

Rejected applications from the Bank for reimbursement of special medical expenses shall not be considered.

In case of doubt and for the purpose of verification of authenticity of the claim, the Managing Committee is competent to seek advice from the concerned authorities

Permanent Disablement:

In case of permanent total disability / loss of both limbs / both eyes OR loss of one limb/one eye due to accident, an amount of Rs.1,50,000/- for self shall be paid only to the existing member whose subscription to the MARF Fund is current as on date, on submission of the following documents with in 60 days from the date of the accident.

i) Duly filled claim form in the prescribed format.
ii) Final investigation report of the Police.
iii) Disablement Certificate from the Doctor.
iv) Photograph showing the disability.
v) Confirmation of accident by the Branch Manager.

Note:

a) Accident shall include any Air / Rail / Road Accidents, falling from Building or Treetop, Electric Shock, Riot Strike, Terrorism, Snake Bite, Dog Bite, Drowning and Natural Calamities like Flood, Lightening, Cyclone, Earth Quake.
b) The overall monetary benefit under the MARF Scheme only in case of permanent disablement shall be limited to a maximum of Rs. 1,50,000/- .

Financial Assistance For Major Ailments

In case of members suffering from major ailments such as Cancer,; Transplantation of kidney/ Liver/ Brain ; Operation of Heart / Lung / liver / Brain / Retina Detachment, Amputation; Total disability / loss of limbs due to Paralysis / Accident,, an amount of Rs.1,200/- per month for a maximum period of 15 months (i.e., upto a maximum of Rs.18,000/-) for self shall be paid only to the existing member whose subscription to the MARF fund is current as on date, subject to fulfilling eligibility criteria laid down below:-

a) The benefit under the Scheme is admissible only for the above specified ailments, provided if the ailing member is covered under the Bank’s Scheme – Compensation for leave on loss of pay on Medical grounds (Refer Circular No.PER/2004-05/91 Dated 16-03-2005).
b) Claim application should be submitted on the prescribed format of the Society, duly filled in and certified by the Branch Manager / Head of the Department. , together with Xerox copies of the sanctioned note of the Bank along with Hospital certificates.
c) The monetary support shall be extended only from the month the ailing member submit the claim application for a maximum period of 12 months OR to the extent of the period on loss of pay which ever is less subject to testifying the bonafides.
d) The overall monetary benefit under the above stated object shall be within the maximum limit as applicable under MARF Scheme.
e) The monthly subscriptions towards MBF/MRF will be adjusted at the time of releasing the financial assistance to avoid disqualification of benefits under the respective schemes.
e) Financial assistance up to a maximum of Rs.10,000/-or actual expenses incurred which ever is lower will be extended for women members, even for normal delivery within the maximum limit under the scheme.

Financial Assistance For Dependent Spouse Or Children:

A Special Provision is created to extend monetary support of Rs.10,000/- to mitigate the hardship of those members, in case of their wholly dependent spouse or children are suffering with major ailments such as Cancer,; Transplantation of kidney/ Liver/ Brain ; Operation of Heart / Lung / liver / Brain / Retina Detachment, Amputation; Bone marrow transplant,;/ Hysterectomy; Knee Replacement; Total disability / loss of limbs due to Paralysis / Accident, upon testifying the bonafides, within the maximum limit, as applicable under the MARF Scheme.

Staff members who have not enrolled themselves as members of the Society are requested to enroll as members and avail excellent benefits offered.