Sri C.S. Verma,
Chairman , SAIL
Our several communications have gone in vain as we were not called by SAIL for a discussion on various issues concerning us. I am sure the formulation, negotiation and implementation of SAIL Mediclaim Scheme must be in the last stages but we have not been called for consultation yet whereas we will be asked to pay 15% of the contribution for SAIL's unilateral, illegal and unethical decisions. We have already intimated several times that the scheme is poorly run as it has lot of loop-holes and the Insurance Co. and the TPA do not appear to be bound by the Guidebook / Scheme circulated by SAIL. Latest of our suggestions on the Healthcare Issues and List of Hospitals to be added can be seen in http://sailex.blogspot.in/2014/12/letter-to-director-to-expedite.html
The Scheme for the period from April 01, 2015 is not circulated yet though the last date for the present Scheme is just a week away. Notification, payment and making it effective for members run into months every year. In spite of our Resolution and suggestion last October SAIL machinery could not be geared to complete the process by the end of the current term. It will leave the Retirees helpless during the long transition period as the Scheme will not factually be in effect for the Insurance Co. and the TPA and the Retirees/ spouse will be left to fend for themselves. Smooth Cashless IPD treatment is next to impossible even with lots of hassles around in the intervening period. Our suggestion is that a provision of grace period is made in the agreement, as also, with the present level of high speed communication technology, the updating at the TPA end should be automatic as and when the payment is made.
We have also come to know that the list of OPD Hospitals is prepared by SAIL. We fail to understand the rational behind this approach but, for sure, this has been creating problems in the past. The difficulty is that once a Member/ spouse visits OPD and is advised IPD treatment the uncalled for expenses increase/ gets almost doubled if a Hospital from the IPD list is visted. One way to remove the ambiguity is to enlist all Hospitals for Cashless/ IPD to be in the OPD list too.
As we have said in the recent past the TPA, under the direction from the Insurance Co., changed the limit of OPD charges to Rs. 1000/- and Rs. 2000/- for this quarter against Rs.4000/- and Rs.8000/ circulated by SAIL. It is not a good shine that SAIL never came up to correct the reverses by the TPA and the TPA continued to have an upper hand the Insured Retirees remain confused to this day. Such a circular for amending the contents of the Guidebook must come from SAIL, not the Insurance Co. and the TPA and that too not by a circular by one to one communication.
A serious issue is the delay in approving the entry of a sick insured retiree into a Hospital for Cashless treatment and also at the time of post-treatment release. Also in case of reimbursement to members by the TPA it is months and months together to the extent that one of our members Sri Asit Nandi of IISCO had to take to suicide out of shame for non-payment to his friends and relatives. We hope there will be clauses providing time limits and penalties for not adhering to them.
Large number of cases have also been reported of the mid-way derecognition of Hospitals during the period of effect in the past which we kept forwarding to you. Such arbitrary action landed the sick Insured Retiree from Cashless to Reimbursement procedure. The problems arising out of this change, in between, for the sick and aged can easily be imagined. It must be making more of Asit Nandi type suicide cases which we may not be aware of. Our suggestion is that the TPA must be asked to include in their Agreements with the Hospitals at least one month time gap for derecognition both ways and TPA should be obliged to issue such a notice to Insured members through SAIL and FORSE.
We feel extremely sorry to remind here that SAIL has not considered permitting renewal of the cases of members/ spouse of lapsed SAIL Mediclaim Policy who might have failed to renew in time due to certain limitations incl. the communications not reaching them in time. It is quite unfair for a Maharatna Company like SAIL to disown their Retirees in this manner. We see no reason for punishing them. We request you to kindly open the Scheme for such cases on a regular basis.
A study of the SAIL Mediclaim Guidebook and functioning of the SAIL Mediclaim Scheme, even from a distance, appears to be highly centralised in both formulation and implementation stages in which the Role of the SAIL Plants/ Units is minimal, limited to collection of Renewal Forms alongwith the necessary document. Because of this the Retirees are left as a helpless creature during their bad days health-wise as SAIL, Delhi is far away. We suggest that Plant/ Unit personnel in charge of Health and Mediclaim Scheme implementation must play an active role in the implementation of the Policy throughout the year and help the Retirees when help is needed.
We hope all the highlighted portions above will be a part of the Agreement and Guidebook this time and will be followed in letter and spirit by SAIL, The Insurance Co. and the TPA and last but not the least with the enhanced role of Plant/ Unit personnel.
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Dr.V.N.Sharma, Chairman
Federation of Retired SAIL Employees
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