SAIL Mediclaim Scheme for 2021-22 in detail can be seen in the link https://tinyurl.com/medi2122
Issues for Immediate Attention:
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Members are requested to wait for further communication from SAIL, FORSE and the concerned Associations. Hope for the best.
With warm regards,
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For & on behalf of Federation of Retired SAIL Employees (Regd)
Ram Agar Singh, GS
https://tinyurl.com/sail-
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By e-mail
FORSE/SAIL-C/1021
June 03, 2021
To
Ms Soma Mondal,
Chairman,
Steel Authority of India Ltd,
Ispat Bhavan, Lodhi Road,
New Delhi – 110 003.
Sub: Request for improvement in SAIL -FORSE communication.
Ref: Our FORSE/SAIL-C/0621 dated May 25, 2021 & May 27, 2021
Respected Madam,
We take liberty in requesting you to call for our two letters nos. FORSE/SAIL-C/0621 dated 25th May 2021 (ref https://sailex.blogspot.com/
The reasons for not convening any such meeting with FORSE, in spite of our frantic and repeated requests, are not known so far though as per the indications available and floating around such meetings with few organisations of unfathomed stature and strengths and without much concern for the retiree’s welfare have been held in virtual mode. In such scenario, our Federation deserves much more merit for having a meeting with you at your convenience as being convened regularly for the retirees of other major PSUs e.g. IOC, ONGC, BHEL etc about which you must be aware being at the helm of SCOPE.
Madam, we the Federation of Retired SAIL Employees, formed 7 years back at Rourkela, registered in Odisha have affiliation of 14 units as may be seen from our letterhead of plants, metropolis, State and other cities operating since long, thereby commanding largest coverage of retirees settled throughout the length and breadth of the country and inexplicably interlinked with their long-term interest, not only with their healthcare, on a continuous basis.
Madam, emphatically we say that we are professionally managed, having retirees with highest academic achievements, business and commercial acumen and also possessing technical expertise having worked on shopfloor as front-line managers also in senior positions. Also, that its founders and the current Office bearers of FORSE have held lead positions in SEFI like Chairman, Vice-Chairman, General Secretary etc and President/ G.S. in SEFI affiliated Executives Associations and NJCS affiliated Unions. Most of them are still continuing with their social & professional commitments.
Besides, our Federation is complying with all statutory requirements as per Society's Act, holding regular committee meetings, AGM, accounts being audited and Income Tax assessed on a regular basis. We do not profess or deal only with healthcare issue or financial gains. We do have a holistic approach and ponder over other issues as well just to brighten the image of the organisation where we served for 35-40 years.
Our members are passing through trials and tribulations specially in this pandemic situation. In some cases, as our limit is low for treatment of covid patients in super specialty hospitals, retiree’s dependents had to take charge of the body or to take discharge of incapacitated member by mortgaging their valuables even. What a pitiable condition of SAIL retirees now?
Right now, we contemplate to take some loan from recently announced SBI offer of soft unsecured personal loan for 5 years. We just wonder whether SAIL can take bulk loan and disburse to needy retirees with lower interest.
There are many organisations both in public sector and private sector coming forward to help covid stricken serving and ex-employees. Tatas have assured to continue with the payment of salary to the dependents of diseased employees till the date of superannuation.
There are lot of ideas coming to our mind at this juncture which could be discussed at your level apart from only Health Care issues. This could bolster our image as benevolent and enlightened large undertaking like SAIL. This will usher in a new era under your leadership and go a long way in better goodwill, mutual trust and respect and unblemished understanding.
In view of the above we request you to kindly accept our suggestions as in FORSE letter dated 25th May 2021 and kindly organize a SAIL-FORSE meeting, in virtual mode, as per your convenience, so that we have an opportunity to clarify our position wrt all-encompassing issues raised in our recent communications and also in the past.
With regards,
Yours faithfully,
For and on behalf of Federation of Retired SAIL Employees
(V. N. Sharma) Chairman | (Ram Agar Singh( Gen Secretary |
By e-mail
FORSE/SAIL-C/0721
May 27, 2021
To
Ms Soma Mondal,
Chairman,
Steel Authority of India Ltd,
Ispat Bhavan, Lodhi Road,
New Delhi – 110 003.
Sub: Acknowledgement of
improvement in SAIL Mediclaim Scheme 2021-22.
Ref: Our
FORSE/SAIL-C/0621 dated May 25, 2021
Madam,
This is to gratefully acknowledge the improvements indicated in SAIL Mediclaim Scheme for 2021-22 through the Tender documents floated by SAIL recently. In addition to some favourable changes in the cuppings on procedures/ packages, a look at the Tender document revealed the following positive changes. Madam, we are thankful to you for your kind initiative and approval to these improvements in the Scheme desired/ demanded by FORSE, some of them for over 7 years now.
1) IPD / Cashless treatment increased to Rs. 8.00 lakhs: Our long-term demand of IPD/ Cashless treatment has been increased from earlier Rs 4 lakhs to Rs. 8 lakhs with floater facilities.
2) Treatment for Age Related Macular degeneration with Injection Avastin/Lucentis/Macugen: Rs.1,00,000
3) Robotic Surgery allowed.
4) Premium for 80+: Only Rs 100 will be the registration fee for those who are 80 and above.
5) Introduction of Tele-medicine and e-pharmacy
6) Premium in respect of gap cases to be same as others
Madam, we request you to kindly
take further cognizance and give serious sympathetic consideration to our Suggestions for improvement in Healthcare policy for SAIL Retirees (2021-22) and introduce necessary changes
in OPD coverage for uniform application throughout the country so that the heart
burning of discrimination in OPD coverage caused by locational disadvantage
does not exist anymore. We also request for a SAIL-FORSE meeting with you, as
per your convenience, so that communication gap is bridged.
With regards,
Yours faithfully,
For and on behalf of Federation of Retired SAIL
Employees
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(V. N. Sharma) Chairman
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(Ram Agar Singh( Gen Secretary |
This is to inform you that SAIL has floated Tender yesterday evening for SAIL Mediclaim Scheme 2021-22 with 16th June as the closing date of the Tender. To the best of our informal communication SAIL Chairman Ms Soma Mondal has taken initiative in deciding all the following important changes that FORSE has been putting up to SAIL on a regular basis, some of them like enhancement in IPD/ Cashless for the last 7 years.. We are thankful to her for her initiative and kind consideration.
A cursory glance of the Tender document reveals the following
changes.
1. IPD / Cashless treatment increased to Rs. 8.00 lakhs: Our
long term demand of IPD/ Cashless treatment has been increased from earlier Rs
4 lakhs to Rs. 8 lakhs with floater facilities.
2. Treatment for age related Macular degeneration with Injection
Avastin/Lucentis/Macugen: Rs.1,00,000
3. Robotic Surgery allowed.
4. Premium for 80+ : Only Rs 100 will be the registration fee for
those who are 80 and above. However, no other changes appear in OPD
premium or coverage.
The following cappings on procedures/ packages, as given below, shall also be applicable:
Disease/ Treatment Cappings
1. Hernia repair including Hernia Mesh: Rs. 40,000
2. Cholecystectomy Rs. 45,000
3. Haemorroidectomy Rs. 25,000
4. Appendicetomy Rs. 35,000
5. Hysterectomy Rs. 45,000
6.Coronary Angiogram/ Angiography : Rs. 16,000
7.Tonsillectomy Rs. 15,000
8. Cataract on one eye (excluding cost of IOL)/Package rate for Cataract
on one eye including IOL
a. Rs. 15,000/
b. Rs. 25,000
9. Knee Implantation-unilateral (excluding cost of implant) :Rs.1,00,000
10. For bed capping cities 1.5% I.e. 6000.00 for state capital 1.25% and
other area 1%.
General:
1. Left out cases will be allowed with normal charges in coming renewal.
After proper detailed study of the Tender document FORSE will decide on the
left out issues and demands. Our other demands which are not considered till
now will be on our priority and our efforts will continue to persuade SAIL to
improve the Scheme further.
FORSE/SAIL-C/0621
May 25, 2021
To
Ms Soma Mondal,
Chairman,
Steel Authority of India Ltd,
Ispat Bhavan, Lodhi Road,
New Delhi – 110 003.
Sub: Proposal for improvement in SAIL Mediclaim Scheme for SAIL Retirees for 2021-22
Ref: Our FORSE/SAIL-C/0521 dated May 10, 2021 with
request for urgent SAIL-FORSE Meeting
Madam,
This has reference to
the latest of our chain of communications starting with our letter No. FORSE/SAIL-C/
0221 dated Jan 02, 2021 addressed to you, mainly with a request to arrange a long-pending
SAIL-FORSE meeting to discuss various issues, concerning the Retirees like
operation of SAIL Pension Scheme, Covid-19, and to resolve the major issues. All of them including
the latest for improvement in SMSRE 2021-22 remained un-responded till now whereas the formulation and
tender calling etc for this matter is already in progress.
We have come to know through reliable sources that SAIL had a formal meeting with SEFI on SAIL Mediclaim Scheme. We are sure that both SAIL and SEFI representatives, participating in such meetings, are serving employees and all of such people are guaranteed of full Healthcare.
To save both SAIL and our members from ending up with an unsatisfactory Mediclaim Scheme for 2021-22 which, has been going from bad to worse in quality of service and satisfaction to Retirees as a Scheme year after year. We also have in mind the fiasco that took place last year and changes, though illegally, were introduced in the Agreement after it was signed and circulated and could not be corrected till the end. Not sure, for whose benefit such a summersault was executed and who were responsible for this. All this resulted from lack of communication between SAIL and FORSE.
In view of the above, FORSE Apex Council obtained the views of large cross-section of the Retirees, located in the nooks and corners of India, prepared the principle- and need- based Suggestions for improvement in Healthcare policy for SAIL Retirees (2021-22) which is attached herewith. Though such a one-sided communication with total silence at the other end cannot substitute for two-way communication- an universally accepted the best way of functioning in a democratic set-up yet we request you to kindly consider the attached suggestions seriously point-by-point. Once again I request you to kindly order for organising a SAIL-FORSE Meeting in virtual mode so that we can formulate a much better SMSRE -2021/22.
With regards,
Yours faithfully,
For and on behalf of Federation of
Retired SAIL Employees
(V. N.
Chairman
(Ram Agar Singh(
Gen Secretary
Annexure-I
Suggestions for improvement in Healthcare policy for SAIL Retirees (2021-22)
1.
All SAIL Retirees to be treated at par with serving employees
at least
for hospitalised treatment in SAIL nominated hospitals as per agreement with
NJCS in 1978 (Annexure -II) and also prevalent in some major PSUs like
ONGC, IOC, EIL, NTPC etc.
2.
We
recommend that New India Assurance Company Ltd alongwith MDIndia
Health Insurance TPA Pvt Ltd. as TPA be allowed to continue for our SAIL
Mediclaim Scheme for 2021-22 also as they were found to have done satisfactory
work in the current year 2020-21.
3.
Till above
is implemented @90% of the premium should be paid by SAIL across the
board for all age groups of Retirees. May be noted that the premium
contribution was fixed at a token amount of Rs. 196 at the start of this scheme from the Retired Employees as it was considered an obligation. This has
gone in the range of Rs.9000 without any improvement, whatsoever, in the
Healthcare of the Retirees.
4.
Coverage under OPD is proposed to be as follows:
a.
For all those Retirees who are availing the OPD
facilities at SAIL Hospitals/ Dispensaries, all medicines plus diagnostics tests to be provided/ done by SAIL Hospitals/
Dispensaries at its own counters/tests as is being done for the serving
employees. (If medicines are not available on the Hospital counters it must be
purchased/ procured by SAIL Hospitals and supplied to the Retiree/ spouse
within two days as is being done in SAIL Corporate Office Dispensary) In such a
situation Retirees will not claim reimbursement for OPD. This practice was in force till 2008. However, without any reason or rhyme
and office order without the approval of the Competent Authority it is a gross
violation of NJCS Agreement and also the established norms of SAIL.
b.
For all other Retirees from other locations, OPD coverage to
be raised to Rs.48000/- for self and Rs 48000/-for spouse on the same terms and
conditions prevalent
in SAIL Corporate Office Dispensary and RMD dispensary at Kolkata as per
circular in Annexure-III
c.
Serious issues of SAIL Retirees at Ranchi Ispat Hospital
Ranchi
i.
Ispat Hospital Ranchi is under MECON and is not following much of the
SAIL Policy on Healthcare and medicines are seldom available on the IH counters
for months and years. Every medicine has to be purchased by the Retiree
ii.
Doctors
visit to SAIL Satellite Township Dispensary which is run and managed for
professional (Medical support) by MECON and infra-structure by SAIL Units
Ranchi is seldom and highly irregular and, there too, medicines are never
available.
iii.
In case
doctor is present and writes the prescription for the SAIL retirees located in SAIL
Satellite Township or nearby places are required to visit Ispat Hospital for
medicines available and visit medical shops outside for those not available.
SAIL Retirees are standing sufferers due to this negligence. How such an
arrangement can help Sr Citizens from not getting infected by Covid-19?
d.
Solution: To mitigate these miseries of Retirees at Ranchi, SAIL must ensure
posting of a doctor and sufficient medicines in SAIL Satellite Township
Dispensary and create a separate facility - within IH or without - for
disbursement of medicines upto Rs.48000/- for self and Rs 48000/- on the
same terms and conditions to Ranchi located Retirees, as is available in SAIL
Corp. Office Dispensary, Delhi. As an alternative, SAIL Ranchi Units may also
adopt the suggestions made in para 4 a and provide all medicines from the
counter under which condition Retirees at Ranchi will not claim reimbursement
for OPD.
5.
FORSE proposes an IPD/ Cashless coverage
a)
FORSE proposes an IPD/ Cashless coverage of Rs.12 lakhs for self and spouse under IPD/
Cashless/ Hospitalisation cases on floater basis without any increase in
premium to be paid by Retired Employees. (A maximum of Rs. 4 lakhs on floater
basis coverage for self and spouse under IPD/ Cashless/Hospitalisation cases
has existed in SAIL for over 15 years when the cost of Healthcare and cost of
living have gone up beyond imagination. Even Vishakhapatnam Steel Plant has
better Healthcare schemes and premium share much lower than SAIL retirees)
b)
SAIL run
Hospitals have been found to be recovering the cost of cashless treatment from
the Insurance Co./TPA as and when he is discharged. Till March 2017 the cost of treatment at Unit
Hospitals were clamed from Insurance Company at the last month of validity period.
Otherwise, in case
of second entry for treatment the Retiree may face financial difficulty. In
light of the SAIL-NJCS 1978 Agreement it is illegal as the Retiree is
supposed to get free treatment. the FORSE proposes that as per the earlier
established practice the recovery should be made at the end of the duration of
the Scheme.
6.
Covid-19 special:
a.
The
premium for the Top up is too high and most members fail to take advantage of
the Top up Scheme even in the midst of the critical Corona wave. It is proposed
that SAIL should bear a minimum of 50% of the premium on this account.
b.
Entry in
the Top up be allowed at any point of time after a Member has renewed his basic
membership.
c.
It is
proposed to provide the option of "Co-Pay"
for the Top Up scheme for those members who want to avail it and reduce the
Premium amount.
d.
A provision
should be made to enhance the coverage of the Top up scheme in between the
period of its coverage in all 4 slabs i.e. Rs 5, 10,15 and 20 lakhs.
e.
Insurance Company/ TPA need to have Tie
up with all COVID hospitals in all places with a guarantee of Bed and
facilities available for Covid treatment.
7.
SAIL
Retirees or spouse must be allowed OPD/ IPD treatment in any SAIL Hospital or
SAIL designated Hospitals/ Nursing Homes/ Dispensaries on production of SAIL
Medical Card/ Aadhar Card/ Mediclaim card.
8.
Actual cabin/ room charges of Hospital should be
paid not exceeding 2 percent of total limit on floater basis ie
Rs.8000 at metropolis and at other places. Calculation should be made on
the Combined floater upper limit. ICU/CCU/ITU/HDU
and Ventilation charges should be on actual basis
9. Capping should be summarily abolished as in all the cases hospitals are
charging much more. Moreover, if capping is insisted then there is no choice
for the doctors. Hospitals are having their list
10. Robotic surgery should
be incorporated in
the SAIL Mediclaim Scheme as it involves less blood loss and convalescence and
it is ideally suited for senior citizens.
11. Immunotherapy
treatment for Cancer patients should be added.
12. In SAIL-
run hospitals
i.
The resources are thinning down very fast due to
superannuation of doctors, staffs and lack of modern machines or infrastructure
and it is forcing a substantial retired employee to go to private hospitals by
paying higher cost. The SAIL burden on this account may reduce drastically
if our unit hospitals are modernized and upgraded
ii.
The
experienced doctors are retiring every month. SAIL should either increase the
retirement age of doctors or engage them to provide their services on a
lucrative package.
iii.
List of
FORSE suggested Hospitals in the link https://tinyurl.com/SMSRE-Hospital2122 can be used for expanding the
Hospital Base for both OPD/ IPD and Covide Treatment.
13.
After a lot of persuasion by us and the public figures/ MPs VISP
Bhadravati employees- retired between 1998 and 2004 - were allowed to avail
the facilities of SAIL Mediclaim Scheme since last year. However, during its
implementation some of the Retirees, living in far flung areas and also due to
restricted movement as an effect of Corona pandemic could not join. We
propose to permit such Retirees - retired between 1998 and 2004- to join.
14.
Due to Covid pandemic most Retirees have avoided
going
to hospitals/ diagnostics centres for regular
check-up and for OPD consultation.
Unless there are new problem(s) the senior
citizens are advised to avoid going out including to hospitals. In
view of this, it should be made obligatory on the Insurance
Company and the TPA to accept a copy of the 2019 prescription and recent
medicine invoices for OPD claims and to reimburse the Bill amount of the claims
as per the norms.
15.
For
similar reasons as above as also heavy consultation charges like Rs. 600-1000
by private doctors and OPD, specially at Kolkata Ispat Bhawan
as indefinitely closed,
reimbursement should be allowed for treatment by National TeleConsultation
Service through https://esanjeevaniopd.in or Registered Medical
Practitioners as there is advantage due to logistics of habitats and high
charges of specialists of hospitals attached to OPD.
16.
Expenses on Dialysis/other diagnostic purposes for which the
person has to visit the hospitals on regular interval must be covered.
17.
Day Care
Treatment: The patients are admitted and
discharged on the same day in such cases as:
a) Endo therapy for liver disease,
b) Chemotherapy & other treatment for
cancer,
c) Dialysis for kidney disease,
d) Diagnostic purposes etc.
Payments in above mentioned cases
should be made not being admitted in the hospital for more than 24 hours. All planned day care procedures at
approved hospitals should be cashless
18. All capping limits need to be reviewed
as they haven’t been modified since inception. They should be on actual basis.
19.
IT
may please be noted that till a few years (3-4 yrs) ago SAIL mediclaim
policy covered Preventive Health Check-up
but suddenly it was put up in IMPORTANT EXCLUSIONS clause. Preventive
Health Check up be removed from Exclusions list and included in regular list.
20. Age Related Macular degeneration (AMD)
a. can strike anyone but is not covered
under the current policy. As it is age related, it is all the more important
that this is covered for retirees. Treatment for Age Related Macular
degeneration like Avastin injection in the eye should be covered. It is
a day care procedure.
b. Treatment of Macular Eye disease should
be taken out from the list formally from the exclusion list. Last year there
was lot of Fiasco. SAIL got it included in the Exclusion list again almost two
weeks later which was both legally and morally wrong.
21. SAIL to
create facilities of a consulting doctor, a dispensary and a medical
store in all cities/towns, where it does not have a Hospital/ dispensary of its
own, on the same pattern as exists in the Corporate Office, Delhi.
22.
SAIL Nodal Officer/IRPs for Mediclaim matters to
be responsible for settling grievances of Mediclaim members in relation to
treatment, payment, entry, release and settling of Bills for Cashless treatment
of member from Hospital. A 24 hr -3 shift office may be set up and operated to
help Retirees.
23.
Renewal of lapsed mediclaim: Anytime
and every time with a nominal charge.
24.
Profit sharing by SAIL with the Insurance Company
in the Agreement should be amended to replace Profit sharing by SAIL exclusively
with Mediclaim members.
25. List of FORSE suggested
Hospitals in the link https://tinyurl.com/SMSRE-Hospital2122
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Annexure-II
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