By e-mail
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.
Madam, in a human
life especially spent in employment, 60+ and 60- years (Age at superannuation)
has a lot of difference and meaning which comes out from person-to-person and
day-to-day experience of a sufferer’s life or close watchers like FORSE
representatives. How can SEFI representatives raise SAIL’s ever continuing
discriminatory approach in OPD coverage of Rs 48000/- for the Retiree and same
for the spouse in SAIL Corporate Office Dispensary, Delhi and RMD Kolkata and
Rs.4000/ 8000 for Retirees in other locations like Ispat Bhawan Dispensary in
Kolkata? Other locations don’t have even that. Ranchi is a peculiar case of
suffering Retirees where SAIL has no control over the Healthcare services which
is fully under MECON. What need for SEFI members toknow the basis of
SAIL-NJCS 1978 Agreement and how it is affecting Retiree’s life?
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. Sharma)
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
