Retired Employees Medicalbenefit Scheme-I

RETIRED EMPLOYEES MEDICALBENEFIT SCHEME-I STATE BANK OF BIKANER & JAIPUR SBBJ RETIRED EMPLOYEES MEDICAL BENEFIT SCHEME-I 1. SCHEME:-I The Executive Committee in its meeting dated 11.08.1998 approved the SBBJ Retired Employees Medical Benefit Scheme for implementation in our Bank and amendments to the Scheme are being made thereafter from time to time. Since the benefits under the scheme are to be extended only to the retired employees and their spouses and not to the serving employees so it is not treated as part of the staff welfare activities. The Scheme is being governed as per the guidelines of State Bank of India and is administrated by the Pension P.F. and Gratuity Deptt., Head Office, Jaipur. 2. OBJECT: The object of the Scheme is to provide financial assistance partly or fully, within specified limits, hospitalization expenses for treatment of specified diseases/ailments to retired employees and their spouses where expenditure involved is large. The treatment will have to be taken at hospitals/nursing homes which have been approved by the Bank for the purpose. Since approval of hospitals/nursing homes throughout the country i.e. at centers where approved hospitals of the Bank are not available, may take time, the facilities of treatment at such centers may be confined to Government Hospitals and hospitals run by the Charitable Trusts. 3. MEMBERSHIP: All the retirees of the Bank who satisfy any one of the following conditions are eligible to become a member of the scheme:-

 Those who retire from the Bank's Service on completion of 30 years of pensionable service. or  Those who will be allowed to retire from the Bank's Service on medical ground. or  Those who have retired/will retire on attaining the superannuation age of 58 years or 60 years provided they have put in at least 10 years of pensionable service.

For applying for membership, an employee retiring from the Bank's service will have to make/pay a onetime lump sum contribution as membership fee equal to one month's gross pension currently drawn by him within 3 months of the receipt of his first monthly pension. Those who will be retiring from the Bank's service and have not opted for pension, will have to make /pay a contribution/membership fee equal to one month’s notional gross pension which they would have drawn currently( to be calculated and advised by PPG Deptt.) had they opted for pension within 3 months from the date of retirement.

The retired employees who have taken up commercial employment or their spouses, are also eligible for medical benefits, but they will have to first exhaust the benefits, if any, available from the present employer. Employees who have been discharged/dismissed/removed from service/compulsorily retired or their services have been terminated on grounds of misconduct will not be eligible for membership of the scheme. Employees those retired under SBBJ Exit Scheme-2005 would also not be covered.

 PROCEDURE FOR MEMBERSHIP : A retired employee, eligible under the scheme, who wishes to become a member is required to fill up a prescribed membership-cum-declaration form which can be obtained either downloading from site ‘Blank preformed for retrial benefits’ at the branch wherefrom he is retiring or from the Chief Manager (P.P.G.), Head Office, Jaipur and will require to deposit the membership contribution equivalent to his/her i) one month's current gross pension/one month's current notional gross pension by means of Bank Draft drawn in favour of the "SBBJ Retired Employees' Medical Benefit Scheme" on Tilak Marg Branch, Jaipur. Cash and cheque or payment by any other means will not be accepted. A Performa of membership-cum-declaration form is given at Annexure - "A". The form will be deposited along with the contribution/fee by way of Bank draft with the Chief Manager, P.P.G. Deptt. at Head Office, Jaipur. ii) After careful scrutiny and verification of the identity of the applicant and receipt of the membership fee, the Chief Manager, PPG Deptt. at the Head Office, Jaipur will permit provisional membership to the Scheme subject to ratification by the Board of Trustees in their meeting. The membership will take effect only on receipt of contribution/membership fee. On granting provisional admission, a suitable membership number will be allotted which should be quoted in all correspondence relating to the member in future.

5. BENEFITS UNDER THE SCHEME: i. The members and their spouses are beneficiaries under the Scheme. The spouse will continue to receive the benefit even after the death of the member. ii. Since the resources available under the scheme are limited and to extend the benefits to the maximum numbers the reimbursement of hospitalization expenses are limited to Rs.0.25 lac per year within maximum limit of Rs.2.00 lac per member throughout the life. Following diseases have been covered under the scheme for reimbursement:- a) Cardiac ailments b)Cancer c) Kidney failure/transplant d)Paralysis e) Retinal detachment/Cornea replacement f) Major accidents g) Prostate enlargement h) Cataract i) Glaucoma Surgery j)Tumors k) Removal of Stone in Gall Bladder l) Cerebra Vascular Accidents'/Brain Hemorrhage m) Total Hip/Knee replacement n) Tuberculosis o) Appendicitis Surgery and p) Hernia diseases Other terms and conditions of the original scheme will remain unchanged. (Circular No. PER/49/2003-04 dated 14.11.2003).

The Managing Committee has also approved to include bodily injury causing all unforeseen /unexpected events under major accident. In case of disease like Cancer, Kidney, Heart ailment and Paralysis reimbursement of Hospitalization expenses are enhanced by the Managing Committee in their meeting on 17.02.2005 to Rs. 1.00 lac per annum from Rs. 0.25 lac within overall limit of Rs. 2.00 lacs in life time. Recently, facility for domiciliary treatment has also been extended to heart/cardiac ailments in addition to paralysis, cancer and kidney transplant.

If both a member and spouse are members of the Scheme and they both pay the contributions/membership fees individually, they would each be entitled for reimbursement separately. iii. Expenses for treatment of the above mentioned diseases/ailments, during hospitalization, including surgical treatment, will be paid fully subject to the stipulation regarding reimbursement limit made in sub Para 5(ii) above. However, in the case of paralysis, cancer or kidney transplant, if the patient was operated/treated even while in service in a hospital and thereafter the post hospitalization treatment continues at his/her residence, the expenses will be paid. iv. The treatment shall normally be taken within the country. In exceptional cases where treatment is not available in India, The Managing Committee will decide whether and to what extent the treatment abroad can be reimbursed within the ceiling stipulated in sub Para 5 (ii) above.

6. PROCEDURE FOR RAISING CLAIMS:

i. The ailments covered above are critical and providing timely medical assistance is essential.

ii. Normally, no member or spouse should be refused the benefit of treatment if he is having to his/her credit funds available within overall limit as prescribed from time to time and subject to availability of funds.

iii. The treatment will have to be taken at hospitals/nursing homes which have been approved by the Bank for the purpose. Since approval of hospitals/nursing homes throughout the country i.e. at centers where approved hospitals of the Bank are not Available, may take time, the facilities of treatment at such centers may be confined to Government Hospitals and hospitals run by the Charitable Trusts. iv. The Trustees will arrange to identify and approve a few hospitals/nursing homes in all major cities and make arrangements for providing treatment thereat. The consideration for identification of the hospitals should be availability of facilities for major surgeries and reasonableness of charges. However, until such arrangements are made services of Government Hospitals or Hospitals run by the Charitable Trusts should be utilized.

v. The Board of Trustees erstwhile Managing Committee at its meeting held on 27.03.2003 approved that the hospitals recognized/approved by State Bank of India and Associate Banks all over India for treatment to our retired employees under the Scheme and they shall be eligible w.e.f. 16.04.2003. The retirees who avail the services of hospitals recognized/approved by State Bank of India and Associate Banks will have to submit a Certificate from the hospital that it is approved/recognized by State Bank of India or Associate Banks while submitting their bills to PPG Deptt. (Circular No. PER/6/2003-04 dated 16.04.2003). The Trustees at their meeting held on 17.02.2005 approved some more hospitals at district level for treatment of diseases identified in the Scheme.

vi. The Board of Trustees erstwhile Managing Committee have empowered on 25.06.2004 to General Manager (Operations) to reimburse the bills of unapproved hospitals/nursing homes if treatment taken by a member in emergency. Such reimbursement will be based on merit of the case. vii. The Scheme is running on reimbursement basis i.e. at the first instance, member will have to incur expenditure on treatment and thereafter he/she may seek reimbursement. In no case advance from the Fund shall be granted. viii. After treatment is over, member should submit his/her medical bills duly verified by the treating doctor within 3 months to the Chief Manager, Pension, Provident Fund and Gratuity (PPG) Department of the Bank at Head Office, Jaipur. The bill will be paid by PPG Deptt. In consultation with the Bank's Medical Officer at Head Office, Jaipur within the ceiling stipulated in sub Para 5 (ii) above.

ix. After making reimbursement of the expenditure, an entry to this effect will be made in the identity card-cum-pass book of the member over full signature of the Chief Manager, Pension, Provident Fund and Gratuity (PPG) Deptt.

x. The members are enjoined upon to make sure that only genuine and reasonable amounts are charged and claimed so that they are able to derive maximum advantage under the given monetary limit. No restriction is proposed to be placed on the type of room taken by a member for treatment.

xi. In case false claims are found to have been submitted by any member, the benefits available to him under the scheme will be forfeited, his/her membership will also be cancelled and the fee so paid will automatically be forfeited. There is no provision for refund of fee for any reason whatsoever. xii. The Bank or the Trustees will not be responsible for any tax liability devolving on a member, arising out of reimbursement of medical expenses under the scheme. xiii. For the present, the format of submitting medical bills for payment under the Scheme is enclosed as Annexure - D. ANNEXURE ‘A’ FORM FOR JOINING MEMBERSHIP OF THE STATE BANK OF BIKANER & JAIPUR RETIRED EMPLOYEES MEDICAL BENEFIT SCHEME-I

(Please attest the Photographs)

Photograph of the Retire Employee and spouse

Note: - Photographs of the member and the spouse duly attested by the Branch Manager of the Branch from where pension is being drawn or the Branch/Department from where employee retired. i. Name of the retired employee : ii. Address : iii. P.F. A/c Number : iv. Date of Birth : v. Date of joining the Bank : vi. Joined the Bank as : vii. Date of retirement from the Bank : viii. Age on the date of retirement from the Bank : ix. Length of pensionable service in the Bank x. Whether the member was removed from service/compulsorily retired/discharged/ dismissed from the Bank : xi. Whether retired in the normal course or on medical ground : xii. If retired on medical ground : a) Whether retired under Regulation 30 of : State Bank of Bikaner & Jaipur Employees Pension Regulations, 1995 b) Whether a medical board was constituted : xiii. Branch from where pension is being : drawn to be drawn/or retired xiv. Amount of gross pension drawn/ : proposed to be drawn per month xv. If employed after retirement from the Bank, : please state details of the medical benefits available from the employer in respect of self as well as the spouse specify the name of the employer/proposed employer xvi. Spouse a). Name of the spouse : b) His/her date of birth

: c). Whether he/she is employed anywhere? : If so, details of the eligible medical benefits from his/her employer xvii. Contact No. Landline Phone No.: Mobile: (For SMS Facility) xviii. Current/Saving Bank Account No. : (For direct credit to account)

Place: Date: Signature of the Retired Employee

Declaration: We declare that:- i) The particulars given above are correct. ii) We have read and understood the terms and conditions of the scheme and undertake to abide by the same. iii) We shall not make any false medical claim from the Bank under the Scheme. In the event of our making any false medical claim, or not settling the medical bill, we are liable to forfeit the benefits under the Scheme as also our membership to the Scheme. iv) We note that claims made under the Scheme will be settled subject to availability of Funds. v) We also note that in case the Bank decides to wind up the scheme and dispose off the contributions/fees received from me in a manner deemed fit, we shall have no legal claim against the Bank or the Managing Committee.

One extra joint photograph duly attested, for pass book is enclosed.

(Signature of the spouse) (Signature of the member)

Date : Date :

(Counter signature by the Branch Manager of the branch from where pension is being drawn or the branch from where the employee retired)

Branch…………………. …………………………………..

Code Number: Date: FOR OFFICE USE: Based on the information provided as above and certificate, the said retired employee is admitted subject to ratification by the Managing Committee in due course. i) Details of the draft received by way of :D.D. No…………………………... membership fee/contribution Amount …………………………... Date………………………………. Drawn on ………………………… ii) Date of remitting the membership fee/ contribution to Pension, Provident Fund & Gratuity Department : iii) Date of admission : iv) Date of ratification by the Managing Committee :

Date: CHIEF MANAGER Place PENSION, P.F. & GRATUITY DEPTT. HEAD OFFICE, JAIPUR ANNEXURE-D

APPLICATION FORM FOR REIMBURSEMENT UNDER SBBJ RETIRED EMPLOYEES MEDICAL BENEFIT SCHEME-I Place: Date: The Managing Committee State Bank of Bikaner & Jaipur Retired Employees Medical Benefit Scheme C/o Pension, PF and Gratuity Department Head Office, Tilak Marg Jaipur-302005 Dear Sir SBBJRETIRED EMPLOYEES MEDICAL BENEFIT SCHEME:-I- REIMBURSEMENT OF EXPENSES

1. I am a member of the SBBJ Retired Employees Medical Benefit Scheme and retired from the Bank’s Service on ------from------(Branch/Deptt. Where last posted) as ------(Cadre/Grade)

2. Now, in terms of provisions of SBBJ Retired Employees Medical Benefit Scheme, I apply for reimbursement of amount in respect of sum spent by me on hospitalization. The full particulars of which are as under:-

A Name of the person hospitalized B Relationship with the retired member C Nature of disease D Period of hospitalization From- to- E Name, Address and Registration number of the Hospital/ Nursing Home F Total amount spent Rs. G Amount admissible under SBBJ Retired Employees Medical Benefit Rs. Scheme. Particulars Actual Expenses I Bed charges @ Rs.------per day.(Excluding charges for food) Rs. ii Medicines/injections/dressing excluding charges for tonics Rs. iii Operation Theatre Charges Rs. iv Aneasthia Charges Rs. v Fees of Specialist Doctor/Visiting Doctors Rs. vi Surgeons fee (including Assistant’s fee) Rs. vii Pathological Tests/X-rays/ECG Charges Rs. viii Other Charges (give details) Rs.

TOTAL Rs. 3. All the relative Bills/cash memos have been paid by me and are enclosed herewith in original duly verified by the concerned Physician/Surgeon along with certificate of illness and period of hospitalization.

4. I hereby declare that the particulars given above are correct and if any time it is found that I have concealed anything or produced anything wrong I will refund back the entire amount received by me and will be debarred to get any further assistance from the Managing Committee.

4 A. I am a normal retired employee. (Employees who have not been removed from the service, compulsorily retired /discharged/dismissed from the Bank)

5. I have not received nor will claim any amount from any other institution without the knowledge of the Managing Committee, in respect of above expenditure.

6. I understand that the tax liability, if any, arising on account of assistance received from the Managing Committee shall be borne by me.

7. In the event of my death, the amount due to me may be paid to my nominee whose particulars are given below:-

I) Name of the nominee ______

II) Relationship with the retired employee ______

III) Full postal address ______8. I also declare that the expenses detailed above are actually incurred by me. Since I have settled at ------(place) the amount of assistance may be remitted to me through State Bank of Bikaner & Jaipur ------Branch/Department.

9. Amount already availed during the year from the Pension, PF & Gratuity Department under the scheme. (Please mention date and amount)

10. Identity Card cum Pass Book is enclosed for necessary entries.

Yours faithfully

(Applicant Full Signature) (Applicant Full Name) Membership No.______

SB A/c NO/ Pension A/c NO.______

Contact NO.______

VERIFICATION BY THE AUTHORISED BANK’S DOCTOR Verified that the nature of disease and the expenditure are within the purview of the “SBBJ Retired Employees Medical Benefit Scheme” of the State Bank of Bikaner & Jaipur.

PLACE: BANK’S AUTHORISED DOCTOR DATE: (SIGNAURE & SEAL) ANNEXURE-F

APPLICATION FOR RETIRED EMPLOYEES TO SBBJ EMPLOYEES PROVIDENT FUND TRUST Date: The Trustees State Bank of Bikaner & Jaipur Employees Provident Fund Trust Head Office, Tilak Marg, Jaipur-302005

Dear Sir

MEDICAL ASSISTANCE SCHEME (MAS): REIMBURSEMENT OF RESIDUAL MEDICAL EXPENSES

I was a member of the Provident Fund and retired from the Bank’s Services on ------from------as ------

2. Now, in terms of provisions of Medical Assistance Scheme, I apply for reimbursement of residual amount in respect of sum spent by me on hospitalization. The full particulars of which are as under:-

A Name of the person hospitalized B Relationship C Nature of disease D Period of hospitalization From- to- E Total amount spent (excluding cost of items disallowable) Rs. F Amount admissible under SBBJ Retired Employees Medical Benefit Rs. Scheme. G Residual amount to be paid under MAS Scheme. Rs.

3. All the relative Bills/cash memos have been paid by me. Original bills have been submitted for reimbursement under SBBJ Retired Employees Medical Benefit Scheme and the photo copies of the same are enclosed herewith duly countersigned by the concerned Physician/Surgeon along with certificate of illness and period of hospitalization. 4. I hereby declare that the particulars given above are correct and if any time it is found that I have concealed anything or produced anything wrong, I shall refund back the entire amount received by me and will be debarred to get any further assistance from the Provident Fund.

5. I am a normal retired employee. (Employees who has not resigned/voluntary retired/dismissed or removed)

6. I have not received nor will claim any amount from any other institutions without the knowledge of the Trustees, in respect of above expenditure.

7. I understand that the tax liability, if any, arising on account of assistance received under MAS from the Provident Fund shall be borne by me.

8. In the event of my death, the amount due to me may be paid to my nominee whose particulars are given below:- I) Name of the nominee ______

II) Relationship with the retired employee ______

III) Full postal address ______9. I also declare that the expenditure detailed above have been actually incurred by me.

Yours faithfully

(NAME OF THE RETIRED EMPLOYEE) PF A/C NO.______SB A/C NO. / PENSION A/C NO.______CONTACT NO.______