To, Shri MSS Rao GM (Admn.)BSNL-HQ Bharat Sanchar Bhavan Building Jan path Road, New Delhi – 110 001 [011-23734157-Off & 011-23718288-Fax / Room No: 1201-SMH ] Our Earlier Ref.Ltr. No: SNEA/CHQ-WL/2008-09/06a09/ Dated: 01 / 06 /2009 Your office Ref Letter: Minutes of the Committee Meeting for Reviewing Medical Policy held on 10th June-2009 at 11.00 Hrs. held in the chamber of Respected GM (Admn.) BSNL-CO-New Delhi Our Letter. No: SNEA/CHQ-WL/2008-09/06b09/ Dated: 13 / 06 /2009 Subject: Submission of proposals / Agenda items from ―SNEA (I), for the forth coming meeting going to be held for ―Reviewing existing Medical policy i.e.BSNLMRS‖. Respected sir, In connection of above reference letter, u/s is directed by our General Secretary-SNEA (I), to submit suggestions / agenda as a representative of SNEA (I). As discussed in our last meeting held on dated 10—6-2009 Our over all mottos behind this exercise is to find the reasonable solutions which help us for providing improved quality base medical facilities which are being extended to our employees / officials, along with ensuring restriction on the expenditure which is to be bear by BSNL. In this regard for (1) Out door (2) In door BSNLMRS, our suggestions are as under. (1) We may explore all the possible steps for improving our present BSNLMRS for outdoor treatment & balancing the present expenditure. For working and retired employee, which are as under. (1a) It is observed that very high expenditure is taking place in 100% (voucher base) opted scheme. And apart from that it consume our costly man hour / time, and involvement of series of officials right from clerk to SSA Head for process of these bills, which is not at all affordable to us. Hence For O/D reimbursement we may fix the amount for all the employees at par. (1b) Existing the reimbursement of chronic diseases listed vide: BSNL/Admn.I/1 Dated 03-06-2004. AND some more felt necessary, is to be continued with 100% REIMBURSHMENT as it is. (1c)As prescribed by concerned Medical officer of our Empanelled Hospital, for various machines / equipments, which is essential for aid & assistance of different organ e.g. for Ear, Heart, Lung/Breathing etc, either for enhancing or maintaining the proper performance of organ, 100% REIMBURSHMENT is to be made under such cases. (2) First of all we may explore all the possible steps for improving our present BSNLMRS (for Indoor treatment) scheme for working and retired employee, which are mentioned as under. (2a) In case of In door treatment also the consumption of our time, and costly man hour i.e. involvement of series of officials right from clerk to the SSA Head / the CGM for process of these bills, which is nighter our business as a service provider nor affordable to us. Consequently we may also explore the possibilities of handling such affairs in which we are having no expertise, through engaging T.P.A. as adopted by various “MediClaim agencies”. (2b) Sr. Issues of Present Improvement Requirement in BSNLMRS scheme. No. BSNLMRS scheme I. In revised CGHS-Rate list in In case of Rates higher then CGHS the concern CGMs / SSAs the many items of surgery, are to be empowered to negotiate with reliable specialized costing more then 1.00lakhs hospitals under their zone and allowed to empanel such e.g. coronary bypass surgery, hospitals within limit e.g. =<10 %, =<15 %, =<20 % above the open heart procedure, open CGHS-Rate list As per the classification of towns i.e. for class C- ASD-VSD,open pulmonary and bellow,B,A-and metro respectively. valvotomy,double valve Now for the issue of balancing / bearing the additional amount replacement,total knee joint beyond CGHS we need to explore various possibilities. replacement,etc. in which the IA. Emloyee,spouse,two child(unemployed) up to 25 years age & rates are slashed up to 20 to above 25 years age in case of disabled, widow /unmarried 25 % compare to earlier rates. daughter, and dependent parents i.e. total SIX-Members are to considered as family member.(For working and retired employee) Due to which the existing IB. Medical card with Group photo is to be issue with all detail ―empanelled hospitals are such as Name, Age /Birth date, Blood group, STATION of staying either quitting BSNL or our (so that it can be allowed for eligible family members who are officials has to pay such staying in other station FOR taking treatment in concerned additional expenses from their STATION) . Accordingly Once in every finical year undertaking is to pocket‖. be obtaining from each employee for conformation of all family members detail & as per need additional Medical card is also to be issue by parent station authority. IC. Beneficiary Reimbursement In case of various categories of Empanelled Hospitals. Hospital= Hospital= Hospital= CGHS CGHS+20% Above the Rates. above Rates. (CGHS+20%) Rates. Up to Up to Up to Employee / 100% of 120% 120% i.e. Self CGHS Maximum i.e. Beyond(CGHS+20%) (CGHS+20%) is to be bear by self All other 100% of 100% of 100% of family CGHS CGHS i.e. CGHS i.e. member Beyond(CGHS) Beyond(CGHS) is to is to be bear be bear by self by self ID. Further it is to be uniformly implemented that, the Payment / claims to all empanelled hospitals is to be made directly from BSNL. II. We are following CGHS-Rate In this connection guideline was issued from BSNL-HQ vide list, but not the overall policy. no:BSNL/Admn.I/1-1/07,Dtd23-04-07,But unfortunately it is not Due to which many ―disease‖ at all fulfilling our purpose. which are not covered in IIA. In such cases concerned CGMS are to be empowered for 80 CGHS-Rate list for such our % advance of estimate without any delay / referring case to officials are facing very much BSNL-HQ. & reimbursement as per either actual expenditure or AIMS. problems in granting advances & reimbursement e.g. Live IIB. Entitled Ward as per CGHS criteria is to be made applicable. liver transplanment, cochlear implant surgery-(ear related) etc. III. In some Circles e.g. Gujarat For sanctioning of Further it is to be uniformly implemented that, For sanctioning of Advance & Advance SSA-Heads are to be empowered irrespective of limit, Reimbursement, SSA-Head are Of Basic + DA. empowered up to 2 basic + While for Reimbursement we may follow the existing DA. Due to which in most of procedure. costly but emergency-type treatments our officials / family members are suffering lot. IV. For sanctioning of Advance & The Hospitalization / Treatment in private Hospitals for the Reimbursement in case of ―disease‖ of the nature of emergency / specialized , wide Hospitalization / Treatment in angles are to be kept as criteria to handle such cases private Hospitals, either in positively, For Advance & Reimbursement at par with cases of Emergency or ―empanelled hospitals within the limit as covered above at IC . specialized treatment i.e. in other then ―empanelled hospitals‖. Our officials are facing very pathetic & embracing condition and are suffering lot. V. Now for the issue of balancing / bearing the additional amount beyond CGHS we may also explore the possibilities of offering dual sources of reimbursement as per Govt.of India letter no: S-11011 / 4 /2003-CGHS (P) optionally/ discretionary to our desire staff, by entering in to agreement with reliable MediClaim agency, with some relaxation in terms & condition in our favor. As done in case of Home loan. Thanking you, Yours truly, (B.G.Patel)-Circle President SNEA (I)-Gujarat. [Representative of SNEA (I)-CHQ] Copy to: (1) All the Respected members of ―Medical review committee‖ of BSNL-HQ, for inf. & N/A.Pl. (2) Com.G.L.Jogi, General Secretary SNEA (I)-CHQ New Delhi, for inf. & N/A.Pl.