Medical Facilities to CSIR Employees and Pensioners

(20)Medical Facilities to CSIR Employees and Pensioners

(20.1.1) Enhancement of powers of Directors of all National Labs./Instts. to admit medical claims - Clarifications regarding.

The Heads of Department in the Government of India are empowered to allow reimbursement of charges for medical treatment in emergent cases in a private hospital to their employees as contained in the, Ministry of Health order dated 23rd February, 1977 and 7th May, 1979 read with their O.M. No.S- 14012/9/75/MC/MS dated 18th June, 1982, subject to conditions stipulated therein.  These orders are contained in the Swamy's Compilation of Medical Attendance Rules.

The question of delegating the above powers to the Directors/Heads of the National Laboratories/Institutes has been under active consideration in CSIR for some time past.  It has been decided in consultation with the Financial Adviser that Directors/Heads of National Laboratories/Institutes may exercise these powers as Heads of the Department for allowing reimbursement of medical charges for treatment in really emergent cases in a private hospital at the Headquarters of an employee subject to the conditions contained in the above orders. Past cases need not be reopened.

(CSIR letter No. 14(2)/25/85-E.II, dated, 6th January, 1987) 

(20.1.2) Sanjay Gandhi Post Graduate Institute,  Lucknow - Recognition as a Referral Institute.

Reference CDRI letter No. CA/CDRI/Misc/89 dated 20th March, 1989 on the above noted subject.  'Re DG-CSIR, in consultation with the Finance has been pleased to accord approval to treat the Sanjay Gandhi Post-Graduate Institute of Lucknow as a referral Institute under CS (Medical Attendants) Rule, 1-944 for the employees working in the CSIR Labs./Institutes at Lucknow on the terms and conditions as are applicable to P.G.I., Chandigarh and All India Institute of Medical Sciences, New Delhi.

(CSIR letter No. 14(6)/83-E.II, dated, 11th May, 1989) 

(20.I.3) Guidelines for Part-time Doctors

The question of framing guidelines for having a uniform policy for engagement of part-time doctors and grant of honorarium to them was under consideration for sometime past.  The DG-CSIR on the recommendation of the committee constituted for the purpose has approved the following guidelines

  1. Not more than one part-time doctor may be engaged by a Lab./Instt.; 
  2. Part-time doctor engaged should be of repute; 
  3. Honorarium may be to the maximum of Rs. 500/- per month per hour per day subject to the ceiling of 3 hours per day and the maximum of Rs. 1500/- per month.
  4. Part time doctors may not normally be engaged where Departmental Dispensary is running with a full time doctor. 
  5. Part-Time doctor could be engaged in exceptional circumstances for the medical care of its employees during working hours even though the employees are covered by CGHS Scheme/Reimbursement Scheme where Authorised Medical Attendants exist under Central Service Medical Attendants Rules, 1944. 
  6. Powers to engage part-time doctor will now rest with the Head of the Lab./lnstt. 
  7. In case of the departure from (a) & (c) above, approval of CSIR be obtained. 

This issues with the concurrence of Financial Adviser, CSIR. 

(CSIR letter No.4(10)/80-E-II, dated, 3rd February, 1988)

(20.1.4) Guidelines for engaging part-time doctors - Modification thereof.

In partial modification of this office letter of even number dated 3.2.1988. I am directed to inform you that DG-CSIR has been pleased to accord approval to the following :-

  1. Rate of honorarium per hour, per-day, per month for a part-time doctor may be increased from Rs.500/- to Rs. 650/- subject to the ceiling of three hours per-day, per-month with a maximum of Rs. 1950/- per part-time doctor. The above consolidated honorarium will include the transportation cost also.
  2. The engagement of a part-time doctor is admissible only in the Allopathic system.  However, if a Lab./Instt. requires a part-time doctor in any other system, namely, Ayurvedic/Unani/Homeopathic, the Head of the Lab./lnstt. will be competent to engage him as AMA subject to the conditions laid down for appointment of an AMA in the CCS (NIA) Rules, 1944, as amended from time to time.
  3. The other conditions for engagement of part-time doctors will continue to be the same as contained in CSIR Circular of even number dated 3.2.1988.

(CSIR letter No. 14(10)/91 -E.II. dated, 3rd October, 1991)

(20.1.5) Sub- Medical facility for retired CSIR employees.

The question regarding extension of medical facilities to retired CSIR employees on the analogy of similar benefits available to Central Govt. employees has been under consideration for some time.  After careful consideration of the matter, it has been decided that retired employees of CSIR and their families who are normally resident at places/stations where CSIR has established its own dispensaries may be provided with medical attendance and treatment to the extent available in the dispensary free of charge.  These employees will, however, not be entitled to any kind of reimbursement of medical expenses incurred by them.

2.  It is requested that admissibility of this concession may kindly be brought to the notice of all the retired CSIR employees who are drawing pension at your laboratory/institute individually to enable them to avail this concession without delay.

(CSIR Letter No: 17(1)/81 -E.II, dated: 16th June, 1982.) 

(20.1.6) Sub: Extension of facilities to CSIR Pensioners.

The matter regarding providing various facilities to the CSIR Pensioners has been engaging the attention of the CSIR.  The DG-CSIR has now been pleased to approve that pending provision of comprehensive social and medical facilities to the pensioners and the members of their families as recommended by the Fourth Pay Commission, the following facilities may be extended to the CSIR Pensioners by the Labs. in the first instance, with immediate effect:-

  1. Facilities of reading room, library, recreation etc. as being provided by the various clubs of the Labs.  If necessary, they will be eligible to become members of the respective clubs;
  2. to provide two journals brought out by the CSIR of their choice to all the retired scientists for rest of their life.  For this purpose, choice of two CSIR Journals may be obtained from pensioners who retired as Scientist 'B' or above and are drawing pension through your Lab./lnstt. and the same forwarded to PID for necessary action.
  3. CSIR/Lab.  Guest House facilities subject to availability on the same rates and terms and conditions as applicable to Council employees while not on duty.

It is requested that all the pensioners drawing pension from your Lab./lnstt. may be informed of the above provisions and they may be extended the necessary facilities as above.

(CSIR Letter No: 17(1)87-E.II(3), dated: 9th January, 1987.)

(20.1.7) Sub: Extension of CGHS Facilities to Employees/Pensioners of CSIR - Nursing Home Facilities.

Consequent upon the withdrawal of Nursing Home facilities to the employees/pensioners of the CSIR and their families under the CGHS, the DG-CSIR has been pleased to approve that pending restoration of such facilities by the Govt., CSIR employees/pensioners and their family members stationed at Delhi, in case of hospitalisation, will be entitled to reimbursement of charges, if any levied, for availing Nursing Home Facilities of their status in the CGHS recognised hospitals, as admissible under the CCS (Medical Attendance) Rules.

(CSIR Letter No: 3(441)/78-E-III, dated: 15th July, 1987.)

(20.1.8) Extension of CGHS Facilities to Employees/Pensioners of CSIR - Nursing Home Facilities

Consequent upon restoration of Nursing Home facilities by the Ministry, of Health & Family Welfare vide their Orders No. F.N. 4-1/87-C&P Section /CGHS-8942-9142 dated 21.7.92) to the employees/pensioners of Semi-Govt./autonomous organisations, it has been decided that the instructions contained in this Office Memorandum of even number dated 15th July, 1987 to provide the facility for reimbursement of charges, if any levied, for availing Nursing Home Facilities of their status in the CGHS recognised Hospitals admissible under CCS (Medical Attendance) Rules 1944, may be treated as withdrawn with immediate effect.

It is requested that wide circulation maybe given to this decision amongst the employees/pensioners of your Laboratory /Institute for their information.

(CSIR letter No. 3(441)/78-E.III, dated, 11/13th November, 1992)

(20.1.9) Sub: Medical facilities for retired CSIR Employees

The Governing Body of the CSIR has approved to extend the Group Mediclaim Scheme to the pensioners of the CSIR and their dependents not covered by CGHS. A copy of the Scheme obtained from M/s Oriental Insurance Company Limited is enclosed.

The Main features of the Scheme are as under:-

  1. It provides for both hospitalisation and Domiciliary Hospitalisation.
  2. The Scheme is divided into following four categories in terms of premia payable and benefits admissible.
Medical facilities for retired CSIR Employees
Category Premium Payable ( Rs.)   Maximum Annual Benefits (Rs.)
i 1300 - 00  96,500 - 00
ii 840 - 00 62,000 - 00
iii 600 - 00 43,000 - 00
iv  350 - 00 30,600 - 00

The scheme will be applicable to persons upto the age of 75.  However, the benefits shall stand reduced by 10% for members in the age group of 70-75.  The rebate of Group Mediclaim Scheme will be as follows:- 

The rebate of Group Mediclaim Scheme will be as follows
Persons Discount
First 100 15%
Next 400  20%
Next 500 25%
Next 4000 30%
Next 5000 35%
Next 15000 40%
Next 25000 50%
Balance 66.2/3%

  In addition, there will be a special discount of 5%.

 While the scheme further envisages Low claim Ratio Discount (Bonus), it also provides for High Ratio Loading (MALUS).  However, this will depend on actual reimbursement after the scheme has been put into operation.

The Scheme will be made applicable to pensioners on the basis of classification held by them before retirement as follows:-

Category Group A
Category Group B
Category Group C
Category Group D

As approved by the GB, the pensioners will have to pay one half of the premium per person minus benefit of group discount as may be admissible, in accordance with the categories in which they are placed.

 The Scheme has been introduced on optional basis as an experimental measure for a period of one year.  It is requested that the scheme with the above salient features may kindly be brought to the notice of all the pensioners and family pensioners drawing pension from your Lab./Instt. In respect of pensioners drawing pension through banks, the Coordinating Labs./Instts. are also requested to bring the scheme along with the above salient features, to the notice of pensioners and fan-lily pensioners.

 It is also requested to obtain option from each of the pensioners in writing whether they would like to join the scheme along with the details of their dependents.  The definition of dependents for this purpose will be the same as contained in CCS Medical Attendance Rules, 1972, as made applicable to CSIR employees.  A copy of the proforma for obtaining details of the Insured persons is enclosed for necessary action.

 It will be appreciated if the option as also the completed proforma containing details of persons opting to be covered under the Group Mediclaim Scheme are sent to this office by 30.4.92 positively,

(CSIR Letter No: 17(1)91-E.II, dated, 29th February, 92.)

Appendix

 The Oriental Insurance Co. Ltd.,                                                                                                Divisional.  Office No.1, Jeevan Vihar Building                                                                     Parliament Street, New Delhi - 110 001.

Re: - MEDICLAIM INSURANCE FOR PENSIONERS, THEIR SPOUSE & DEPENDENT            CHILDREN OF COUNCIL OF SCIENTIFIC & INDUSTRIAL, RESEARCH.

Hospitalisation is an unforeseen eventuality which calls for expenditure beyond the capability of even the well-off in the society. Responding to our customers' needs, we are in the market since November, 1986 with our Hospitalisation & Domiciliary Hospitalisation Insurance Scheme known as "Mediclaim Policy".  The underlying theme of all insurances is to mitigate the financial loss to the 'Insured' caused due to a sudden and unforeseen event.

 This policy is being offered specifically for the pensioners of CSIR, their spouse and dependent children and provides for reimbursement of Hospitalisation and/or Domiciliary Hospitalization expenses for illness/disease contacted or injury sustained anywhere in India.

The reimbursement of such expenses are to the extent of 100% subject to overall limit under the category opted.

The policy covers actual Hospitalization as an fax in-patient for treatment of non-surgical and major surgical and major diseases.  It does not include outdoor treatment.  The other salient features of the policy are:

Age Limit: -

 (a)     Persons from the age group of 5 to 70 years are covered by the Scheme.

(b)     Persons beyond 70 years are covered when the Company may accept the proposals from people over 70 years on receipt of Medical Certificate from a qualified doctor certifying the general condition of the insured to be satisfactory.  In such cases the scale of benefits are reduced by 10% in case the member is in the age group of 70-75 and 20% for those beyond 75 years of age.

 Definitions:

 1.    Hospital/Nursing Home

 Hospital/Nursing home shall be deemed to mean any institution in India established for Indoor care and

treatment of sickness and injuries and which has been registered either as Hospital or Nursing Home with the local authorities and is under the supervision of the registered and qualified Medical Practitioner.  The term "Hospital" shall not include an establishment which is a place of rest, a place for the aged, a place for drug addicts, a place for alcoholics, or a hotel or a similar place.

2.    Surgical Operation

 Surgical operation Means:- Manual and operative procedures for correction of deformities & defects, repair of injuries, diagnosis and cure of diseases, relief of suffering and prolongation of life.

3.    Domiciliary Hospitalization Benefit:

 Domiciliary Hospitalization Benefit means medical treatment for a period exceeding three days for such illness/disease/Injury which in the normal course require care and treatment at a Hospital/Nursing Home but actually taken while confined at home in India under any of the following circumstances, namely

      a)    The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home or

b)    The Patient cannot be removed to hospital/nursing home for lack of accommodation therein, or

c)    The patient prefers to be confined at Home for treatment with the approval of the attending Medical Practitioner.

 Subject to however, that Domiciliary Hospitalization Benefits shall not cover:-

 i)     Expenses incurred for pre- and post-hospitalisation treatment and

 ii)    Expenses incurred for treatment for any of the following diseases:

 1.  Asthma, 2. Bronchitis, 3. Chronic Nephritis and Nephrolic Syndrome, 4. Diarrhoeas and all types of Dysenteries including gastroenteritis, 5. Diabetes Mellitus and Inspious, 6. Epilepsy, 7. Hypertension 8. Influenza, cough and cold, 9. all Psychiatric or Psychosomatic Disorders, 10.  Pyrexia of unknown origin for less than 10 days, 11. Tonsilities and Upper Respiratory Tract Infection including Laryngitis and Pharyngitis and 12.  Arthritis, Gout and Rheumatism..

 NOTE: When treatment such as Dialysis, Chemotheraphy, Radiotherapy etc., is taken in the Hospital/Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalization Benefit Section.

 4.     Any One Illness:

 Any one illness will be deemed to mean continuous period of illness and it includes relapse within 45 days from the date of last consultation with the Doctor/Hospital/Nursing Home/Clinic occurrence of same illness after lapse of 45 days as stated above will be considered as fresh illness for the purposes of this policy.

 i)        Medical Practitioner means a person who holds a degree/diploma of a recognised institution and is registered by Medical Council of respective state of India.  The term Medical Practitioner would include physician, Specialist and Surgeon.

 ii)       Qualified Nurse means a person who holds a certificate of a recognised Nursing Council and who is employed on recommendations of the attending Medical Practitioner.

 iii)      Maternity Expenses Benefit:- Means treatment taken in Hospital/Nursing Home arising from or traceable to pregnancy, childbirth including normal Ceasarian Section.  This is an optional Benefit available on payment of additional premium.  When Maternity Expenses Benefit is extended in the policy, Exclusion 10 of the policy stands deleted.

 Exclusions:

 The company shall not be liable to make any payment under this policy in respect of any expenses

what-so-ever incurred by any insured person in connection with or in respect of:

 1.     Any disease other than those stated in clause(13) suffered by the Insured person during the first 30 (thirty) days from the date of his/her entry into the Policy.  This exclusion shall not, however, apply if in the opinion of the panel of medical practitioners constituted by the company for the purpose, the insured person could not have known the existence of the disease or any symptoms thereof at the time of his/her entry into the policy.

      This Exclusion shall also not apply in case of the insured person having been covered under this scheme of Group Insurance Scheme with any of the Indian Insurance Companies for a continuous period of 12 months preceding, without any break.

2.     Injury of disease directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, hostilities or war like operations (whether war be declared or not) and breach of criminal law by the insured person.

3.    Circumstances unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.

4.       Routine eye examinations and cost of glasses and contact lenses.

5.      Dental treatment or surgery of any kind unless requiring hospitalisation.

6.    Convalescence general debility, "Run-down" condition or rest cure congenital, external disease or defects or anomalies, sterility venereal diseases, intentional self injury, use of intoxicating drugs.

7.       Charges incurred at Hospital/Nursing Home primarily for diagnostic, X-Ray or laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of the positive existence of presence of. any ailments, sickness or injury, for which confinement is required at a hospital/nursing home or at home under Domiciliary Hospitalisation as defined.

8.     Expenses on Vitamins and Tonics unless forming part of treatment for injury or disease as certified by the attending physician.

9.    Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.

10.  Naturopathy Treatment.

11.   Exclusion for 1st year of policy for treatment of cataract benign prostatic hypertrophy, hysterectomy for menorrhaais or fibromyoma, hernia, hydrocele congenital internal diseases, fistula in anus, piles, sinusitis and related disorders unless such diseases are excluded as pre-existing.

12.  All diseases/injuries which are pre-existing when the cover incepts for the first time.

Conditions:

1 .    The Insured alone shall have the sole and exclusive right of receiving any payment or of enforcing any claim under this policy and ito other person whether named in the schedule hereto or not shall acquire any right whatsoever against the company under or by virtue of this policy.

2.     The premium payable under this policy shall be paid in advance.  CSIR shall remit the entire premium on behalf of its members to OIC Ltd.

3.     Upon the happening of any event which may give rise to a claim under this policy preliminary notice with full particulars relating to PIN, name of insured person in respect of whom claim is made, nature of illness/injury and Name & Address of attending Physician Hospital/ Nursing Home should be given and shall be sent to the company within 7 days from the date of hospitalization/domiciliary hospitalization.

4.     Final claim along with receipt bills/cash memos etc. must be filed by the insured person within 15 days after completion of treatment under hospitalization of domiciliary hospitalisation.

NOTE: Failure to give notice or file such claim in time as provided in conditions 3 and 4 may not invalidate or reduce any claim if it is substantiated that it was not reasonably possible for the insured person to give notice or file claim within the prescribed time.

5.    The insured person shall obtain and furnish the company through the insured with all original bills, receipts and other documents upon which a claim is based and shall also give the company such additional information and assistance as the company may require in dealing with the claim.

6.     The insured shall in order to avail benefit under 'Domiciliary Hospitalization' Clause, furnish to the company a certificate from the medical practitioner treating the insured person certifying necessity for hospitalization by allowing medical attention under one of the circumstances described in the definition of "Domiciliary Hospitalization Benefits".

7.     Any medical practitioner authorised by the company shall be allowed to examine the insured person in case of any alleged injury or disease requiring hospitalization or domiciliary hospitalisation when and so often as the same may reasonably be required on behalf of the company.

8.     The company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any manner fraudulent or supported by a fraudulent means or device whether by the insured or the insured person or by any other person acting on his/her behalf.

9.     If at the time when any claim arises under this policy, there 'Is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society and Medical Benefits Extension under Personal Accident Policy) whether it is affected by or on behalf of any insured person in respect of whom the claim may have arisen covering the same loss, liability, cost or expenses, the company shall not be liable to pay or contribute more than its rateable proportion of any loss, liability, cost or expenses.  The benefits under this policy shall, however, be in excess of the benefits available under Cancer Insurance Policy and medical benefits extension under Personal Accident Policy.

10.     For same illness, the benefits payable shall be either under hospitalisation benefits or domiciliary hosptialization benefit but not under both the benefits.  Pre-and post-hospitalization expenses shall be considered under the hospitalization benefits only.

11.     If any difference shall arise as to the quantum to be paid under this policy (liability being otherwise admitted) such difference shall be referred to arbitration in accordance with the provisions of the Indian Arbitration Act, 1940 as amended from time to time and for the time being in force.

12.     If the Company shall disclaim liability to the insured for any claim hereunder and if the insured shall not be within 12 calendar months from the date of receipt of the notice of such disclaimer notify the company in writing that he does not accept such disclaimer and intends to recover his claim from the company that the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.

13. All claims under this policy shall be payable in Indian Currency.

CSIR has allowed individuals to opt any one out of four categories.  The benefits under the four categories and the premium per person is given hereunder:

                                                                                  PREMIUM              CATEGORIES

                                                                              I                  11               III                 IV

Hospitalization and domiciliary                   1300               840             600              350

Hospitalization Insurance

  Important:       Premium paid under the Scheme is eligible for deduction as per the provisions under Section 80-D of the Income Tax (Amendment) Act 1986.  As required by the Act the premium is to be paid by cheque only.

 Other Important Provisions:

 Low Claim Discount: There are provisions for low claim ratio discount, allowed to the group.

 Tie up Arrangements: There are provisions for taking the treatment at tie-up Hospitals without payment of any deposit or advance.  List of such Tie-Up Hospital shall be provided by the company. "On Account Payment" In certain exigencies company may accept the request for "On Account" Payment while the treatment is continuing based on the attending physician recommendations.  The above are only the salient features of Mediclaim policy.  In case any further clarification is required, we shall be pleased to offer the same.

 Table Of Benefits

Mediclaim (Hospitalisation and Domiciliary Hospitalisation) Policy (all Limits are for the Policy Period)

                                                                          CATEGORIES

                                          I             II                             III               IV

                                         Rs.             Rs.                           Rs.              Rs.

    1.   (a) Room, Board & Nursing expenses per day not   exceeding (including Boarding  to be provided by the Hospital)

                                    750             550                          350             250                                        

                  (b) I.C. Unit, Board & Nursing expenses per day not  exceeding           

                                    1500             1100                        700             500

          2.    Aggregate limit for policy period for 1(a) & 1 (b) above not exceeding              

         I) Hospitalisation Benefits other than Room Board & Nursing Expenses & ICU (including Pre & Post Hospitalisation)

                                 33000             24000                      15500         11000

        II)          Surgeon Anesthetist, Medical Practitioner, Consultants, Specialist fees.             

                        22000            13200            9200                7000

   3.          Anesthesia, Blood, Operation Theatre charges, Blood, Surgical Appliances, Medicines & Drugs, diagnostic ,materials & X-ray, dialysis, chemotherapy, Radiotherapy cost of pacemaker, artificial limbs & cost of  Organs and similar other expenses                           

                            28000            16800            12800              9000

                ii)    Domiciliary Hospitalisation Benefits (Non-Surgical treatment only)

                    1.          Medical practitioners. consultants & specialists fees for visits etc.          

                            6000              3500              2500                1600

  2.          Blood, Oxygen, Diagnostic Materials, X-ray,  Employment of qualified  Nurses, Medicines and Drugs  and similar expenses.

                              7500              4500              3000                2000

A.      Group Discount:

 The group discount is permissible as per the following scale depending upon the total number of insured persons covered under the Group Policy at inception.  Increase/decrease in the size of the group during the currency of the policy is permissible.  The final Group Discount (Increase/decrease) will be adjusted on the basis of the size of the group existing on the last day of the policy period provided the policy is renewed for the next 12 month.

Group Discount
No. of Persons insured Under Group Discount %
First 100 Persons 15
Next 400 Persons 20
Next 500 Persons 25
Next 4000 Persons 30
Next 5000 Persons 35
Next 15000 Persons 40
Next 2500 Persons 50
Over & Above 66-2/3

B.      Bonus/Malus:

(i)         Low Claim Ratio Discount (Bonus):

Low Claim Ratio Discount at the following scale will be allowed of the tota1 premium at renewal only depending upon the incurred claims ratio for the entire group insured under the Group Mediclaim Policy for the preceding 3 completed years excluding the year immediately preceding the date of renewal.  Where the Group Mediclaim Policy has not been in force for 3 completed years, such shorter period of completed years excluding the year immediately preceding the date of renewal will be taken into account.

Low Claim Ratio Discount (Bonus)
Incurred Claims Ratio Under the Group Policy.  Discount %
Not Exceeding 60%  5
Not Exceeding 50%  15
Not Exceeding 40%     25
Not Exceeding 30% 35
Not Exceeding 25%  40

(ii)      High Claim Ratio Loading (Malus):

 The total premium payable at renewal of the Group Policy will be loaded at the following scale depending upon the incurred claims ratio for the entire group insured under the Group Mediclaim Policy for the preceding 3 completed years excluding the year immediately preceding the date of renewal.  Where the Group Mediclaim Policy has not been in force for the 3 completed years, such shorter periods of completed years excluding the year immediately preceding the date of renewal will be taken into account.

High Claim Ratio Loading (Malus):
Incurred Claims Ratio Under the Group Policy.  Loading %
Between 80% and 100% 25
Between 101% and 125% 55
Between 126% and 150% 90
Between 151% and 175% 120
Between 176% and 200%  150
Over 200% Cover to be reviewed

NOTE : Incurred claim would mean claims paid plus claims outstanding in respect of the entire group insured  -under the policy during the relevant period.

(20.1.10) Sub: Introduction of Group Mediclaim Scheme for the pensioners of CSIR, their spouse and dependent children.

In continuation of this office letter of even number dated 29.2.92 forwarding therewith the modalities of the Group Mediclaim Scheme received from the Oriental Insurance Company Ltd. enumerating the salient features of the scheme and this office letters of even number dated 15.5.92 and 17.12.92 requesting to forward the options received in favour of this scheme early, I am directed to state that it has been decided to introduce the Group Mediclaim Scheme w.e.f. lst March, 1993 for the pensioners of CSIR, their spouse and dependent children.

 The options -received from the respective Labs./lnstts. are being forwarded to the Oriental Insurance Company Ltd. (OIC) for processing the membership under this scheme as per terms and conditions already circulated to the Labs./lnstts.

 As OIC has agreed to grant the Group Discount on the basis of total membership from all Labs./lnstts. instead of treating each Laboratory as a separate unit, the list of persons who have exercised their option in favour of this scheme from your Laboratory is being forwarded to OIC.

 As payment of premium depending upon the classification of category based on the post held before retirement is required to be made by first week of March, 1993, you are requested kindly to contact the pensioners/their spouse/dependent children for getting from them the payment of half the premium per person prescribed for each category so that after including 50% of the premium from your own funds, full payment of premium could be sent to OIC by 1st week of March, 1993.  Ale Scheme will come into operation only after receipt of premium by OIC from your Labs./Instt. in respect of the optees and membership of each optee shall be confirmed by OIC to each individual under intimation to you.

 The OIC shall be functioning as a single-window service for all the Labs./Instt. and thereby each Lab./lnstt. should remit the premium in respect of each optee to OIC direct as well as send the claim papers direct to OIC for settlement as per Scheme.  Though only one policy shall be issued in respect of all the Labs./Instts. by OIC in favour of CSIR Hqrs. but it will not affect the channel of remittance of premium and settlement of claims in respect of each Laboratory direct with OIC.

 The OIC has allowed a period of two months from 1st March, 1993 for arriving at the Group Discount i.e. the Group Discount shall be admissible on the basis of number of optees existing as on 1.5.93 and the final Group Discount after taking into consideration any addition/ deletion of an optee during the year, shall be intimated at the time of renewal of this Scheme after one year.  It may be made clear that addition of any optee can be made at any stage during the currency of the Scheme and in case of deletion from the membership of this Scheme due to death, pro-rata refund will be given by OIC through the Laboratory.

 It may, however, be made clear that each beneficiary shall have to pay separate premium for becoming the member of this scheme on payment of premium as prescribed for the category.  Though initially the payment of premium shall be made per beneficiary according to the category but benefit of Group Discount and Bonus/Malus shall be calculated at the time of renewal of this Scheme after expiry of one year.

 From the above, it may kindly be seen that Group Discount is admissible on the number of optees for this Scheme, it is requested that the Scheme may kindly be given wide publicity amongst the pensioners/their spouse/dependent children of your Lab./lnstt. in order to enrol the maximum number of optees to avail more and more Group Discount for the beneficiaries on the whole.  It is possible that you may face some difficultly in the beginning in the operation of this Scheme but you are welcome to seek the clarification from OIC direct under advice to CSIR.

 A list of optees belonging to your Labs./lnstts. is enclosed for your information and necessary action with a request to kindly contact the pensioners/their spouse/dependent children so that half the premium for each category could be collected from them by 3rd week of Feb., 1993 to enable you to send the full premium, as explained above, to OIC in respect of each beneficiary by first week of March, 1993.

 (CSIR Letter No: 17(1)/91 -E.II, dated, 4th Feb., 93.)

(20.1.11) Sub: Medical facilities for the retired CSIR Pensioners.

The CSIR pensioners residing in Delhi are presently covered under the CGHS Scheme and, therefore, get all the medical facilities including hospitalisation etc, as available to the serving employees.  However, as the CSIR is not covered under the CGHS Scheme for stations other than Delhi, pensioners residing outside Delhi do not get full medical facilities at par with their counterparts in Delhi.  This has been engaging the attention of CSIR for quite some time.  The Director-General, CSIR with the concurrence of Financial Adviser, CSIR has now been pleased to decide that CSIR dispensaries of all the National Labs./lnstts. (other than Delhi) may be treated at par with the CGHS dispensaries so that the CSIR pensioners residing outside Delhi may get the same facilities as available to Govt./CSIR pensioners residing in Delhi.  Accordingly, the CSIR Pensioners who either are already enrolled or may wish to enroll themselves with the dispensaries at Labs./Instts. (other than Delhi) shall now be eligible for medical treatment and reimbursement as applicable to the Govt. pensioners covered under CGHS Scheme.

 In terms of the existing instructions issued by the Govt. of India on the subject, no reimbursement shall be admissible to the pensioners for OPD treatment at the Govt./Recognised hospitals and the medicines prescribed by the specialists of such hospitals are to be procured and supplied by the dispensaries.  As regards indoor treatment, the medical reimbursement shall be admissible provided the patient is referred for specialist treatment by the Medical Officer-in-charge of the CSIR dispensaries.  Reimbursement of such claims shall be regulated under CCS (Medical Attendance) Rules as applicable for taking indoor treatment at the Govt./recognised hospitals.

 It is requested that the above decision may kindly be given wide publicity and also be brought to the notice of all the Pensioners drawing pension through your Laboratory.

(CSIR Letter No: 17/1/91 -E.II, dated, 8.11.1994.) 

(20.1.12) Group Mediclaim Scheme - regarding renewal thereof.

The Governing Body of CSIR at its 138th Meeting held on 26.5.1995 has accorded its approval to the renewal of Group Mediclaim Scheme for a further period of one year w.e.f. 1.4.1995 to 31.3.1996 on the existing terms and conditions. The above decision may kindly be brought to the notice of all concerned in your Lab./Instt. their information. guidance and necessary action. (CSIR letter No. 17/1/91 -EII, dated, 14th June, 1995)