IBA has finalised the tender of Group Medical Insurance Policy for Bank Employees fo year 2025-26 and the procedure has also been completed. National Insurance Co. continues to be the insurer.
The following are the important improvements/modifications:
| Award staff | Rs. 4.00 lacs | (now Rs. 3 lacs) |
| Officers upto Scale V | Rs. 5.25 lacs | (now Rs. 4 lacs) |
| Officers Scale VI & above | Rs. 7.00 lacs | (now Rs. 4 lacs) |
| Corporate Buffer | Rs. 125 crores | (now Rs. 100 crores) |
- For Cataract operation, upper cap shall be Rs.40,000/- per eye.
- Hormonal therapy for cancer and Immunotherapy for non-cancer to be included.
- Robotic surgery shall be considered in cases where the condition of patient warrants such treatment. This needs to be vetted by the treating doctor.
- Thyroid cancer shall be included under critical illness.
- For retirees: Mentally/physically challenged dependent family member shall be included by way of add-on. Premium to be paid by retiree/spouse.
- Top-up options to be made available for Rs. 1 lac, 2 lacs, 3 lacs and 4 lacs, the premium of which shall be borne by the retiree/spouse.
The following rates of premium has been accordingly finalized for the ensuing Policy for 2025-26.
| In-service staff | Insurance cover | Premium |
|---|---|---|
| Workmen (clerical/Substaff) | 4.00 lacs | 31,001 |
| Officers Scale I to V | 5.25 lacs | 40,231 |
| Officers Scale VI and above | 7.00 lacs | 60,001 |
(Rates are Without GST)
Note: Premium for the in-service staff will be paid by the Banks. Additional premium for domiciliary treatment coverage, Ex-gratia amount for critical illness (Rs. 1 lac) and Corporate Buffer (Rs.125 crores) amount will also be paid by the Banks.
| Retirees (with spouse) | Insurance cover | Premium |
|---|---|---|
| Retired Workmen | 3.00 lacs | 27,001 |
| 4.00 lacs | 31,001 | |
| Retired officers upto scale V | 5.25 lacs | 40,231 |
| Retired officers Scale VI & above | 5.25 lacs | 40,231 |
| 7.00 lacs | 60,001 |
(Rates are Without GST) (without Domiciliary cover)
| Retirees (without spouse) | Insurance cover | Premium |
|---|---|---|
| Retired Workmen | 3.00 lacs | 24,301 |
| 4.00 lacs | 29,251 | |
| Retired officers upto scale V | 5.25 lacs | 37,181 |
| Retired officers Scale VI & above | 5.25 lacs | 37,181 |
| 7.00 lacs | 48,001 |
(Rates are Without GST) (without Domiciliary cover)
| Retirees TOP UP | Premium – with spouse | Premium – without spouse |
|---|---|---|
| Rs. 1 lac | 12,501 | 10,621 |
| Rs. 2 lacs | 20,001 | 17,001 |
| Rs. 3 lacs | 29,301 | 24,901 |
| Rs. 4 lacs | 39,001 | 31,201 |
(Rates are Without GST)
| Optional – Add on For Retirees – for dependent physically or mentally challenged family member | |
|---|---|
| Insurance cover Rs. 3.00 lacs | 10,001 |
| Insurance cover Rs. 4.00 lacs | 12,501 |
| Insurance cover Rs. 5.25 lacs | 15,001 |
| Insurance cover Rs. 7.00 lacs | 35,001 |
| Optional – Add on For Retirees – for dependent physically or mentally challenged family member | |
|---|---|
| Top up – Rs. 1 lac | 5,001 |
| Top up – Rs. 2 lacs | 10,001 |
| Top up – Rs. 3 lacs | 20,001 |
| Top up – Rs. 4 lacs | 30,001 |
GST on premium: As per the decision of the GST Council/announcement by the Government, only individual Medical Insurance Policies are exempted from GST. From AIBEA/UFBU, it has been taken up with the Government to exempt GST on premium for Group Policy for the senior citizens.
Policy coverage:
The Policy will cover all the features and provisions as provided in the Scheme under the 10th Bipartite Settlement dated 25-5-2015 with subsequent modifications/improvements which include the following:
- Treatment for Age Related Macular Degeneration (ARMD) and Intra vitreal injections for eye disorders other than ARMD also.
- Approved targeted therapies for treatment of Cancer in Day Care and standalone basis (Immunotherapy – Monoclonal Antibody Cancer treatment on standalone basis).
- Hormonal therapy for cancer and Immunotherapy for non-cancer to be included.
- Robotic surgery shall be considered in cases where the condition of patient warrants such treatment. This needs to be vetted by the treating doctor.
- Thyroid cancer shall be included under critical illness for payment of ex-gratia of Rs. one lac.
- Domiciliary coverage will continue to be extended for serving employees and dependent family members.
- Retired workmen employees will have the option to take the base policy for Rs. 3 lacs or Rs. 4 lacs.
- Retired Scale VI and above officers will have the option to take the base policy of Rs. 5.25 lacs or Rs. 7 lacs.
- Employees will be permitted to add/update dependents during the currency of the Policy on account of birth of a child/marriage of the employee.
- Substitution/change of dependents shall be allowed before the commencement of the Policy (1-11-2025) and not during the policy period.
- Corporate Buffer amount is increased to Rs. 125 crores.
- A Committee consisting of CGM-HR/GM-HR of 5 participating member banks will be formed to monitor the performance of TPAs on regular basis and will recommend to delist hospitals/medical units in the event of adverse feedbacks. If the performance of the TPA is found wanting despite repeated observation of deficiency in the service, the Committee may recommend removal of the TPA.
xiii. Retirees who have not joined the Policy so far will be given an opportunity to join the Policy now.
premium for retirees also may be born by the Bank
If not in full, atleast half of the full premium may be borne by the bank. Regards.
Happy with this
Who are the TPAs from this year onwards.
Me
Premium for retired employees is to be borne by the individuals and not by the bank, as such GST may be waived, by the government. This is one of the biggest anamoly in the retired group medical insurance.
Premium for the retired employee is to be paid by retiree only. Hence it is to be treated as a individual policy and GST should be waice as for other clients
Nice. Some thing is than nothing.👍
Its high time that retirees are given relief i. r. o. GST now, which will reduce the burden in their twilight years..
Govt choose to chew GST may not waive hence may be borne by concerned banks
All medical bills to be born by IBA even on OPD. Reimbursement to be given.This to be done by this settlement no insurance policies any more.
Banks should not collect GST from retirees, since GST paid by banks on complete policy- gets accounted for bank’s GST obligations.
Does the policy contain any co-pay clause in case of hospitalization. Also any cap on room rent?
For senior citizens GST ro be waived & premium should be borne by the bank👏
What is the procedure to be followed in case the retired staff or their dependants covered under insurance gets hospitalised? Where is it given?