The Governor’s Administration on Thursday formally rolled out the Group Mediclaim Health Insurance Scheme for employees, pensioners and Accredited Journalists in the State.
Giving details of the scheme, Principal Secretary Finance Navin K Choudhary said that the scheme is mandatory for government employees including employees of PSUs, Autonomous Bodies and Universities while it will be optional for Pensioners, AIS Officers, Adhoc, Contractual, DRWs, Work Charged/ Contingent Paid Workers and Accredited Journalists.
The scheme, he said, shall come into effect from 1st October 2018, for a period of one year and extendable annually for three years based on satisfactory performance of the Insurer.
Navin said the policy has been tied up with M/S Reliance General Insurance Company Ltd on annual premium of Rs 8777and Rs 22,229 (for employees and pensioners respectively). The Policy will provide health insurance coverage up to Rs 6 Iakh per employee/pensioner per annum along with his/her five dependent family members on floater basis.
He said the Shri Mata Vaishno Devi Shrine Board, Shri Mata Vaishno Devi University, Shri Amarnathji Shrine Board and the Accredited Journalists of the State shall be also covered under the scheme. They may do so provided the premium is collected in four quarterly installments in advance and paid to the Insurance Agency on due dates by the Agency concerned themselves.
He said the Medical Allowance in favor of all enrolled employees shall be discontinued, drawn and credited to the M.H.8235 during the currency of the policy on monthly basis.
Navin said the annual premium for the insurance cover of Rs 6 lakh would be Rs 8777 and the same shall be deducted in four quarterly installments of Rs 1295 on 1st October, 15th January, 15th April and the last installment of Rs 1292on 1st July each year.
He said the M/S Reliance General Insurance Company will create a corporate buffer of Rs 10 crores as part of Policy to meet the expenditure incurred on the identified illness over and above the insurance cover of Rs 6 lakh.
He said in case of both husband and wife or their any other family member is/are Government Employee(s) or pensioner(s), the Premium shall be payable by any one of them. The DDO shall obtain an authenticated certificate in case the premium has been paid by any other family member(s) of the employee and check/verify it from the concerned Treasury Officer.
“If the parents or one of the parents of an employee, who are/is pensioners/pensioner, fall within the employee plus dependent’s cap of 1+5, they are not required to pay the premium separately and take out a separate policy. However, if the employee and his dependents, which include his family plus his pensioner parents, exceed the above cap, one of the pensioner parents can take out a separate policy for himself or herself and his or her dependents,” he said and added that in case where either husband or wife is a Central Government Employee and has opted for the Mediclaim Insurance Policy launched by his/her employer, the Group Mediclaim Insurance Policy shall be optional in the case of his/her spouse, who is State Government Employee. However, the State Government employee have to necessarily provide a certificate from the DDO concerned of his/her spouse to the effect that the latter is covered under the Insurance Policy of his/her employer and has paid the premium for the said purpose.
He said the Government shall not refund any premium amount paid in excess by any employee due to his/her own negligence or by the concerned DDO. So, the instructions/ directions issued in this behalf are required to be adhered to in letter and spirit. Any deviation will be the personal responsibility of the concerned DDO.
He said the Drawing and Disbursing Officers (DDOs) shall deduct the premium amount from the salaries of Employees and remit the same into the concerned Government Treasuries under the General and Other Reserve Funds Group Mediclaim insurance.
“The concerned DDOs shall thereafter furnish the details of total number of employees and total amount deducted and remitted to the said account to their concerned Treasury Officers who shall forward the same to Director General, Accounts and Treasuries within two days,” he said and added that the Director General Accounts and Treasuries shall consolidate the information and forward the same to the Joint Director (Resources)/Chief Accounts Officer, Finance Department on most immediate basis.
Navin said that since the Policy is compulsory in nature, it shall be the personal responsibility and liability of the DDOs to register every employee under the scheme so that no employee is left out. AIS Officers can opt out of the policy only if they are otherwise covered under a separate Mediclaim Policy of the Central Government or have taken an individual policy with any Insurance Company. In case, any employee fails to have his premium deducted, the State Government shall not be in a position to accept such a claim for medical reimbursement. All the concerned shall in their own interest ensure that necessary premium is deducted from their salaries.
The Principal Secretary Finance said that the Heads of PSUs/ Autonomous Bodies/ Universities, shall have the prescribed premium including taxes deducted from the salaries of their employees and pay the same to the concerned Insurance Company directly in the shape of Bank Draft along with the list of enrolled employees against proper receipt under an intimation to the Finance Department.
For a pensioner, he said, the annual premium for pensioner will be Rs 18629 which will be deducted in four quarterly installments of Rs 4657 on 1st October, 1st January, 1st April and the last installment of Rs 4658 on 1st July each year. The Medical Allowance in favor of all enrolled pensioners who opt the policy shall be drawn and credited to the concerned A/C NO with Moving Secretariat Branch of J&K Bank during the currency of the policy on a monthly basis
He said all the pensioners who opt to be covered under the scheme shall make an application to the concerned Treasury Officer/Branch Head of J&K Bank for making a deduction of premium from their pension.