FAQs, Clarifications-GMP for OPD expenses
As you are aware RBI has introduced GMP for OPD expenses for RBI pensioners who are 70 years of age and above.
There are some requests for clarifications about the coverage and implementation of the scheme. We are reproducing the information as received from various sources.
1. This scheme is for pensioners only who are above 70 Years of age and does not cover Ex-Gratia Recipients.
2. This GMP on OPD treatment is over and above the existing GMP on Indoor treatment/hospitalization.
3. Prescribed Ceiling for both the policies i.e. Indoor and Out Patient Department are different.
For OPD treatment – ceilings are different for 70 years to 75 years and 75 years and above.
4. All the claims will be settled by TPA only and not by the Bank.
5. Any number of claims can be preferred till you reach the ceiling to the respective TPA to which a retiree will be attached to. The ceiling is the assured amount and will be calculated for both (employee & spouse) on a combined basis.
6. There is no need to intimate the TPA in case of OPD treatment whereas there is compulsory need to intimate for indoor hospitalization within 7 days of admission.
7. The claim has to be submitted within 60 days after the treatment gets over in case of OPD but in case of indoor treatment, the claim has to be submitted within 15 days after discharge from the hospital.
8. The facility will be available only when the employee (he/she) becomes 70 years old. Spouse will enjoy the benefit irrespective of her age.
9. Since OPD of serious ailments viz. Cancer, Heart & Kidney are settled by the Bank, OPD of very ordinary ailments will be settled through this GMP on OPD.
10. All are entitled for separate TPA Identity Cards for OPD treatment which will be issued soon by the TPAs.
11. The treatment can be had anywhere across the country.
Important : Where a pensioner who has attained the age of 70 and is not a member of MAF Scheme but derives the benefit of MAF from his/her spouse’s membership with MAF Scheme, he/she will be eligible for the Scheme. And ,the spouse (he or she) will be eligible for this benefit before attaining the age of 70 years.
Coverage details /Answers to questions frequently asked are here.
Are retiree’s other than pensioners eligible?(P F opted)
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all pensioners who are 70+ (other than Ex-gratia recipients) are eligible. retirees who are CPF optees not covered in the scheme presently.
As usual, Bank has decided on a unilateral age cut off for the OPD scheme. There are many retd. colleagues who are less than 70 years but suffer from chronic diseases like COPD , nephritis , dental and other problems and are frequently getting specialist treatment/ consultations. Diseases don’t diffrentiate between age groups. Bank shd review the age bar of 70 years and make it applicable to all retired employees., irrespective give of age.