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Mumbai Press Club Group Health Insurance Scheme

Unexpected illness, an expensive operation or prolonged hospitalization is not only debilitating but can wipe out our hard-earned savings and deal a crippling blow to our finances. Hospital tariffs are on the rise every day, and the nature of our profession puts us at enormous stress and risk. The numerous cases of our own members and fellow journalists facing unexpected medical crisis or the discovery of a rare disease have been upsetting experiences.

It is in this context that we at the Press Club began searching for ways of providing health care options to our members and their families which would soften the blow at the time of crisis. As a first step towards affordable hospital facilities we have tied up with Seven Hills Hospital to provide regular and free health check-ups as well as subsidized room charges and medicines in the case of hospitalization. We are in the process of approaching other hospitals as well to provide a similar package.

In this search for better health care for our members, we are now happy and proud to announce that we have taken the next logical step. After negotiating long and hard with several insurance companies, we have inked a super-duper Health Insurance Scheme with the state owned New India Assurance Company.

The salient features offered by the Mumbai Press Club – New India Assurance Health Insurance Scheme are:

  • This scheme is applicable only for Mumbai Press Club 'Ordinary Member'
  • Health Insurance cover of Rs 3 lakh on floater basis will be available for enrolling member; their spouse and a maximum number of 3 children @ Rs 6,000 annually. (Floater Basis means the maximum amount payable for admissible claims for any or all of the family members shall not exceed Rs. 3 Lakhs.
  • No medical tests required
  • Existing diseases will also be covered 
  • Comprehensive maternity benefit have been included
  • Top up coverage of Rs 5 lakh or Rs 10 lakh for just Rs 4,500 and Rs 6,500 respectively. (For instance if a person is already covered by a Rs 3 lakh company policy by BCCL or Hindustan Times, he can opt for a TOP-UP of Rs 5 lakh or Rs 10 lakh.)
  • A member can opt for Base cover or Top Up cover, or both.  In case he opts for both, two separate cheques need to be given.
  • Personal Accident Cover of Rs 3 lakhs (for members only).

DETAILED FEATURES OF THE MUMBAI PRESS CLUB – NEW INDIA ASSURANCE HEALTH INSURANCE SCHEME:

ENTRY

All Existing “Ordinary Members” of the Mumbai Press Club will have an option to enroll themselves under this Health Insurance Scheme. A member can get enrolled for coverage by April 28, 2015. Thereafter he will not have the option to get himself enrolled at any future date, either during the first year or during subsequent renewals.

Persons becoming members of the Mumbai Press Club during the currency of the Policy shall have an option to enroll themselves within 30 days of the commencement of their membership. If they do not exercise such option within this prescribed time limit they shall not be permitted to get enrolled at any future date, either during the first year or during subsequent renewals.

This condition of one time option for enrollment applies for both Base Plan and Top Up Plan.

COVERAGE for Plan A – BASE

Coverage under Plan A is as under:-

Persons covered

Member , Spouse and not exceeding 3 dependent children

Sum Insured

Rs. 3 lakhs on Floater basis

Coverage

Medical expenses for Hospitalisation as per the terms of Group Health Policy. Detailed terms and conditions will be provided

Room Rent Limit

Rs. 4000 per day and for ICU Rs.6000 per day.

Deduction for occupancy in rooms having room rents higher than the limit

Entire admissible claim would be paid in the proportion that the eligible room rent bears to the occupied room rent.

Maternity Benefit

 

Rs. 35, 000 for Normal delivery and Rs.50, 000 for caesarean. Pre and Post Natal expenses will also be covered, provided they are within the Maternity limits.

Pre-Existing disease covered

 Yes

Period Of Insurance

 From 10.05.2015 to 09.05.2016

Day one Baby Cover

 Yes, within the floater sum insured

Personal Accident Cover

 Rs.3 lakhs. Cover is only for members and not for other insured persons.

COVERAGE for Plan B - TOP UP

Top Up will be available for Sum Insured bands of Rs. 3 lakhs, Rs.5 lakhs and Rs.10 lakhs on THRESHOLD amounts of Rs. 3 lakhs or Rs. 5 lakhs. THRESHOLD is the amount of Cumulative Hospitalisation Expenses chosen by the Member up to which no Medical Expenses can be claimed under this policy.

The terms of coverage would be the same as per the BASE cover, with the exception that claims will become payable only where the Cumulative Hospitalisation Expenses exceed the Threshold.

CASHLESS facility would be available only at Network Hospitals. Persons taking treatment outside Network Hospitals will have to seek reimbursement.

Third Party Administrator would be chosen on mutual agreement.

 

PREMIUM

Premium payable for coverage for BASE Plan is Rs.6000/- per member including service tax. For new members the premium payable will be proportionate.

Premium payable for TOP UP Plan is as under:

THRESHOLD

TOP UP SUM INSURED

(Rs)

500,000

1,000,000

300,000

4500

6500

500,000

4500

6000

A member can opt for Base cover or Top Up cover, or both.  In case he opts for both, two separate cheques need to be given. Cheques should be drawn in favour of “The New India Assurance Company Limited”. These amounts are inclusive of Service Tax.

DISPUTE REDRESSAL

A Committee comprising a nominee of New India, and a nominee of the Mumbai Press Club, and a person with judicial or medical background- to be mutually agreed by New India and Mumbai Press Club. In case of any dispute regarding any matter under the policy, the member can refer the matter to this Redressal Committee. The Redressal Committee will go into the merits of the complaint and take a decision thereon. This Redressal Committee does not prejudice the member’s right to seek any other remedy available to him under Law or under the terms of the Insurance Policy.

PAYMENT OF PREMIUM

For all existing members who have opted to get covered, Mumbai Press Club will collect the premium and remit the premium to New India. This is a pre-condition for Insurance coverage.

ENROLMENT

All members enrolling to be covered will have to provide data for their family in respect of name, age, gender. ID card will be issued to all members for Cashless facility in Network Hospitals.

 

MID TERM ENROLMENT

Any member whose family size increases on account of marriage or child birth should notify New India, within 30 days of marriage or birth, the names of such family additions along with details of their age, gender and photograph.

 

IT CERTIFICATE

New India will issue Certificate for remittance for the amount of Health Insurance Premium paid for claiming relief under Section 80 D

 

EXITS

In respect of any member who ceases to be a member of Mumbai Press Club during the currency of the Policy, Coverage will continue for the member and other insured persons until the expiry of this policy. However, such members who exit during the currency of the Policy will not be covered at the time of renewal. They, however, have an option to port to any retail policy of New India at retail rates, without medical examination, and subject to the terms of the retail policy to which they port. Such option to port to a New India retail Policy, should be received at least fifteen days before the expiry of the Mumbai Press Club Policy, and should be accompanied by a proposal form and the appropriate premium amount.

 

RENEWAL

Terms of this policy and price may vary at the time of renewal. Mumbai Press Club should collect details of all members opting to renew their policy and the total premium in respect of such renewal should be remitted to New India before expiry of the current policy. If any member chooses not to renew the policy he would not be permitted to get enrolled into this scheme at a future date.

STORY BY

Press Club
Content Team
Article posted on 08/04/2015

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