CHAPTER 16

MEDICAL AID AND EXPENSES

16.1 ELIGIBILITY
Medical facilities as detailed hereunder are available to the employee and his
family.

16.1.1 Definition of family

a) 'The expression 'family' of an employee shall mean the employee's spouse, wholly
dependent unmarried children (including step children and legally adopted
children) as also parents ordinarily residing with and wholly dependent on the
employee.

b) The term 'parents' shall include step mother wholly dependent on an employee,
but shall not include step father. In respect of employee who has been adopted
legally, the parents who adopt him/her become the legal parents for all intents
and purposes.

c) The term 'wholly dependent child/parent' shall mean such members of the family
having a monthly income not exceeding Rs. 2550/- p.m. If the income of one of
the parents exceeds Rs.2550/- p.m. or aggregate income of both the parents
exceed Rs. 2550/- p.m. both the parents shall not be considered as wholly
dependent on the employee.

d) A married female employee may include her natural parents or parents-in-law

under the definition of 'family' - but not both, provided that the parents/parents-
in-law are ordinarily residing with and are wholly dependent on her and satisfy
the income criteria as stated above. (a) If the parents / parents-in-law are living
separately, she should establish to the satisfaction of the Bank that they are still
dependent on her. (b) If she is the only earning member in the family. (c) If there
are other members earning but they are married daughters, the Bank may
consider on merits the claim of the employee for inclusion of parents.

Clarifications:

i) A female employee, whose husband is also an employee of the Bank will not be
eligible to claim reimbursement of medical expenses in respect of her children,
unless the children are dependent on her and not on her husband.

ii) An employee is eligible to claim reimbursement of medical expenses on account

of spouse irrespective of income dependency. As such we may reimburse
hospitalisation expenses within the ceiling laid down, provided no claim of the
same bills has been received by the employee or the spouse.

iii) Where the employee's spouse is eligible for reimbursement of medical expenses
from his / her employer, the claim will be reduced to the extent of his / her
spouse's entitlement under his / her employer's dispensation.
 iv) Where more than one brother/sister are working in the Bank, reimbursement of
medical expenses in respect of dependent parent can be claimed by only that
employee with whom the dependent parents ordinarily reside. Whenever such
employees claim reimbursement of medical expenses incurred in respect of
their dependent parents, they should submit a suitable declaration along with
their application for reimbursement of medical expenses as given below.

"I further certify that dependent parent(s), in respect of whom the reimbursement
is being claimed, ordinarily reside(s) with me and my other brothers and sisters
working in the bank have not claimed/are not claiming reimbursement of such
expenses".

v) Where both Husband and Wife are working in the Bank

a) Where the husband is a member of the Supervising Staff and the wife is an award
employee in the Bank, the wife may avail herself of medical facilities as per her
entitlement as award employees and expenses incurred by her in excess of the
amount to which she is entitled to as an award employee, may be claimed by
the husband under his service rules i.e. 75% of the balance.

b) Where both husband and wife are members of the award staff it will be in order
to reimburse the medical bills submitted by an employee, on account of
treatment taken by his/her spouse, from the balance available in the employee's
medical aid account, provided there is no balance in the medical aid account
of the spouse.

The age of a family member will not be a factor to decide his/her dependence
on the employee, unless it is specifically so provided.

16.1.2 Children/family staying separately

An employee who is posted to a difficult and inconvenient centre and who

keeps his children for their education, outside the place of his posting, may be
reimbursed with the medical expenses to the permissible extent for the treatment
of his children in the usual manner. The principle equally applies in case of an
employee who is staying alone at the place of his posting and his family members
are not staying with him at the place of his posting for some convincing reasons.

16.1.3 Employees under suspension

A suspended employee may be allowed reimbursement of medical expenses

pertaining to self or his family on the same terms and conditions as applicable to
employees in active service

16.1.4 New recruits

Expenses incurred by new recruits for medical examination at a time of

recruitment in the Bank will be borne by the them. In case of new recruits,
reimbursement of medical expenses upto full annual quota is allowed in the first
year, irrespective of their joining the service in that year.
 16.1.5 Part-time employees in subordinate cadre

Permanent Part-time employees drawing scale wages (since converted to full

scale of wages) are eligible for medical benefits on the same scale as applicable
to full-time employees in the subordinate cadre. They are also eligible for
Improved Medical Aid facilities, provided they are not entitled to similar benefits
in their other employment.

16.1.6 Ex-servicemen

The previous service in the army, in respect of ex-serviceman may be taken into
account while considering their eligibility for higher medical aid from the year
1985.

16.1.7 Ceilings

In substitution of clause 17 of the bipartite settlement dated 27th March,2000, with

effect from 1st November, 2002, the reimbursement of medical expenses under
medical aid scheme shall be restricted to an amount of Rs.1500/- per annum.

NOTE :

a) On the 1st January every year the appropriate medical aid permissible will be
credited to the medical aid account of the employee concerned. (SETTLEMENT
DTD. 31.3.1967)

b) Maximum accumulation in Medical Aid Account

The amount of total expenses from January to December of each calendar year
will be allowed to be accumulated so as not to exceed, at any time, 3 times the
maximum permissible on annual basis.

c) A register as per pro forma given at Annexure 16.1 should be maintained for
medical expenses in respect of each employee at the Branch/Office.

16.1.11 Submission of claims under yearly quota

Reimbursement of medical expenses of the workmen and his family will be made
on the strength of his certificate of having incurred such expenses duly supported
by a statement of account as per Annexure 16.2 for the amounts claimed.
Having regard to the difficulties faced by the employees in obtaining bills,
vouchers, etc., especially when the amount involved small and the medicines are
supplied by the attending physicians from their own dispensaries and the fact
that the scrutiny of such bills involves unnecessary work at the branches,
reimbursement of claims of medical expenses subject to the ceiling, may be
made without production of bills/vouchers/prescriptions, based on the strength of
their certificate, duly supported by a statement of account, as stated above, for
the amounts claimed.
(PER/IR/9970 Dt.15.03.1983, PER/IR/CIR/75 Dt.15.04.1985)
ANNEXURE -16.2
To, ...................................................
State Bank of India
...................................................
................................................... Date :

Dear Sir,

REIMBURSEMENT OF MEDICAL EXPENSES

I hereby declare that I have actually incurred a sum of Rs……………... (Rupees

...................................................only) towards medical expenses in respect of
myself/dependent members of my family, as per details given below:

(1) Name of the person for whom the

treatment has been taken (in case of
a dependent family member, his/her
name, age and relationship with the
employee also to be given) :

(2) Name of the doctor consulted :

(3) Nature of illness :

(4) Duration of treatment (with dates) :

(5) Professional Fees paid :

(6) Cost of medicines purchased :

(7) Total expenses incurred :

(8) A statement of account for the amount claimed is given below.

(9) I request that the above mentioned sum be reimbursed to me in terms of

paragraph XII of the Bipartite Settlement dated the 17th September 1984.

(10) I, further certify that dependent parent(s), in respect of whom the reimbursement
is being claimed ordinarily reside(s) with me and his/her/their present monthly
income is Rs.................................. My other brothers and sisters working in the Bank
have not claimed/are not claiming reimbursement of such expenses.

Yours faithfully,

(Signature of the Employee)

Full Name :
Designation :

Department/Branch :
--------------------------------------------------------------------------------------------------------STATEMENT OF
ACCOUNT
---------------------------------------------------------------------------------------------------Sl.
Date of For SelfParticulars(indicating expenses Amount Remarks
No expenditure or family relating to medicines/
pathological test/doctor's fees, etc.,
separately against each date)
----------------------------------------------------------------------------------------------------------------------------------
--------- 1 2 3 4 5
6
---------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------Total
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Signature

Name of Employee :
Branch/Department :