THIRUVANANTHAPURAM: It has been alleged that four crores of rupees are being frauded in the medical insurance scheme for the pensioners of KSEB. After collecting Rs 20 crore as premium from the pensioners, the fraud was done by making an agreement with the insurance company that only Rs 16 crore worth of benefits needs to be paid. The agreement has also been signed with a 'stop loss clause', which prevents the applicants who apply at the end from getting the benefits. The KSEB Pensioners Association, a pensioners wing of the pro-CITU Employees Association of KSEB, is implementing the health group insurance for pensioners.
KSEB does not have Medisep health insurance provided to government employees and teachers. Those in service will get medical reimbursement. There is no pension. It was in this context that Arogya Group Insurance was implemented. The premium for this will be deducted from the pension amount and transferred to the KSEB association. The National Insurance Company is paid by the association.
It is said that the stop-loss clause was made to provide insurance cover up to Rs 16 crore so that the insurance company does not suffer any loss. With this, if there are more insurance claims, there will be a situation where everyone will not get the benefit. That is why many people are staying away from the project without joining it, says the opposition leaders. Those suffering from diseases and economically disadvantaged are forced to join the association's insurance. The new system will come into effect on March 15th. The pensioners association has complained to the electricity minister and the KSEB chairman against the implementation of the insurance scheme in collaboration with the KSEB management, but no action has been taken.
Fraud accounts
- Total pensioners 38,000
- 8369 people enrolled in insurance
-Rs 1165 for one lakh benefits
-2175 rupees for two lakh benefits
- 19.80 crore rupees is collected from 8369 people
-Total Benefit: Maximum Rs.16 Crores
May not get benefits
In health group insurance, there is a rule to provide for stop loss. Therefore, those who apply beyond the limit may be denied the insurance benefit. This is a precautionary measure to avoid a loss to the insurance company in exceptional circumstances. The premium is determined in relation to this. This trend has become widespread in medical and accident insurance in the event of covid, flood, etc.
Association says it's GST
The insurance company will get only Rs 16.80 crore even though it collects about Rs 20 crore as premium. The remaining amount is GST. A stop-loss clause is included in the insurance contract to reduce the premium amount. The contract was with another company for five years. Claims of more than 13 crores have not come. So even if you put a stop loss, no one will miss the benefit.
- Balakrishna Pillai, General Secretary, Pensioners Association