BANGIYA GRAMIN VIKASH BANK

Head Office: Berhampore, Murshidabad

CIRCULAR NO: HR/85/2023-24 Date: 29.08.2023

All Branches / Offices

All Departments at H.O. & PMO

Re: Medical Insurance Scheme for the serving Officers & Employees along with option for Super
Top Up facility

The Group Medical Insurance Policy in respect of the Bank’s existing Officers & Employees relevant to
the period from 29.08.2022 to 28.08.2023 expired on 28.08.2023 and the Policy is renewed w.e.f.
29.08.2023 for those who are on pay roll as on 28.08.2023 with National Insurance Company Limited
through our insurance broker Anand Rathi Insurance Broker Limited. Heritage Health Insurance TPA
Pvt. Limited has been selected as the Third Party Administrator (TPA) for servicing of this Group
Medical Insurance Policy.

The Bank has already remitted the requisite premium of the base policy for serving Officers &
Employees as per rates quoted by National Insurance Company Limited for the respective sum insured
as per Table-I

Table-I
Basic Premium Effective Expiry
Designation Cover (Inc. GST) Date Date
(₹) (₹)
Officer (With Domiciliary) 400000.00 19,523.00 29.08.2023 28.08.2024
Office Assistant/ Office Attendant/PTS
(With Domiciliary) 300000.00 14,641.00 29.08.2023 28.08.2024

In view of the ever increasing expense of modern treatment incurred by the Officers & Employees on
account of medical/hospitalization bills, this year Bank has floated the opportunity of availing additional
cover of Super Top Up Facility to the extent of Rupees Four lakh only for Officers and Rupees Three
lakh only for Employees. The extra premium to be borne by the intending insured who will express their
respective willingness in this regard through the Option form annexed hereto positively within
01.09.2023, is as per Table-II below:

Table-II
Designation Super-Top Up Top Up Premium Effective Expiry
Cover (Inc. GST) Date Date
(30% of members opting)
(₹) (₹)
Officer 400000.00 11,714.00 04.09.2023 28.08.2024
(Domiciliary not covered)
Office Assistant/ Office
Attendant/ PTS 300000.00 8,785.00 04.09.2023 28.08.2024
(Domiciliary not covered)

It is to be noted that the above Super Top Up facility will be made available by the Insurance Company
if at least 30% of the Total Officers and Employees opt for the same by exercising their options relating
to premium payment respectively.

Accordingly, all the willing Officers and Employees who wishes to avail the facility of Super Top Up are
requested to maintain the requisite premium amount in their individual salary accounts, as may be
applicable to the kind of sum insured they may be opting for.

The Officers and Employees willing to avail the facility of Super Top Up are advised to submit their
option form as per Annexure-I, within the stipulate date (01.09.2023) through their branches via
respective Regional Offices. Officers and employees posted at Regional Offices and Head Office are
1
required to exercise their option through Regional Manager of their respective region or Head of the
Department at Head Office as the case may be. The Regional Offices will then consolidate all the option
forms in a spread sheet (enclosed) and send us the consolidated report by e-mail to Manager HR,
BGVB Head office (mail id: managerhr@bgvb.co.in) marking a copy to General Manager HR, BGVB
Head office (mail Id: gmhr@bgvb.co.in latest by 12.00 noon of 02.09.2023 followed by hard copy of the
same. The premium will be debited on 02.09.2023 from the salary accounts of respective optees for
instantly remitting the same to the Insurance Company to ensure commencement of the Super Top Up
coverage from 04.09.2023. Relevant provision relating to the rules of Income Tax as per Income Tax
Act, 1961 is applicable for payment of Insurance premium towards the Super Top Up Policy meant
herein above.

Details of the said policy will be intimated as soon as the policy bond is made available with us.
Corresponding Health cards etc., will be circulated in due course.

The contact details & escalation matrix of Heritage Health Insurance TPA Pvt. Limited along with Anand
Rathi Insurance Broker Limited and National Insurance Company Limited is annexed along with
process flow of claims and modalities of mobile app registration. Mobile app and Whatsapp chat will
be made available soon.

A copy of this circular is to be displayed on the notice board of the Branch/Office and at Banks website.

GENERAL MANAGER (HR)

Enclo: 1. Contact & Escalation levels for Bangiya Gramin Vikash Bank.
2. Annexure I- Declaration to avail Super Top Up Facility.
3. Employee Details for Super Top Up Health Insurance.

2
 Bangiya Gramin Vikash Bank Group Mediclaim Policy
Serving Employee Policy Period-29.08.2023-28.08.2024
Retirees Policy Period – 04.10.2023-03.10.2024

Contact & escalation levels for Bangiya Gramin Vikash Bank

Insurer-National Insurance Company Limited

Escalation
Level - 1

Claims Related Issues

Policy Related Issues
Mr. Tirthankar Marik,
Ms. Ranita Bhandari,
Sr. Assistant (Mob- 9831420117)
Assistant Manager (Mob- 8335080456, Mail id- tirthankar.marik@nic.co.in
Mail Id: ranita.bhandari@nic.co.in)

Escalation
Level - 2

Mr. Nilesh Das, Senior Divisional Manager (Mob –8335080177, Mail Id: nilesh.das@nic.co.in)

Final Escalation

1. Sh. Suman Kumar Paul, Manager, Mob- 8335080657, Mail id- sumank.paul@nic.co.in
2. Sh. A K Dey, Regional Manager, Mob- 8335080115, Mail id- ak.dey@nic.co.in
 Contact & escalation levels for Bangiya Gramin Vikash Bank

Broker-Anand Rathi Insurance Brokers Limited

Escalations
Level - 1

Claim Related Issues

Policy Related Issues
Mr. Kaustav Saha, Manager (Mob-
Ms. Sompurna Moulik, Assistant
9830496454, Mail
Manager (Mob- 9830299411, Mail
Id: kaustavsaha@rathi.com )
Id: sompurnamoulik@rathi.com)

Escalation
Level - 2

Mr.Khushal Goenka, Relationship Manager, (Mob-9830302176, Mail Id:khushalgoenka@rathi.com

Escalation
Level - 3

Mrs.Jayalekshmy Kesavan, Vice President,( Mob-7012320346, Mailid:jayalekshmyk@rathi.com

 Contact & escalation levels for Bangiya Gramin Vikash Bank

TPA- Heritage Health Insurance TPA Pvt. Ltd.

Email : For Any Information -

heritage.kolkata1@bajoria.in

Escalation Contac
Department Concerned Person Email
Level t No.
98310
I Sandip Srivastava ssrivastva@bajoria.in
56476
ID Card
94750
II Rajat Ghosh rghosh@bajoria.in
66448
987458 cashlesskolkata@herita
I Anirban Chatterjee
6357 gehealthtpa.co.in
Cashless Facility
877701 cashlesskolkata@herita
II Angshuman Chatterjee
6621 gehealthtpa.co.in
977548 kamalh.heritage@gmai
I Kamal Halder
5810 l.com
Reimbursement
629225 heritage.kolkata1@baj
II Sougata Bhattacharya
0010 oria.in

Grievance Redressal
(Cashless) :
Concerned Person Contact No. Email
cashlesskolkata@heritag
Dr.Suman Poddar 9831650852
ehealthtpa.co.in

Grievance Redressal
(Reimbursement) :
Concerned Person Contact No. Email

Sanjeev Kumar 9477445055 skumar@bajoria.in

 Heritage Health Insurance TPA
SPoC for BGVB

Sl. No. Region Heritage Contact person Contact No

1 Head Office Kamal Haldar 9775485810

2 Bankura Regional Office Ripon Majumder 6297323766

3 Malda Regional Office Amit Mondal 7278571849

4 North 24 Parganas Regional Office Dibyendu Dey Chowdhury 9073567117

5 Nadia Regional Office Dibyendu Dey Chowdhury 9073567117

6 Murshidabad Regional Office Kamal Haldar 9434164046

7 Uttar Dinajpur Regional Office Amit Mondal 9476286957

8 Purulia Regional Office Sanjay Chatterjee 9434147391

9 Purba Medinipur Regional Office Dibyendu Dey Chowdhury 9073567117

10 Paschim Medinipur Regional Office Ajay Kumar 9749190184

11 South 24 Parganas Regional Office Sougata Bhattarcharya 6292250010

12 Dakshin Dinajpur Regional Office Amit Mondal 9434176650

 Heritage Health Insurance TPA Pvt. Ltd.
Cashless Procedure:
Patient Party will visits a
Network Hospital, then
approach TPA desk/Insurance
desk in the Hospital for cashless
The cashless will be processed
by Heritage Health.
Authorization letter will be
faxed / e-mailed to the hospital
with the receipt of Documents
A SMS will be sent to the
member in registered mobile
No uploaded in our system
Patient Party will show
the Health Card and
photo identity card at the
TPA Help Desk/Insurance
Help Desk of the Hospital
Request for pre-
authorization is received
by Heritage Health
directly from the
Hospital
During discharge, sign The Hospital will send the
the claim form and final
Bill. Do not collect any
bills/Discharge
Card/Reports from the
Hospital (Non medical
expenses will be borne
Pre-authorization
Request Form will
be available at the
TPA Help
Desk/Insurance
Help Desk of the
The Form has to
be filled up and
submitted at the
Hospital Counter
documents directly to
Heritage Health for
settlement of the bill.
 Heritage Health Insurance TPA Pvt. Ltd.

Reimbursement Procedure:

Claim form to be filled for
hospitalization and give a prior
intimation to Heritage Health in
case of planned Hospitalization
or within 24 hours of
hospitalization.
Insured submits a duly filled The Heritage Health
claim form and supporting representative shall
documents to Heritage Health review and collect the
within 30 days of discharge documents for further
processing

In case of unavailability of any
document a letter shall be
issued directly to the insured
along with SMS.
Once the claim is processed,
the payable amount is directly
transferred via NEFT/RTGS by
Insurance Company to the
given account
Once the document is uploaded
in the system, Claim intimation
Number will be generated online
and SMS sent to the Insured
with uploaded mobile No.

Note: Claims are processed as per Policy Terms and conditions of the
policy.
Slide.1 - Download Heritage Mobile application from playstore for anroid mobile
Slide.2 – Home screen of the Heritage application
Slide.3 – First page for registration
Slide.4 – Fill up details for registration
Slide.5 – Drawer menu
Slide.6 – Dowload Preauth & Claim forms
Slide.7 – Search PPN Hospital Name with City wise
Slide.8 – For empanelled Hospital List
Slide.9 – List of Hospital with location map
Slide.10 – Search claim with Claim number (CCN)
Slide.11 – Claims summary

–
Slide.12 – Click on arrow icon for more details (Main Claim in Page1)
Slide.13 – Pre-post Claim in Page2
Slide.14 – Claim details
Slide.15 – Claim details
Slide.16 – For download E-card and Insured details against particular policy details
Slide.17 – Insured & E-card details
Slide.18 – Insured & E-card details
Slide.19 – Download E-card details
Slide.20 – For lodge grievance if any
Slide.21 – For lodge Claim intimation
Slide.22 –
Slide.23 – For FAQ
Slide.24 – Contact us
Slide.25 – Contact us
Slide.26 – Contact us
 BANGIYA GRAMIN VIKASH BANK

ANNEXURE-I to the Circular No. HR/85/2023-24 Dated 29.08.2023

Fill in ‘BLOCK LETTERS’

Name of Officer/
Employee
S.P.F. No. Designation
Address for House No. and Street Name
communication
City Police Station
Pin Code Post Office

Tel. No. Mobile No.

Email Sum Insured Rs. 0 0 0 0 0
(4/3 lakh)
Super Top-Up (Domiciliary not covered) Sum Insured Rs. 0 0 0 0 0
(4/3 lakh)
Premium ₹ 11,714.00 ₹ 8,785.00
Amount
(Tick Box)

I hereby opt for insurance cover under the scheme and authorize the Bank to debit my Salary Account
bearing No.________________________________for a sum of Rs.____________________(in
words_________________________________) as premium for joining in the Medical Insurance
Scheme (for availing the facility of Super Top Up) with the insurance provider National Insurance
Company Limited.

Statements made above on my behalf are true and correct to the best of my knowledge and belief. It is
hereby understood and agreed that the statements are the basis on which the insurance is being
granted. If, after the insurance is in effect, it is found that the statements are incorrect or untrue in any
respect, the Insurance Company shall have no liability under this insurance in respect of my proposal
for facility of Super Top Up. I also confirm that I have read the terms & conditions relating to eligibility
to join the scheme. My signature tallies with the recorded specimen Signature in the Account.

Place:
Date: Signature of (Officer/Employee)

Forwarded to Regional Manager, _________________________ Regional Office for necessary

action.

Branch Manager/Regional Manager

___________________ Branch/ ___________________Region

Forwarded to General Manager (HR), BGVB, Head Office for kind noting and record.

Regional Manager/ Chief Manager (_____________________Department)

___________________Region/Head Office
 BANGIYA GRAMIN VIKASH BANK
Head Office: Berhampore

Region Name:
Employee details for Top-up Health Insurance
Sl No. SPF No. Name Officer / Employee Debit account no Branch name Region Name Amount
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