The Merchant Navy Officers Welfare Fund
Registered under Bombay public trust Act 1950, Register No: E/4771 of 1972 (BOM).

MEDICAL

MEDICAL REIMBURSEMENT

Eligibility Criteria:

  1. Medical Reimbursement assistance is applicable for all Merchant Navy Officers’ who are not below the age of 18 years and who have not actually retired from service, employed in Indian Shipping Companies and sailing on INSA-MUI Terms of agreement are the beneficiaries of the Fund & Scheme (Officers, Wife and 2 Kids). Subject to the Contribution received by the Shipping Company on behalf of the sailing Officer.
  2. Officers’ may please note that those employed otherwise than on INSA-MUI Agreement are not entitled to the benefits of the Scheme.
  3. Officers, Wives and their 2 kids (up to the age of 25 years and unmarried) are entitled to the benefits of the scheme subject to the condition and they are unemployed and solely dependent on the officer.
  4. Dependent Parents, Brother, Sisters and Relatives of Officer will not be entitled for the Medical benefits.
  5. Officers’ wives who are employed and who are covered under the Medical Facilities available from their companies, also if officers’ family is covered under the medical Insurance Companies then the Medical Benefits will stand to the difference between the two scales.
  6. Officer and his family will cease to be beneficiary of the fund on retirement, taking up Shore occupation or joining a foreign company.

Types of Medical Treatment Covered:

Domiciliary treatment: Domiciliary treatment: Under the head of Out Patient Department (OPD) Claims for different treatment will be reimbursed (Officer, Wife & 2 Kids).

Dental Treatment:Under this head Dental Treatment Reimbursed (Officer, Wife & 2 Kids).

Maternity Treatment: Maternity expenses will be reimbursed for two pregnancies Only. This Include Pre-natal, Delivery and post-natal treatments (All expenses included).

Hospitalisation Treatment: This treatment cover Charges which include registration, Bed/Room, Stay Charges, Operation Theater, Investigation, Medicines, Surgeon Fees and Consultation Fees (Officer, Wife & 2 Kids).

Major Surgical treatment: This treatment includes Cancer, Kidney Transplant, Coronary Artery Bypass Surgery, Angioplasty, Replacement of Major Joints Like Hips, Knees Shoulders, Elbows, replacement of Heart Valves, Neurological Treatment of brain, Blood Cancer Treatment which will be onetime payment and no further claims will be considered for that specific Illness. (Officer, Wife & 2 Kids).

Day Care Treatment: This treatment includes cataract Surgery, Angiography, Lithotripsy, Endoscopy and Dialysis, Day Care treatment where the patient has to stay in hospital for few hours (within 24 hours) and discharge on the same day (Officer, Wife & 2 Kids).

Instructions to be followed while Claiming Medical Claim:

  1. Fill Declaration form for the first time Claiming for Medical Reimbursement.
  2. Please attached Original Receipts for Consultation, Investigation and Medicines and also Prescription, Investigation reports to enable us to expedite settlement of claim(s). (refer Section "D"& "E") for Domiciliary Treatment /Form.
  3. Please ensure that Section "F" is certified / stamped / signed by Medical Practitioner to avoid delay for Domiciliary Treatment/ Form.
  4. Details of Medical Expenses should be supported by relevant documents like Hospitalisation bill, Doctors prescription, Discharge Card, Investigation Reports, Medical Receipts and Cash Memos in Original (to expedite its settlement of your claim) for Hospitalisation Treatment.
  5. In case of Maternity claim certified photo copy of Birth Certificate should be attached.
  6. Any correction or overwriting on Original Hospitalisation bill, Medical receipts or any other receipts will not be considered.
  7. In case of Maternity Claim certified photo copy of Birth Certificate should be attached.
  8. Expenses for Voluntary sterilization and abortion will not be reimbursable unless they are performed for the safety and health of the wife.
  9. Involuntary abortion/miscarriage will be dealt with as Maternity Claim.
  10. Treatment for infertility (Primary Sterility) shall be limited to a maximum of two treatments.
  11. Treatment for Diabetes and Hypertension will be permissible only in respect of the first initial treatment up to a Maximum period of 3 months.
  12. Apart from the details in the Claim Form, if there is any other information which need clarification for the consideration and settlement of the Claim, it should be furnished.
  13. Orthodontic Treatment (Dental), Laser vision correction (Refractive error), Vaccination, Inoculation, Circumcision (other than on medical grounds) plastic Surgery or beauty treatment, Convalescence or Anxiety Neurosis (Psychiatric), General Debility are to be excluded.
  14. Charges incurred in Hospital/Nursing Home/ Clinic primarily for X ray or any other diagnostic or laboratory examination not in connection with any Disease or presence of any illness for which treatment is required are excluded.
  15. Any Disease or Diseases specifically excluded by the Scheme.
  16. No claim below Rs. 1000/- will be entertained.
  17. Claim Form should be submitted within 90 days after completion of treatment.
  18. Separate Claim Form should be submitted for each illness.
  19. Officers are requested to submit photo copy of relevant page of CDC of last Vessel sign off while filling of Claim Forms.
  20. The officer must ensure that Claim Form should be signed either by the Officer or in his absence by his wife.
  21. Verification by the Doctor giving the diagnosis and period of treatment is a MUST for audit purpose.
  22. Please intimate if you are receiving medical financial benefits for self and family from any other source(s). Please give details.
  23. Officer's children up to the age of 25 years are entitled for the Medical reimbursement benefits, subject to the condition that they are unmarried, unemployed and are solely dependent on Officer.
  24. Parents, Brothers, Sisters and Relatives of Officer are not eligible for the Medical benefits.
  25. Reimbursement of medical expenses will be processed exclusively through NEFT/RTGS. Please ensure that you submit accurate details of your savings bank account along with a copy of the cheque.
  26. Additional information pertaining to your Medical Claims may be furnish in a separate sheet or to be mentioned in covering letter for sake of clarification.
  27. Medical Reimbursement Forms (Hospitalisation Treatment or Domiciliary Treatment) can be obtained from the Funds office on request or you can download Claim Forms from website: www.mnowf.com.
  28. All correspondence relating to Medical claims should be sent directly to "The Merchant Navy Officers' Welfare Fund", Udyog Bhavan, 4' Floor, 29 Walchand Hirachand Marg, Ballard Estate, Mumbai - 400 001.

Note:
Officers may please note that all Medical Claims will be settled in accordance with rules laid down under the Medical Scheme. All above settlement are subject to approval of Trustees as per the rates list available under various head categories. Claim settlement are subject to modifications made by the Trustees from time to time.