Sbi Retired Employees Medical Benefit PDF Details

If you are a retired employee of SBI, then you may be interested in the medical benefits that you are eligible for. Recently, the SBI Retired Employees Medical Benefit Form was updated, so it is important to ensure that you are aware of the changes. In this blog post, we will discuss the medical benefits available to retired SBI employees, as well as how to access them.

The following are some details about sbi retired employees medical benefit. You can browse it before filling out the gaps.

QuestionAnswer
Form NameSbi Retired Employees Medical Benefit
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessbi health assist scheme for retired employees, sbi retirees health insurance 2021 22, portal for sbi retired employees, sbi retiree health assist

Form Preview Example

STATE BANK OF INDIA

RETIRED EMPLOYEES' MEDICAL BENEFIT TRUST

 

CLAIM FOR REIMBURSEMENT OF DOMICILIARY TREATMENT

 

 

 

01

Name of the employee (member pensioner)

 

 

 

 

02

Date of Retirement

 

 

Membership Number

 

 

 

 

03

Whether claimed for self/spouse

 

 

 

 

04

Address & Telephone No.

 

 

 

 

 

05

Retired As

 

 

 

 

 

06

Pension Paying Branch SB A/C No.

 

 

 

 

07

Nature of illness

 

 

 

 

08

Name of the dependent family member for

 

 

whom the Medical Expenses made

 

 

Name

-

 

 

Age

-

 

 

Relationship

-

 

 

 

 

08

Duration of illness

 

 

 

 

09

Name & address of the attending Physician

 

 

 

 

10

Details of expenditure incurred & claim to

Total Amount

 

be submitted alongwith Doctor's

 

 

prescription--as per reverse

 

 

 

 

11

I certify that I have incurred above expenses

 

 

for myself & / eligible family

 

 

members

 

 

 

 

 

 

`

 

 

Signature of the pensioner

member

Forwarded for payment

Branch Manager

Branch ______________

DETAILS OF THE BILLS

BILLNO.

DATE

PARTICULARS

OF THE BILL

AMOUNT

TOTAL

Signature of the pensioner member

AT ADMINISTRATIVE OFFICE

 

Amount of the expenditure claimed for Domiciliary treatment

Rs.

Amount of expenditure for Domiciliary treatment

Rs.

already claimed during the year

 

Balance available for domiciliary treatment

Rs.

sanctioned Rs.

Towards Domiciliary treatment

 

Chief Manager (HR)

Assistant General Manager (ADMIN)

 

 

 

 

 

 

 

 

 

 

 

Watch Sbi Retired Employees Medical Benefit Video Instruction

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