Brief Notes on Mediclaim
When we trace the history of Medi Claim in LIC, we wonder to know that Medi Claim Scheme in LIC
was started without any Sum Insured. The Premium was not dependent on Age. But the Scheme has
travelled for more than 34 years and lot many improvements came along. The Insurer was also getting
changed in between. When TPA entered the arena, Medi Assist India was the only TPA through out
India and now as you all know we have separate TPA for each of our Zones. Let us glance through the
history in brief of our Medi Claim scheme.
1. Medi Claim Scheme for LIC employees came wef 1-1-1988. At that time there were 4
Categories. There was NO SUM INSURED. Reimbursement was depending on Room Rent.
Premium was dependent on Age.
2. Special Entry Rules were framed vide CO Circular dtd.8-9-1990. For retired employees, the
total benefit was reduced by 10% between Age 70 to 75 and by 20% between Age 76 to 90.
3. Premium Sharing started vide CO circular dtd 12-9-1996 at the rate of 25% and 75% between
Employee and LIC (For Class 2, 3, 4) and for Class 1 at 1/3 & 2/3.
4. Policy year was changed from Calender year to Financial Year wef 1-4-1997. For the First
time Sum Insured concept was introduced. Within the Sum Insured, limit for Domiciliary
Hosp expenses were also spelt out.
5. From the year 1998-99 Dependent Parents below age 75 were allowed to be included. One
moe option to Join the Scheme for Retirees was given, who had not joined the Scheme
earlier – for both who had retired earlier to 1-1-1988 and retired subsequently.
6. Parents / Parents-in-Laws were allowed to be included wef 1-5-2006 till retirement of the
employee.
7. Optional Sum Insured concept was first time introduced wef 1-4-2009.
8. Retirees were extended premium sharing at 25% and 75% between Employee and LIC
wef 5/2010. All Classes of employees and Retirees have same % of sharing of Premium.
9. One more option to join the Scheme was given wef 1-4-2011 vide CO circular dtd 9-3-2011.
10. For Retirees subsidy for 2 Disabled Dependent Children was given wef 1-4-2013.
11. Family Floater Medi Claim policy was introduced first time wef 1-7-2014. Max SI was 20
Lacs.
12. Upper Age Limit of 90 years was removed wef 2012-13. Now covered till their Death.
13. Family Floater rules spelt out vide CO Cir dtd. 28-4-2014.
14. For retired employees addition of Parents/Parents-in-Laws was given wef. 1-4-2015 for
those were covered while the employee was in service vide CO Cir dtd. 17-12-2014.
15. For the purpose of Room Rent, for the first time cities were classified into A, B and
When we trace the history of Medi Claim in LIC, we wonder to know that Medi Claim Scheme in LIC
was started without any Sum Insured. The Premium was not dependent on Age. But the Scheme has
travelled for more than 34 years and lot many improvements came along. The Insurer was also getting
changed in between. When TPA entered the arena, Medi Assist India was the only TPA through out
India and now as you all know we have separate TPA for each of our Zones. Let us glance through the
history in brief of our Medi Claim scheme.
1. Medi Claim Scheme for LIC employees came wef 1-1-1988. At that time there were 4
Categories. There was NO SUM INSURED. Reimbursement was depending on Room Rent.
Premium was dependent on Age.
2. Special Entry Rules were framed vide CO Circular dtd.8-9-1990. For retired employees, the
total benefit was reduced by 10% between Age 70 to 75 and by 20% between Age 76 to 90.
3. Premium Sharing started vide CO circular dtd 12-9-1996 at the rate of 25% and 75% between
Employee and LIC (For Class 2, 3, 4) and for Class 1 at 1/3 & 2/3.
4. Policy year was changed from Calender year to Financial Year wef 1-4-1997. For the First
time Sum Insured concept was introduced. Within the Sum Insured, limit for Domiciliary
Hosp expenses were also spelt out.
5. From the year 1998-99 Dependent Parents below age 75 were allowed to be included. One
moe option to Join the Scheme for Retirees was given, who had not joined the Scheme
earlier – for both who had retired earlier to 1-1-1988 and retired subsequently.
6. Parents / Parents-in-Laws were allowed to be included wef 1-5-2006 till retirement of the
employee.
7. Optional Sum Insured concept was first time introduced wef 1-4-2009.
8. Retirees were extended premium sharing at 25% and 75% between Employee and LIC
wef 5/2010. All Classes of employees and Retirees have same % of sharing of Premium.
9. One more option to join the Scheme was given wef 1-4-2011 vide CO circular dtd 9-3-2011.
10. For Retirees subsidy for 2 Disabled Dependent Children was given wef 1-4-2013.
11. Family Floater Medi Claim policy was introduced first time wef 1-7-2014. Max SI was 20
Lacs.
12. Upper Age Limit of 90 years was removed wef 2012-13. Now covered till their Death.
13. Family Floater rules spelt out vide CO Cir dtd. 28-4-2014.
14. For retired employees addition of Parents/Parents-in-Laws was given wef. 1-4-2015 for
those were covered while the employee was in service vide CO Cir dtd. 17-12-2014.
15. For the purpose of Room Rent, for the first time cities were classified into A, B and
16. One more option to include Parents/Parents-in-Laws to retired employees was given vide CO
Cir dtd. 22-6-2015. Last date to add was 28-2-2016.
17. Deduction of Premium from Pension of the Pensioner started from the year 2016-17 from
February 2016 Pension. (CO Cir dtd. 14-1-2016).
18. Submission of Form A dispensed with – if there is NO CHANGE in the membership. (CO Cir
dtd 16-1-2016).
19. Option for Increased Family Floater Sum Insured was made irrevocable. (CO Cir dtd. 26-2-
2016).
20. CO Cir dtd. 16-4-2016 made the following changes : a) Family Floater S I increased to Rs.30
Lacs. b) Registration/Admission/Service Tax was made payable c) ARMD reimbursement
was introduced. d) Ambulance Charges doubled to Rs.5000/-.
21. Total Floater Sum Insured extended to Rs.40 Lakhs and Rs.50 Lakhs. Family Floater SI
can be reduced to next lower SI on the exit of any member. Independent Children were to
be added in the Policy till their marriage. (CO Cir dtd. 23-9-2017).
22. Compulsory Floater Sum increased to Rs. 5L, Rs.6 L and Rs.10 L for Cat III, II and I
respectively wef 2018-19. (CO Cir dtd. 26-12-2017).
23. From policy year 2019-20 ISMO scheme introduced free of cost.
24. Cashless facility started when TPAs came on the scene in 2013-14. This facility was
allowed only for few major diseases viz. Cancer, Cardiac, Neuro Surgery, Renal diseases
and Accidental trauma cases. In 2014-15 Organ Transplant was added to this list.
25. Only in 2015-16 Cashless facility in the present form was introduced with 5 TPAs covering
8 Zones of LIc
26. Diagnostic Tests without Hospitalisation came in 2006-07 with only 4 Tests viz. MRI,
CTScan, Sonography, Biopsy(internal & external). Now it has swelled to 16 Tests. Still
some more may be added.
27. For the coming policy year 2022-23 Floater Sum is increased to Rs.75 Lakhs. Independent
Children upto their Age 45 can be added, without any condition (married/unmarried,
son/daughter, employed/unemployed) vide CO Circular dtd. 8-3-2022. Family Floater Sum
Insured can now be reduced – on the exit of a member – proportionately.
VIJAYAPURA COMPILED BY
15-03-2022. C T JOSHI.
Mobile No:+91 9731955044
Mail id : joshi.chidambart@gmail.com
Cir dtd. 22-6-2015. Last date to add was 28-2-2016.
17. Deduction of Premium from Pension of the Pensioner started from the year 2016-17 from
February 2016 Pension. (CO Cir dtd. 14-1-2016).
18. Submission of Form A dispensed with – if there is NO CHANGE in the membership. (CO Cir
dtd 16-1-2016).
19. Option for Increased Family Floater Sum Insured was made irrevocable. (CO Cir dtd. 26-2-
2016).
20. CO Cir dtd. 16-4-2016 made the following changes : a) Family Floater S I increased to Rs.30
Lacs. b) Registration/Admission/Service Tax was made payable c) ARMD reimbursement
was introduced. d) Ambulance Charges doubled to Rs.5000/-.
21. Total Floater Sum Insured extended to Rs.40 Lakhs and Rs.50 Lakhs. Family Floater SI
can be reduced to next lower SI on the exit of any member. Independent Children were to
be added in the Policy till their marriage. (CO Cir dtd. 23-9-2017).
22. Compulsory Floater Sum increased to Rs. 5L, Rs.6 L and Rs.10 L for Cat III, II and I
respectively wef 2018-19. (CO Cir dtd. 26-12-2017).
23. From policy year 2019-20 ISMO scheme introduced free of cost.
24. Cashless facility started when TPAs came on the scene in 2013-14. This facility was
allowed only for few major diseases viz. Cancer, Cardiac, Neuro Surgery, Renal diseases
and Accidental trauma cases. In 2014-15 Organ Transplant was added to this list.
25. Only in 2015-16 Cashless facility in the present form was introduced with 5 TPAs covering
8 Zones of LIc
26. Diagnostic Tests without Hospitalisation came in 2006-07 with only 4 Tests viz. MRI,
CTScan, Sonography, Biopsy(internal & external). Now it has swelled to 16 Tests. Still
some more may be added.
27. For the coming policy year 2022-23 Floater Sum is increased to Rs.75 Lakhs. Independent
Children upto their Age 45 can be added, without any condition (married/unmarried,
son/daughter, employed/unemployed) vide CO Circular dtd. 8-3-2022. Family Floater Sum
Insured can now be reduced – on the exit of a member – proportionately.
VIJAYAPURA COMPILED BY
15-03-2022. C T JOSHI.
Mobile No:+91 9731955044
Mail id : joshi.chidambart@gmail.com
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