As desired by BY LIC MANAGEMENT -from all associations/unions suggestions for improvement in GMP

DEAR SRI G.KRISHNASWAMY GEN.SECRETARY, AIRIEF RESP.SIR, As desired by BY LIC MANAGEMENT -from all associations/unions suggestions for improvement BEFORE RENEWAL OF GROUP FLOATER MEDICLAIM SCHEME FOR 2017-18, OUR AIRIEF TEAM MUST TAKE UP WITH LIC CHAIRMAN & NEW INDIA ASS.CO. LTD. FOR REMOVAL OF LACUNAE IN SCHEME , WHICH EXIST INSPITE OF HUGE PAYMENT AS PREMIUM BY LIC to New India Assurance co. WE CAN PUT UP FOLLOWING POINTS IN THIS REGARD:- (A) INCLUSION OF REIMBURSEMENT OF DENTAL TREATMENT IS NECESSARY AS ALL SR.CITIZENS ARE BOUND TO GO IN FOR IT AS OUTDOOR PATIENT. (B) EITHER The ceiling for room charges be REMOVED WHICH IS, AT PRESENT @ 1.5% of sum assured WITH OVERALL CITY WISE ceiling of Rs. 7500 in Metro city, Rs.5000 in B class city and for others Rs 4000/-. It should be at least 10000- 0r 2% of the SA, WITHOUT ANY OVERALL CEILING OR IF, FOR ANY REASON WHATSOEVER INS.CO. DOES NOT AGREE FOR CHANGE in RATE@1.5 % S.A., WE MAY GO IN FOR INCREASE IN SUM ASSURED TO BE DOUBLED IN CAT. I , II & III (c) Clause 16 Medical claim policy already states as ID card means the identity card issued to the insured person by the TPA to avail cashless facility in network hospital. Under the rules of group policy,It is clear that ID Cards will not be issued by the LIC. We may construe that Divisional offices/Zonal Offices failed to follow up the effectively for issuance of cards by TPA. as such even in MARCH 2017, all PENSIONERS HAVE NOT RECEIVED E-Card. (d)The clause 4D of the mediclaim policy must go as it is negative clause and generally, it is applicable to general public. The clause reads as : The TPA reserves the right to deny pre authorization in case the insured person is unable to provide the relevant medical details AS REQUIRED BY THE TPA. TPA will make it clear to the insured person that denial of cashless access is in no way construed to be denial of treatment. The insured person may obtain the treatment as per his/her treating doctors advice and later on submit the full claim papers to TPA for reimbursement. This clause must go as in many cases , it has come to our light that they have denied treatment without any cause. In some cases, even the approval sent earlier was withdrawn before discharge without any reasons.The TPA gets some discount from the hospital from the bill and the burden is shifted by the hospital to the patient to pay and, later on it is denied by the TPA. So, the policy should be transparent and once the patient is admitted under the cashless scheme, No denial should be there,otherwise our member will be under heavy burden to pay. (e)The Insurance Cos. have NOW begun to reimburse the Outdoor expenses to the tune of 5% or 10%of the sum assured, It should be also included in our group mediclaim Policy.(f) Scanning of all types must be allowed -- CT, MRI, PET etc. (g)Consultation fee must be allowed EVEN if Hospitalisation does not happen - like for DIABETICS (h) Full reimbursement for ORTHOPAEDICS, SURGERY & plasters etc. (I)Re-inclusion of those retirees, who, for one reason or other,or by mistake could not pay/opt for renewal at retirement or afterwards, although, they were members from inception of group mediclaim scheme. Please also take up the issue that tri cities Mohali , Chandigarh and Panchkula are just adjoining each other and their total population makes Tri Cities as A Class City. But New India treats each city separately as C Class making the room rent eligibility for just Rs four thousand and every good private hospital here charges not less than Rs seven thousand five hundred and things don't stop here .New India and TPA reduce entire hospital bill proportionately as per c class city category causing lot of financial hardship to LIC Pensioners who are senior citizens also. All the above point wise deficiencies of scheme ,have also been sent to AIRIEF H.Q. BY ME EARLIER ALSO. PL ENSURE TO INCLUDE THESE IN OUR SUGGESTIONS. WITH KIND REGARDS,​ N. D. MEHROTRA, GEN.SECRETARY. RETIRED INS.EMPLOYEES' ASSOCIATION, JAIPUR mob./ whatsapp 9828270263 ​P.S.​ 1-To my knowledge SBI Pensioners are getting OPD reimbusement with Annual ceiling. 2-Under cashless treatment -detail of treatment should also be provided to the insured member. 3-There should be audit provision by LIC/Irda. 4-Registration of claim should be from the date it is received from the Concerned Divisional Office,not from the date TPA office enters data in their computer.This causes delay in settelment. REGARDS, N. D. MEHROTRA, GEN.SECRETARY. RETIRED INS.EMPLOYEES' ASSOCIATION, JAIPUR mob./ whatsapp 9828270263