As per para C in page 11 of the Group Mediclaim Policy for 2017-18,there are 16 diagnostic tests for which provisions have been made for reimbursement without hospitalization ranging from Rs 750/- to Rs 15000/- subject to a maximum amount reimburseable of Rs 75000/- for all the tests undergone in a year.
It has come to our knowledge that one of the pensioners has had to undergo diagnostic tests costing about Rs 40000 as reported to me for brain related treatment.One more test has been prescribed by a neurologist costing Rs 10000 which he has yet to undergo.
In the absence of the details of the tests undergone,I am not able to know whether the tests undergone by the retired officer falls any of the items in the aforecited para,but it is possible that some of the tests which the officer has undergone may be outside the list of the 16 items and costing more than Rs750/.
It is therefore reasonable that such tests prescribed for some conditions costing Rs 750/- or more for patients in acute or chronic conditions without hospitalization qualify for reimbursement.In order to fix the correct amount allowable for reimbursement can be reasonably fixed by the New India Assurance Co based on enquiries with reputed hospitals.
It is therefore necessary for the employees' Associations and Pensioners' Associations to take up with LIC Management to pursue with NIA to enlarge the list to include all diagnostic tests costing Rs 750/- or more irrespective of the nature of the test provided such tests have been prescribed in the course of the treatment to the patient.
This arrangement will obviate the need for piece-meal requests for reimbursements put in by members of the scheme for tests falling outside the 16 tests specified in the policy.
Greetings.
C H Mahadevan
No comments:
Post a Comment