Sri Agarwals right query & suggestion re Eye treatment & heavy denial to such pensioners
Dear Sri RKSahni,
1)This is the last 2 days correspondence I had to pursue Sri Agarwals query ,with 84 year old Sri SRNagarajan,Chennai
It is reproduced
2)Every year much before negotiations & talk between LIC Top Mgt & New India,I & AIRIEF send comprehensive suggstions to MD & ED Per,ED OS requesting them to have a breakthrough & introduce New Features & not to routinely dismiss them as NOT possible quoting adverse claims ratio etc
Many even do not claim.
We have brought to LIC Notice the high % of Non Medical deduction in every case which robs of the Very definition of Group MediClaim under Family Floater Policy
We protested the universal reduction of proportionate expenses, when room rent occupied is more & to suffer in medical expenditure is a negative & retrograde .None claims petty nonmedical expenditure , we asserted
3)Look now even after IRDAI Circular extending to 2 diseases,when we include for 2019-20120 FFP ,NI may still refuse dentaltreatment,as its is anaethema to them.They think every such, other than due to accident,which dental is covered,all others as model, fashion, beauty etc We debunked that too & pleaded sincerely for some beginning to be made & not OUTRIGHT REJECTION of nay dental treatment
Who knows because of Stick hanging from IRDAI, they may do small beginning but proportionate charges of Premium may become heavier
In fact we were bringing to their notice that this Year. massive premium collection NI has done as ALL Employees almost plumped in for OSA of Rs 50 lacs & Pensioners much less percentage & many Rs 30 or Rs 40 lacs & in small numbers only
4)This was the reason why simultaneously I pursued with MD that Pensioners more than Employees need Domiciliary Expenses & Same Yly allowance can be given to us also
Equally we said Preventive Health Check up is more needed for Pensioners & so atleast Yly check up Amount can be earmarked for Pensioners
Rs 3000,4000, 5000 for Employees as it starts from age 40 !!,so for us atleast Rs 5000 once a year
Sri RKSahni even calculated the app Outlay & it was very moderate
5)So,such new reveleations which come to our Notice has to be pursued face to face talks at regular intervals so that we can force Mgt to take decisions & not postpone or procrastinate
Thanx for bringing this crucial costly delicate treatment.Needful will be pursued with vigour
In fact,RMOS should call us too at his chamber to have issues aired & grievances highlioghted so that TPA & ZO can pursue with CO to exert pressure & hasten right decisions
III)Of course the charges for cataract operation for both the eyes reimbursed to the hospital under cashless scheme. I omitted this point in my earlier communication.
SRN.
II) From: nagarajan sr <nagarajan_sr32@hotmail.com> Sent: 31 August 2018 15:25 To: Seetha And Kishore Subject: Re: REIMBURSEMENT FOR EYES TREATMENT UNDER OUR MEDI CLAIM SCHEME
Dear Sir,
Sorry for the delay in responding.
My wife had problem in one eye for which 3 injections were administered with an interval of one month between them. The cost of each injection was Rs. 25000/- total outgo on this account Is Rs.75000/-. She also had her cataract operation for both the eyes. When I submitted the papers for reimbursement I was told that as per the then terms of Medi-claim policy no amount could be reimbursed. That was in the policy year 2015-16. And the entire amount was spent during the period. But I got reimbursement of about Rs.23000 or so out of Rs. 25000/- spent after some deduction on a/c of service tax or some such thing. I was informed that this amount is being reimbursed as pre-operation treatment expenses before undergoing cataract operation for that eye.
From the subsequent pol. year the item was included as reimbursable item with a limit of Rs. 25000/- per eye per year per person insured.
The reason for my delay in response is that I wanted to send you the case summary issued by the hospital; it is stored in computer. I will send it soon.
Take care of your health and with kind regards to you and your Mrs.
Yours,
SRN.
From: Seetha And Kishore <rbkseetha@yahoo.com> Sent: 30 August 2018 06:15 To: Nagarajan Sr Subject: Fw: REIMBURSEMENT FOR EYES TREATMENT UNDER OUR MEDI CLAIM SCHEME
I )Dear sri SRNagarajan,
1) I need ur observations on this email of Sri SRAgarwal
2)U faced some such similar problem few years before
Can u narrate the eye problem , the diagnosis,the correct terminology used, Charges demanded, paid,
the extent of reimbursement u got,
the follow up done with authorities, the final result , amendment brought in next year Mediclaim Scheme etc
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