Dear Sri MKGupta,
Family Floater Policy under Group Medi Claim 2019-2020
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1)You would have received worthwhile suggestions for improvement in Group Mediclaim Policy from all stakeholders,employees & Pensioners Federations. Our General Secretary,Sri G.Krishnaswamy with his team met Chairman-in-Charge & MD on 7 Dec 2018, & he has also sent crisp suggestions on 5 March 2019 as a followup measure. The position of aged pensioners is unique,because of age-related medical disabilities, infirmities & diseases,many chronic in nature. It is but natural,with meagre pension ,when daily living & sustenance is becoming harder with many hardships in family,we approach the Top Management like you,to bestow extra care & attention & display empathy, as we are confronted with other lacuna ,like No Domiciliary allowance as in the case of Employees,& even Preventive Health check ups allowed to employees right from age 40 but deprived to pensioners who are 60 & above. Added to these general state of affairs,pensioners groan under the burden of continued treatment nowadays for many ailments adversely afflicting them,causing enormous drain on finances & making impossible happy,serene & tranquil living during the twilight years of their lives.
2) We salute you for the series of benefits or privileges for reimbursement to employees recently announced.The only request is to have the same heart & a more liberal consideration & treatment for requests coming from pensioners,as they are practical, experienced with different treatments at various stations & places causing refusal, reduction in amount claimed,even repudiation at some centres,& not having an open mind or some degree of flexibility in approach,without being too mechanical in an otherwise real customer-centric approach ,which ought to be the major criteria for acceptance of mediclaims.
3)It is needless to mention that New India would have garnered substantial premium after OSA was raise to as high as Rs 50 lacs & further ,one more option was given recently for those who failed to choose the high Rs 40 lacs or 50 lacs, which entitles them for a higher Room rent of Rs 8500.We thank you again for the same.
4)We have pleasure to forward some pensioners suggestions received , based on their experience and difficulties and problems faced by them in cashless or reimbursement of mediclaim expenses on hospitalisation. We append below the feed back received from 4 friends from across the country.
The main issues are :-
(i) The ceiling on room rent in C Class Cities of Chandigarh, MOHALI, Panchkula & Manimazra. The Top Hospitals like FORTIS, Max, Alchemist and Ojas are located in these four cities and the patients from Punjab, Haryana, Himachal Pradesh & J&K are referred to these High Fi Hospitals for further treatment. The room rent of the these hospitals are not as per 'C' Class Cities but not less than ₹ 9000 per day besides nursing charges. Even though the pensioners have opted for Floater SI of ₹ 40/50lacs, these maximum permissible room rent including nursing charges is ₹ 4000 per day. As such all expenses excluding medicines would be reduced to less than 50%.
Hence, there is urgency to remove the ceiling on the room rent for Chandigarh, MOHALI & Panchkula. It must be remembered they pay the same higher premium & so not ethical to reduce benefits.
(ii) The increase in the rates of Diagnostic Tests and payment of consultation fee of the MD. Clause-C on page 10 provides for payment of various diagnostic tests .If these are prescribed by a doctor having minimum qualification MD or equivalent, but it is ironical that the consultation charges payable to the doctor, who prescribes such test, are not payable, and this anomaly should be removed. No doctor of this level will be available to anyone free of cost.
(iii) That SN 8 of Clause-D on page 12 provides for a payment of Rs 25,000/- per eye per year for the eye ailment of AGE RELATED MACULAR DISORDER, which is grossly inadequate inasmuch as such treatment needs minimum 3 injections per eye, in some cases may be more, and each injection costs about Rs 20,000/-.Thus, this limit needs to be increased to minimum Rs one lac per eye per year or, in the alternative, this item should be included in the category of LESS THAN 24 Hrs.
(iv)The claim last year for reimbursement of cost of CABG KIT charged by hospital for CABG Open heart surgery, was disallowed by TPA Vidal Healthcare quoting New India saying the same are not allowed under our policy conditions. It is strange that the kit used for the surgery itself is not payable.Similarly , the cost of compression stockings specially prescribed for CABG patients by hospital during post operative and convalescence period must be paid .
(v) a) We reiterate that acute Varicose Veins & Cellulitis resulting in swelling of legs need longterm treatment costing heavily for the Pensioner Patient & no reimbursement comes except small Investigation Tests. Continued bandaging to stop oozing of pusliquid from ulcer pores open is also costly. Vascular & Plastic Surgeons prescribe AEROWRAP stockings with air pumped for tight control to progressively reduce swelling,for legs to return to fair normalcy .Such stockings cost a pair Rs12,000 with aerometer for pumping adequate air.
b) Such progressive measures to facilitate cure depending on innovations in medical technology must be reimbursed without a blind NO,as a limit of CSA ,say 5 % can be imposed as a restrictive measure, as any excess over that prescribed limit will be rejected.Such empathetic decisions ,especially for Elders & Sr Citizens,who suffer from so many handicaps will neutralize hardship to some extent.
(5) Refusal by TPAs for cashless treatment in cases where hospitalization is not required.
(6) TPAs not providing the details of items disallowed even after reminding them repeatedly
7)NonMedical deductions from claim are still high & no pensioner ever claims such fringe nonmedical items for reimbursement,which are already listed as exclusions.This must be brought to the attention of New India.
8)The provision ,when RegularPensioner dies, Family Pensioner finds it difficult & even impossible to pay same Mediclaim premium as FP is the lowest in LIC with Appendix V restrictive slabwise provisions. Just to know firsthand real pathetic position of a nosedive in Pension , eg Chennai here, late Sri NSLakshman,ZM scale who died on 22 Oct 2018,with BP Rs 2740 & DR 27555, in all Rs 30,295 & now Mrs Parvathi Lakshman Family Pension BP, Rs0915, DR Rs 9210 totalling Rs 10,116 ,so miserly,human dignity vanishes,& so proportionate rule is not helpful but Uniform 2 Slab reduction of OSA be allowed without regret to help them .SUCH gross injustice for the Spouse survivor must be ended,thereby enabling the survivor to pay reduced premium as deduction from pittance of FP. PLEASE APPROVE THIS AS A HUMANITARIAN DECISION, which will be widely welcomed.
9) IRDAI Circular dt 17/8/2018 has removed 10 items at a stretch from Exemptions & has been made compulsory with immediate effect,in cases of mental health care, dental, stem cell infertility & psychiatric treatment etc.As these are no longer optional, we request you to ensure New India implements this, as IRDAI fiat is an order to be taken serious note of & complied without delay any further. It appears New India says the decision rests solely with LIC .
10) Many times, we feel that eminent PublicRelations with TPAs, New India,CO Personnel & OS Depts & equally at ZO level with RM OS, Zone TPAs,New India, stakeholder representatives ,will enable us to see each other, in better light & perspective,appreciate other persons point of view & steadily we come closer,with more practical insights.RBI,Banks do such freelance meetings many times in a year & results have been sound as many times, even on the spot decisions they had taken & paved the way for cross-currents to flow freely without much impediments.
We plead with you with all sincerity at our command, to announce a pragmatic solution to make lives of all pensioners happier with emphasis on welfare & progress of this tribe of Sr Citizens & Super Sr Citizens ,whose grievances must be addressed & resolved satisfactorily.
I am endorsing a copy to worthy ED (E & OS),Sri R.K.Sood
Greetings for the new financial year, & with respectful regards,
Yours sincerely, Sri Mukesh Kumar Gupta,Addl ED Personnel,LIC, CO
R.B.KISHORE ,2/4/2019
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RB Kishore,
PATRON,AIRIEF,
ED(Retd),LIC
Life Member,Probus Club
044-2815 5810 & 098 4034 0591.
.
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RB Kishore,
PATRON,AIRIEF,
ED(Retd),LIC
Life Member,Probus Club
044-2815 5810 & 098 4034 0591.
.
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