Suggestions/Feedback on improving the Mediclaim policy during the next revival

Regd. No. TU19772

Federation of LIC Class-I Officers' Associations

President Prabeer Kumar Rath

AI/2224/letter/44

Chairperson Sujeet Kumar, MP Gen. Secretary S. Rajkumar

Dated 19th Feb 2024

To The Executive Director (Personnel) Central Office, Mumbai.

Sir,

Sub: Suggestions/Feedback on improving the Mediclaim policy during the next revival

Further to our discussion on 6th February 2024, we are submitting our suggestions on Mediclaim for your favourable consideration during the subsequent revival of the policy.

• 1.
  Room Rent: the current ceiling of Rs.6000/- per day for Class B cities and Rs.4000/- per day for Class C cities should be suitably increased or correlate the room rent limit to the 'sum insured' opted by the employee as applicable to Class A cities. In many hospitals in our town, the rent and nursing charges exceed Rs.6000/4000, and employees are losing considerable amounts due to this ceiling even though the sum insured opted by them is Rs.50/75 lakhs.
• 2.
  Ambulance Charges: Rs.5000/- per trip per hospitalisation – to be revised. Also, the ambulance charges should be reimbursed as pre/post-

  Central Committee Office: 5th floor, Industrial Assurance Building, Vir Nariman Road, Near Eros Theatre, Churchgate, Mumbai- 400020.

  Reg. Office: RG210B, Kochulloor, Medical college P.O., Thiruvanthapuram-695011 e-mail :aicl1fed@gmail.comWebsite: www.licclass1federation.in

  hospitalisation expenses for bedridden patients for further OP consultations after hospitalisation.

• 3.
  The cost of Intravitreal injection/intervention for ARMD treatment should be revised.
• 4.
  Cataract Surgery: The Rs.60000/- limit per eye should be revised.
• 5.
  Robotic Surgery: Now available only for Cancer/Heart/Brain/Spine surgeries. As a new technological intervention, this should be extended for all other complicated surgeries, like Knee replacement surgery.
• 6.
  Treatment for Psychiatric disorder: Now payable only for hospitalisation expenses subject to a max amount of Rs.50,000/-. - It should be paid without a ceiling, and pre/post-hospitalisation expenses should be allowed.
• 7.
  Maternity Benefits: Ceiling of Rs.65000/- and 1,25,000/- for normal delivery/Caesarian, respectively, should be suitably revised.
• 8.
  Physiotherapy expenses (for cases other than permanent/temporary disabled cases): Now expenses for pre/post hospitalization are payable subject to a maximum of Rs. 40000/- per year. - This should be paid without ceiling and pre/post-hospitalization period clause.
• 9.
  Modification of Annexure III :(Hospitalization for which 24 hours is not required):

  • (a)
    The list under Annexure III seems to be 'not exhaustive' since it does not cover the treatment of some chronic ailments for which 24-hour hospitalization is not required. For instance, one of our employees had undergone treatment for 'Myasthenia gravis', a chronic disease (the patient is unable to swallow solid food since the peristaltic movements are restricted). CMC Vellore advised him to take a 'Rituximab' injection at

    Central Committee Office: 5th floor, Industrial Assurance Building, Vir Nariman Road, Near Eros Theatre, Churchgate, Mumbai- 400020. Reg. Office: RG210B, Kochulloor, Medical college P.O., Thiruvanthapuram-695011 e-mail :aicl1fed@gmail.comWebsite: www.licclass1federation.in

a 45-day interval for a more extended period (for more than 60 days), costing Rs. 30,000/- for each infusion. However, the claim for expenses done after 60 days was denied as the same was done on an OP basis. In the same way, the cost of injections taken by another employee for severe rheumatoid arthritis, costing Rs.20000/- for each injection, was also denied, stating the same reason.

• (b)
  The laser treatment for retinopathy, which is one of the most common treatments, is not included in Annexure-3- to be added
• (c)
  Dental Treatments: The root canal treatment and the treatment of periodontal (gum) diseases are to be covered in the policy. (at least with a ceiling clause)

Hence, the list under Annexure III should be enhanced by including these treatments.

• 10.
  Reimbursement of the cost of Diagnostic tests without hospitalisation:

  • (a)
    Ceiling fixed to various tests are to be suitably revised.
  • (b)
    Some of the standard diagnostic tests viz, OCT (Optical coherence tomography) for the eye, Cystoscopy (endoscopy of the urinary bladder), Cytometry, Doppler study, Laryngoscopy, PFT, and such other tests are to be added to the list.
  • (c)
    the cost of drugs used in CT imaging is also to be considered as the cost of a CT scan.

    In our opinion, it is unfair to deny the Mediclaim in these kinds of genuine cases where the patients suffer from severe health issues and have opted for an insured sum of 50/75 lakh and paying a premium from their salary.

• 11.
  Pre/Post hospitalisation period now available for 30/60 days should be extended to 60/90 days respectively. (This facility is available in some of the individual Mediclaim policies)
• 12.
  Health check-up facilities may be added to the policy as available in some of the individual Mediclaim policies so that all covered under it can go for PMC without any extra burden to LIC.
• 13.
  One more option to add dependent parents/parents-in-law.
• 14.
  The approval process should be available 24/7 and faster. As an alternative, LIC should settle the claim directly with the hospital, get the settlement from the insurance company and recover the balance if any from the employee. This will avoid unnecessary harassment of the family members. A cashless Mediclaim card is to be introduced to the head of the family, which should cover the cashless hospitalisation for the entire family.
• 15.
  If the Doctor advises further investigation to rule out any disease, the same should be covered without hospitalisation.
• 16.
  Reimbursement of the cost of EECP treatment should be covered under Mediclaim/ high-cost treatment.
• 15.
  The minimum sum assured under the family floater should be one crore, and the basic sum assured is to be increased from 10 lakhs to 30 lakhs, for which the corporation should bear the entire premium.
• 14.
  Others: We are getting many complaints from our employees and retired employees that they are not getting any reply for the representations sent by them to the 'Grievance Redressal Cell' of New India, Mumbai, the address given in the policy document before approaching Insurance Ombudsman. The email ID of NIA for grievance redressal is not provided in the policy document, which creates much difficulty for the employees to contact NIA. As a corporate customer covering more than 1.5 lakh customers, the insurer should introduce a specific grievance redressal mechanism for licians.

S. Rajkumar General Secretary