FEDERATION OF RETIRED LIC CLASS I OFFICERS' ASSOCIATIONS
PATRON:
G.N.SRIDHARAN,
7, II Cross St
Karpagam Gardens,
Chennai-600020
Mob.:9841072951
E mail:
PRESIDENT :
RAVISHANKER PRASAD
B2002, Atelier, Rustomjee
Urbania City, Majiwade
Thane(W) - 400601.
Mobile: 9920844915
E mail
S. K. AWASTHI
2/182, Vikas Nagar,
LUCKNOW- 226022.
Ph: 9451663802, 7007886404
E mail:
TREASURER
D.P. SINGH
1/33, Avas Vikas Colony,
Barabanki, U. P. -225001.
Ph: 9415633256
9935507527.
E mail
SKA-CO-9-25-26
20-01-2026
Smt. Rashmi Singh ji Executive Director (Personnel) LIC of India. Mumbai
Re. Improvement in Group Medical Scheme Madam,
In the matter of implementation of the Medical Scheme, an appreciable initiative has been taken at your end by arranging an interface between the TPAs, RM(OS) and the beneficiaries ( employees/ Retirees) to understand each other's view points, so that the problems in settlement of bills are minimised.
There are certain shortcomings in the Terms & Conditions of our existing Floater Mediclaim Scheme, which need to be addressed while renewing it for the period of 1.4.26 to 31.3.27 . They are given below with some suggestions:-
The Changes and improvements needed in the Policy
1. Increase in Basic Sum Assured
The Medical treatment has gone so high that the Basic Sum Assured of Rs. 15lakh & Rs10 lakh have become insufficient. We request you to kindly raise the limit to Rs 25 lakh for Category 1 and Rs 15 lakh to category II.
2. One More Option for VRS employees & Others not included:
For VRS employees one more Option to be given to include them and their all family members , without any age restrictions especially for the spouse. *In 2023 this option was given but not to VRS employees* They are Pensioners like us and hence there is no logic to keep them out of Medical Scheme. Similarly, one more option to all those who were not included for some reason or other, are to be included now. e.g., parents, parent-in-laws etc.,
3. Master Health Check-up:
Periodical Health Check-up to the retirees to be included once in a year for age upto 75 years and twice for those aged above 75 years. This can be as a part of the policy package at a subsidised cost. It is a must because as we advance in age, we are likely to develop some health issues. It is a preventive approach. Moreover such prevention will only help the insurance company to minimize their claims.
4. Inclusion of Naturopathy:
Naturopathy is gaining importance because of its effectiveness and it so to be included in the scheme.
5. Cashless facility for Ayur / Homeopathy and Naturopathy:
Cashless facility to be given for Ayur/Homeo/Naturopathy . Addition of Hospitals to the list of cashless facility. Full reimbursement to be given and not capped to 25% of SA as per IRDAI guidelines.
6. Physiotherapy:
Reimbursement is to be given for physiotherapy for chronic illness done at recognised hospitals for a period recommended by the Doctor, without any cap of period. Reimbursement may be considered for OP cases also.
7. Dental Care:
Dental care other than cosmetic treatment are to be included. E.g.,. In India, poor oral hygiene and lack of timely dental care act as a foundational cause of, and contributor to, several chronic systemic diseases. The country faces a significant oral health crisis, with nearly 90% of adults suffering from dental issues, and maintaining proper oral health directly helps the insurer to reduce claims. The policy may cover the insured for dental consultations, Root Canal and other dental treatments, emergency palliative treatment for dental pain, minor dental procedures, tooth conservatives and extractions, diagnostic tests, and periodontal and endodontic procedures
8. Eye Care Treatment:
The Laser treatment for eyes are to be allowed. The cost of cataract treatment is to be enhanced to the extent of Laser treatment cost. . There should be upward revision of cost from 70k to 100k or actual cost per eye. GIC medical policy provides reimbursement upto 100k.
9. Domiciliary Treatment Expenses:
Domiciliary treatment expenses to be increased and many more nonmedical items to be included. OPD rider should be taken of as it exists, enhancing the cover.
10. Revision of Room Rent:
Delhi NCR covers Gurugram, Faridabad, Ghaziabad and NOIDA. Unfortunately NOIDA is not treated as part of NCR in current Mediclaim Policy. So Noida is to be included in the NCR category as it is done for all other purposes. Similarly Howrah and Kolkata are twin cities like Hyderabad and Secundrabad. Howrah should get the status of Kolkata. So also Chennai Metro has expanded and all area under Chennai Metro are to be treated as Metro. Room Rent needs to be revised upwards. It should be - Metros 15k, A-class 12k, B-class 10k & C-class 8k. The Nursing charges and RMO/DMO charges are not to be included in room rent and reimbursed separately. 3. Due to non availability of room of entitled amount in the Hospital ,if a higher rent Room is opted, proportionate deduction should not be done. .
11. Miscellaneous Matters to be included in the Policy:
- a)Option to be given for increase in additional coverage upto 1 Crore.
- b)One or more OP consultation facility be allowed after discharge from hospital without any fee.
- c)The following tests to be included, i.e. High Resolution Anorectal Manometry test and Tc99m Sulphur Colloid Colon Transit Study.
- d)Limits of amounts for reimbursement for various diagnostic tests should be increased by 25%.
- e)Reimbursement of physiotherapy should be allowed for a maximum of 6 months.
- f)Ailment of heart disease is to be classified as a continuous treatment and reimbursement to be allowed.
- g)Consultation charges to be reimbursed.
- h)Latest procedures & Tests and operation methods ( Robotic ) are to be included,
- I)Hospitalisation period of 24 hours to be replaced to 2 hours as per the new IRDA guidelines.
- k)When higher limit Room is taken for non-availability of within limits,, all procedure charges and other expenses should not be disallowed proportionately besides room rent.
- l)Consumables 205 items are in this category and disallowed. This needs a thorough review.
- m)Waiting period after critical treatment after discharge is 2 months, which needs to be increased to atleast 3 months.
- n)Diagnostic expenses are reimbursed without 24 hrs hospitalisation, with compulsory prescription from MD, the consulting charges to be reimbursed along with diagnostic expenses.
- o)Pre-hospitalisation for 60 days and post-hospitalisation for 90 days to be modified.
- p)Charge of hospitalisation outside India for higher treatment, on recommendation of Doctors to be included.
- Q.)Diagnostic tests without hospitalisation: With the advancement of medical science, more and more new and modern diagnostic tests are recommended by the physicians in lieu of tests mentioned in the policy, e.g., WEB CARDIO test is recommended in lieu of the HOLTER MONITOR test. Some more tests should be considered for inclusion. Uroflowmetry, Lipid profile, Thyroid, Vitamin D tests are recommended for inclusion.
- R)It is suggested that reimbursement of Lasik Laser treatment cost be increased to ₹50000/- per eye.
- S)It is suggested that vaccination & inoculation be allowed after the age of 60 for influenza & pneumonia.
- u)NCV Test is repudiated as that is not in the list of OPD cases where as EMG is allowed.
Reimbursement for tests which are done together. E.g. Stress Echo Test which is a combo of Echo Cardiogram and Treadmill Test. The reimbursement is given for one test only. The test without hospitalisation to be reimbursed.
With the advanced technology, robotic knee surgery has become a common treatment, which is to be included for reimbursement for actual cost.
For special reports, prescription from MD/MS or specialist has to be made liberal, as at initial stages, we will not be knowing the gravity of the disease.
In Cases of Total Bed Rest and the patient cannot do the work on own and depends on a care taker/maid, in such case the reimbursement of Care taker Charges to be given. E.g. Spinal CordSciatica problem.
- a)For Fibro scan (test for fatty liver) the insurance co., is not paying full amount. Specific rule is quoted in bilo by TPA.
- b)Inclusion of Botox injections in the list without hospitalisation for treatment of non-cosmetic neurological problem like cervical dystonia.
- c)Lab tests expenses and plasma therapy to be included.
- d)Reimbursement for test reports are allowed once in policy year. In case of continuous treatment i.e., Cancer, oncologists insist on MRI every 6 months, in such case to be reimbursed.
We request you, while renewing the Medical Scheme, please see that the above improvements are made, to provide better medical support to Employees and Retirees.
With regards
S. K. Awasthi.
General Secretary
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