LIC GROUP MEDICLAIM SCHEME 2026–27
Item-wise Summary (Same Headings with Page Numbers)
Sr No
Heading
Page No
1
Policy Schedule
2–3
2
Servicing TPAs
4–6
3
Coverages at a Glance
7–8
4
Preamble and Definitions
9–15
5
Benefits Covered Under Policy
15–18
6
Add-on Coverages
19–24
7
Diagnostic Tests Without Hospitalization
22
8
Facility of Tele-consultation
23
9
Facility of Medical Examiner
24
10
Exclusions
25–32
11
General Terms & Clauses
33–38
12
Classification of Cities for Room Rent
39
13
Non-Medical Items Not Payable
40–50
14
Day Care Treatments List
51–55
15
Insurance Ombudsman Details
56–59
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GROUPMEDICLAIMSCHEME202627.pdf
2. Compare LIC GMC 2025–26 vs 2026–27
Major Changes / Continuity
Feature
2025–26
2026–27
Change
Sum Insured Options
Up to 75 lakh
Up to 75 lakh
Same
Pre-existing diseases
Covered
Covered
Same
Room Rent Caps
Present
Present
Same / refined
ICU Charges
No capping
No capping
Same
Cataract
₹70,000 per eye
₹70,000 per eye
Same
Maternity
₹1 lakh / ₹1.5 lakh
Same
Same
Diagnostic Tests
Available
Continued
Same
Tele Consultation
Available
Continued
Same
Medical Examiner
Available
Continued
Same
TPA Network
Revised zone-wise
Updated
Changed TPAs
Main Difference:
Policy wording cleaner and more structured in 2026–27. No major reduction in core benefits.
3. Hidden Clauses / Important Clauses in 2026–27
A. Room Rent Limit Still Applies
Even with ₹50 lakh / ₹75 lakh cover, room rent capped city-wise.
If higher room taken → proportionate deduction may apply.
B. Surgeon Fees Paid in Cash Restricted
Cash payment reimbursement only:
Surgeon ₹30,000
Assistant Surgeon ₹12,000
Anesthetist ₹20,000
Digital payment preferred.
C. Non-Medical Items Not Payable
Many consumables excluded (gloves, tissues, etc.)
D. AYUSH Limit
Only up to 25% of Sum Insured
E. Psychiatric Treatment Limited
Only hospitalization covered up to ₹50,000.
Consultation/counselling not covered.
F. Cochlear Implant
First ₹1.5 lakh borne by insured, then policy pays.
G. Maternity Only First Two Living Children
H. Diagnostic Tests Without Hospitalization
Only listed tests, with limits.
I. Newborn Cover Starts After Declaration + Premium
No age bar mentioned for existing retirees.
Pre-existing diseases covered.
High sum insured continues.
Strong senior citizen support.
The above a ChatGPT generated Summary for Reference Purpose.
R K SAHNI
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