This policy provides for medical insurance cover to present and past employees, their spouses and dependent children. It provides for benefits by way of reimbursement of hospital expenses, domiciliary treatment expenses and cash-less treatment facility in case of specified illnesses.
Have you read the policy conditions? If not, please read them.
I give here two comments on the policy conditions:
1. Cash-less treatment facility is available for serious illnesses. It is not always that you require this facility when you are in your headquarters, where people know you and it will be easy to obtain a letter from LIC. You may need it when you are out of head quarters or when you are on travel. On all such occasions the Medical Identity Card issued by the TPA should come to your help. Interestingly no Identity Card is issued by the TPA to members of the scheme. I contacted the TPA recently as if I need cashless facility. I was asked the number of my Medical Identity Card issued by the TPA. When I reported that no card is issued to me by the TPA their customer service executive asked for my SR number to assist me. When I gave my SR number, after verifying from their system, he told me that no data pertaining to me is available in the system. If this is the case with a person who has been a member of LIC's medical scheme since its inception in 1987, can you be sure that your details are available with them and in case of need you will get 'cashless treatment' facility? Please take up with your office and insist that Identity Cards should be issued to members covered by the medical insurance.
2. Exclusion clauses are incorporated in policies to protect the insurer from adverse situations. But the clause 4.21 of our Medical insurance policy says "Medical expenses under two policy periods: If a claim spreads over two policy periods the total benefits will not exceed the sum insured of that policy during which period the insured person was admitted to the hospital...." That means if you are admitted in the hospital on 25th March of a year (and it costs you Rs 1,50,000 for various investigations in the hospital in March) and discharged on 30th April after a major surgery (it costs you another Rs 1,50,000 in April) the TPA / insurer will give you only Rs 2 lakhs - even though they have collected premium for both the years (e.g.2013-14 and 2014-15) and in each policy year you should get coverage for Rs 2 lakhs. Don't you think such clauses should go? If yes, please take up with LIC through proper channel.
Relevant information on the insurance:
Insurer: New India Assurance Company Ltd
TPA: M/S MEDI ASSIST INDIA PVT LTD
Toll free no. of TPA: 1800-4259-449
Tel.no. of TPA: 080 26537870
Please read the policy conditions. If you need a copy of the policy write to me from your email...vns pillai
Dear Sir, it is interesting to note your observation on mediclaim policy. will take up at apt forums. Indeed it is a great service that you are sharing your knowledge with all those who come to this blog. We will always remain indebted to you. Many stalwarts have left LIC into oblivion but you are always there in our action, thought inspired by our learning from your teachings
ReplyDeleteYou can compare Group Mediclaim Insurance Policy from any online insurance portal between various insurers and can select plan according to your own wish.
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