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Sunday, June 05, 2016

Changes in Mediclaim benefits



Dear Sir,

Re: Changes in benefits and other policy conditions under Group Mediclaim Policy 2016-17

Group Mediclaim Policy for the year 2016-17 has been issued. Following changes in benefits and other policy conditions have been incorporated in the above policy.

1.      Registration/Admission charges and Service Tax/Surcharges are payable.

2.      Expenses in respect of claim relating to Physiotherapy shall be limited to actual or maximum of Rs.30,000/- per person per year, whichever is less.

3.      Maximum charges payable for Biopsy (Diagnostic Test without hospitalization) per insured has been increased from R.3000/- to Rs.4000/-.

4.      One additional Diagnostic Test without hospitalization, i.e. PET Scan has been included for which actual or maximum of Rs.15000/- per insured, whichever is less, shall be reimbursed.

5.      Age Related Macular Degeneration (ARMD) and/or treatment for retinal disease by intravitereal/ intraocular injection/intervention are admissible. Actual or maximum of Rs.25000/- per eye per annum for each insured, whichever is less, shall be payable.

6.      Robotic surgery for Malignant Cancer/Cancer, Brain and Spine only are payable.

7.      Maximum payable ambulance charges per hospitalization has been increased from Rs.2500/- to Rs.5000/-.

8.      Artificial limbs will be covered, except the Robotic Limbs which may be paid at the rate of conventional artificial limb.

9.      Genetic disorders and stem cell implantation/surgery are not covered. However, treatment for Thalessima, Haemophilia, Sickle Cell Anemia, Hemolytic Anemia, Myeloma, etc requiring hospitalization is covered subject to maximum of 75% of Floater Sum Insured of the family.


Sanjay Gupta
Administrative Officer,
PERSONNEL/ER-A DEPT.,
CENTRAL OFFICE.