I am contributor to Mediclaim Scheme since inception, though there was no occasion for me to claim anything from the scheme. I feel happy that I did not have to file a claim so far, though I retired 11 years ago. I wish to continue to be so. While in service or after retirement I was helping colleagues in filling claim forms and helping them to get relief from the scheme.
While we feel that the cover is enhanced substantially under floater policy for current year, the important aspect many would miss is the totally inadequate provision for TPA services under the policy. Anyone can see the copy of policy document available in the Chronicle Blog. I doubt whether majority saw it. The schedule of the policy reveals that TPA services are available only for treatment/surgeries on hospitalisation in SPECIFIED DISEASES. These specified contingencies are ...Cancer, Cardiac surgeries, Neuro surgery, Renal failure as also ACCIDENT/TRAUMA and includes Organ transplant. I do not know how
many pensioners prefer to have their organs removed and transplanted. Such cases will be very very few, presuming miracles can be done at advanced ages and follow what in Statistics is known as POISSON DISTRIBUTION. ( I think I still remember the subject of statistics and probability distributions.)
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| The accident victim pushed to death... |
So it is obvious TPA services are not available in all cases of sickness/treatment at hospitals. The services are available only for a few and perhaps rare cases. So what does it mean? Do the figures of enhanced cover under the scheme have any real meaning? I FEEL IT IS LIKE GOLD IN PYRAMIDS. OR THE AVAILABILITY OF RARE GEMS ON OCEAN BED. In fact it amounts to denial of TPA availability. The Insurance Company has the satisfaction of getting substantial good business year after year from LIC under group scheme. LIC is satisfied that it is making available a good scheme to its employees/pensioners. The TPA also is happy that he has business from a big employer like LIC. The Persons covered under the scheme have no reason to be happy.
Most of us do not claim small amounts spent by us for routine occasional bouts of sickness like viral fevers and a sprained leg. We prefer to bear the cost for ourselves as that would not require us to wait for the mercy of the Insurance Company and go round our offices to collect cheques. At this advanced age most of us have cover at best for us and spouses. That is all. No dependants on us who need our attention. In fact we are at an age when we need the attention of sons, daughters-in-law and other children. We feel lucky if they shower their love and attention on us.
Ultimately the point is TPA services are available ( please observe) for cases requiring deposit of huge amounts of money for surgeries or treatment. In all other contingencies you have to fend for yourself. DO WE HAVE ANY FACILITY FOR ADVANCE PAYMENT BY LIC IN CASE OF HIGH COST TREATMENT ( WHICH LIC CAN LATER RECOVER FROM MEDICLAIM PROCEEDS.? THIS FACILITY IS AVAILABLE TO THOSE IN SERVICE. Do the pensioners belong to another species? Does LIC feel all the claims from pensioners under mediclaim scheme are likely to be rejected by the insurer? We are not worthy even for an advance for high cost treatment. Time to sit up and think. Everyone kindly think. In addition if the hospitals refuse to serve us simply because the employer LIC or TPA did not issue us identity cards what is our fate?
My dear top executives of LIC, New India Insurance and TPA ....kindly place yourselves in the place of the unfortunate pensioners and think. You will certainly realise the gross injustice that is being perpetrated. Do you high and mighty think that you would never retire?
I can go on and on. But I come to my refrain as the only purpose I have is to highlight the serious difficulties faced by pensioners in unforeseen, sudden sicknesses or accidents.
Regards, B. Ganga Raju, Hyderabad