Dear friends,
I followed up my talk with LIC Chairman on 2nd February, with EDP on 11/2/2015. I briefly narrated the issues & concerns faced by pensioners for long. While introduction of a worthy mediclaim scheme of Family Floater Policy with revised higher Basic SA, also eligible for 75 % subsidy & Optional SA stretching upto Rs20 lacs. was laudable & recent CO Circular dt 17 Dec 2014 so quickly following the heels of New FFP, giving yet another opportunity to all employees/pensioners to opt for higher OSA if they want & to convey their final choice before 28 Feb 2015 was equally commendable.
I added that many pensioners have died are dying & number of Family Pensioners have multiplied as the proportion of FP to RP has risen from 18% to 38% in the last few years. Sadder still will it be, if the Sum Assured risk disappears, on account of pensioners/family pensioners, for genuine reasons not able to pay the full mediclaim premium before 31 March every year. Is it not necessary, therefore that same consideration by which Employees were given the facility of 12 monthly deductions of premium from Salary, so too Pensioners be graciously given now atleast SAME treatment, so badly needed at advanced age, which will earn for LIC goodwill & gratitude from entire pensioners fraternity.
I conveyed that recently we learnt that New India is prepared to include under CASHLESS more critical illnesses & approve of the same but no letter has gone to them. I briefly hinted the pathetic condition of Sri RS Ahuja, ZM Retd, whose wife went for total knee replacement, uncertainty & rejection in hospital/TPA & atlast intervention of Sr Executive NI helped receive cashless facility.His letter to Chief P, CO, is an eyeopener & so CO Per can send a forceful communication to NI to open up cashless for more critical illnesses of organ transplant like knee joints, hip replacement & of any such nature, brain hemorrhage & much more.
I brought to EDP notice that, though Cashless is allowed ONLY for earmarked diseases of around 6 severe ailments, even for other operations, pensioners have to spend out of their pockets a very heavy amount & with this meager pension,find it almost impossible to fund the stream of tests, medicines, room rent, nursing charges, Surgeon’s fees & post-operation expenses etc.Many other worries remain in such cases for the family.LIC as an enlightened Employer must empathise with pensioners & persuade NI to make this Cashless service universal, as lot of delay is there to grant approval,many items disallowed too,& after admission from Discharge Voucher yet another delay,This is too much to bear for poor pensioners who are hungry obviously to get reimbursement of amount spent .In fact, contrary to negative Exclusion Clauses,which deprive of facility,this must contain Positive Inclusion Clauses so that ,because of intensity & severity of ailment or illness,Cashless must be automatically granted & patient allowed admission with no hassles.
I emphasized that already talks must be going on to finalise FFP for 2015-16 & so all these issues must be fully addressed & resolved to suit reality. It is well-nigh impossible to get Pre-authorisation Request form jointly by pensioner/beneficiary & pay all non-medical expenses before discharge .
To leave no stone unturned, I wanted to finally remind Secretary P & on 18th February, I could contact her.I told her that they all were busy with Parliamentary Committee perhaps.She said she was on long leave resumed & shall do the needful.I delineated the above problem of cashless service for all hospitalization to be taken up vigorously to benefit employees & pensioners,as it has not taken off at all.
Further, the deductions of premium must follow same pattern as for employees. She said 12 months deduction may not be possible. I intervened to tell her that atleast 3 or 4 monthly deductions will help some residual pension & it should not be 2 ,as net pension will be very low in many cases.
I emphasized that even a simple administrative matter like supply of Statistics of Pensioners—Regular, Family, Exgratia – Zonewise, Division wise & for CO, I am not able to get & last year I could succeed as she helped,but I was told this work was transferred to COOS.After I directed my efforts towards Sy OS,CO, I sent email as per her request,reminded them twice but of no avail.I was told by Sy OS on followup that upto 31/3/2014,CO Personnel will give .So, I pleaded with Smt Aruna Seth that she can help me for this statement.It seems that person is promoted & transferred& no substitute is posted. I told her that Statements normally to be sent by ZO/DOs must come on course to CO & it is a mere consolidation.We Pensioners Fedn need them badly, I urged & pointed out how then Chairman even agreed & all CO Circulars are sent same day to all of us.That spirit must be maintained.
Pensioners Portal has not seen the light of day,even though we have given 4 page Suggestions in April 2012 & a boon to pensioners from many angles,we are denied the facility of getting personal attention & resolution of individual grievances. All others have portal for them designed by LIC,even agents, policyholders etc & same spirit must be shown to us so that we can key in, get any info on pension & related matters & also air grievance or complaint which will be replied to & redressed to satisfaction.She said work is on with an agency & matters are moving.
I have requested GS, AIRIEF, Bengaluru to followup this & all Resolutions passed at 9th GC & to forcefully & assertively secure CO consent & approval on many matters
To refresh readers,Resolutions on Mediclaim issues by AIRIEF :
Medi Claim-One More Option
This General Council Meeting of the All India Retired Insurance Employees Federation held at Bangalore on 15 & 16thOctober,2014 applauds the generous act of LIC in extending the subsidy to the tune of 3/4 th of medi -claim premium on basic sum assured to pensioners also from 1-4-2010, on the same lines as applicable to existing employees. Some of the pensioners were forced to opt out of the scheme earlier, because of the exhorbitant premium involved.Many had gone abroad & were not aware of the happenings.There was a golden opportunity for LIC to announce One More Option when they introduced Family Floater Policy wef 1/7/2014 .They will be willing to join the scheme again since FFP is a comprehensive Basic & Optional SA Cover.. This GC meeting, therefore, demands that LIC should allow one more final option to all such pensioners who have gone out of the scheme to join the medi claim scheme.
ii) The Cashless Service Scheme is now restricted to one or two hospitals in metro city for LIC group mediclaim policyholders. This is insufficient to serve our purpose. GIC has now approved several hospitals in all places to whom this facility is extended, after prolonged talks with hospitals. Pensioners who are generally& mostly starved of huge funds find it extremely difficult to pay for their treatment first and then claim reimbursement from the insurer. This causes severe hardships,especially at a time ,when they need to save the life being admitted for emergency treatment. All our request to LIC CO to incorporate SA cover in LIC Identity Cards as also to compel TPAMed Assist to expedite TPA Id cards ,as the talks were going on for many months with New India to finalise FFP.This meeting, therefore, demands that LIC should negotiate with New India Assurance Co. and TPA & quickly arrange for this cashless treatment facility to all pensioners of LIC in maximum number of hospitals so that pensioners need not run to long distances for treatment, followup etc.
iii)This GC brings to the notice of LIC that, though Cashless is allowed ONLY for earmarked diseases of around 6 severe ailments,even for other operations,pensioners have to spend out of their pockets a very heavy amount & with this meager pension,find it almost impossible to fund the stream of tests, medicines,room rent, nursing charges, Surgeon’s fees & post-operation expenses etc.Many other worries remain in such cases for the family.LIC as an enlightened Employer must empathise with pensioners & persuade NI to make this Cashless service universal, as lot of delay is there to grant approval,many items disallowed too,& after admission from Discharge Voucher yet another delay,This is too much to bear for poor pensioners who are hungry obviously to get reimbursement of amount spent.This must be possible ,with an analysis of last 2 years claims, the rough amount every month, quarter & so on claim experience & NI must pump reasonable adequate funds, so that 2nd delay is cut off & pensioner happy that LIC OS will credit the claim amount thro NEFT to his Bank account.