Group MediClaim Policy 2015-16 with CASHLESS Facility for All diseases & treatment covered under Policy 2014-15‏

On this crucial benefit, on several fronts, many moved in right direction to persuade, cajole, Top bosses of LIC for a long time, earlier coupled with AIRIEF 9th GC Resolution, followed up by Sri Anand Tyagi with LIC Chairman,MD & EDP & phone calls from me to LIC Chairman,EDP & Sy P/ER & even recently with Sy P/ER about the dire need to allow this as a Full-Fledged Facility, without Ifs & Buts PLUS impressing on EDP Time has arrived for Simultaneous grant of Mediclaim Premium Deduction in the Same Manner as for Employees ie 12 instalments from Pension, to facilitate preserving the risk so wisely taken by this new fangled Family Floater Policy & allowing poor Pensioners to face life with dignity & good health in the twilight of their lives. If at all 12 months is found difficult, as was expressed by Sy P/ER one month before, I pleaded it should be MINIMUM 3 or 4, as 2 quick instalments will create hardships of a SIZEABLE deduction & a Net Pension so low not sufficient to make both ends meet in this hard & troublesome life of continued real inflation, already eroding the frugal minimal pension.

All will like to see the subsequent follow up circular & the other details like premium rates, data collection, List of hospital covered under TPAs network, process, etc

Normally, there is a tendency to create unnecessary lacuna, bottleneck while issuing a Circular spelling out New decision & benefits & a nebulous situation ,where benefits are SUPPOSEDLY showered,but cannot be SECURED by the employees & pensioners in the absence of COMPLETE & Full-Scale Coordination between LIC & NI as also with Various TPAs as mentioned .M/s MD India Health Care Service TPA P.Ltd for as many as 3 Zones & CO,---NZ,WZ,CZ,CO,M/s Heritage Health TPA P.Ltd for 2 Zones, EZ & ECZ ,existing MediAssist India TPA P.Ltd for SCZ only, M/s Vidal Health TPA PLtd for SZ only,M/s Raksha TPA P Ltd for NCZ only

Earnestly pray no conditions are imposed, we shall salute LIC CO,when they have underlined --with cashless facility for all diseases & treatments

But added continued sentence--covered under mediclaim policy for the year 2014-15 should not make ZO/DOs misinterpret, with exclusive & restrictive confinement to THOSE illness or treatment covered in earlier policy of 2014-15.It looks that PARA will have to be scrapped & a clause inserted UNAMBIGUOUSLY , meaning & signifying the REAL intentions of pleadings, requests & clear fup by many Fedns & understood by LIC CO.

Cashless facility covered under TPA network ,again should not sabotage ,FEWER Hospital list to be released & Employees/Pensioners, made to rush to DISTANT Hospitals COVERED by TPA, that too in GOLDEN HOUR,when Emergency situation warrants PLETHORA of recognised Hospitals nearby ,but for want of INCLUSION.All of us shall fup like an eagles eye & sincerely endeavour to do the needful.

This PROVISION " In cases where cashless facility is not availed or when there is some balance reimbursable amount to be claimed representatives of TPAs will be collecting the claim papers directly from Divisional Offices." appears to be an INVITATION not to choose Cashless, as though special efforts will be made by TPA to settle such claims on Priority basis !! I wish I prove wrong

We know in Cashless service, a big chunk is not to be borne by employee/pensioner on the basis of furnishing of Requirements & ONLY fringe amounts not covered & we realise it, shall be borne by us

Already, because of Cashless Service hitherto, only in THEORY & on PAPER, NEITHER Employees nor Pensioners availed of such a so-called beneficial service lying at the root of the Principle & saving headache, sweat & tension for the employee/pensioner s family during DIRE DISTRESS.UNLESS LIC brings out SALUTARY POSITIVE ENABLING provisions to make it real & operative with no discomfort or inability or unrelated unnecessary queries to delay ADMISSION to Hospital,thorns will remain.Hope fragrance spreads in quick succession.

Yet another query crops up,"Detailed information about premium rates, data collection, List of hospital covered under TPAs network, process, etc will be provided shortly."

We are again worried what will be premium rates, will it be the same ,what will be the quote of premium etc

We also hope PROCESS is simplified,not elongated to trouble the employee/pensioner/family

When much earlier .EDP hinted to me that data of claims after NEW FFP came into being wef 1/7/2014,I marshalled my efforts in that direction telling him, even if because of higher Sum Assured , claim amounts tend to be more,that should not be the reason for increasing premium.Majority still has adhered to Revised BSA Rs 3lacs, 4 lacs & 6 lacs.Next best is some good numbers for Revised Optional SA Rs 8 lacs, 10 lacs, 12 lacs. Rs 15 lacs & 20 lacs are the least in numbers

Further, for SZ ,app the claim amount has risen by app 15 -17 % for employees & pensioners in general for the period 1/7/2014 to 28/2/2015

NOW, the CRUX of the issue,"Till the id cards are issued from TPA existing process for cashless facility will be followed, i.e. cashless request will be processed by TPA on the basis of certificate issued by the OS department of LIC and photo id proof."

TPA cards & delay,as we have experienced with multi-pronged aggressive fup ,has so far been insurmountable.Initial euphoria died down after all expressed helplessness.LIC saying same tune--we have taken up,it may take some more time, but that will be over ' can be believed ONLY when it REALLY fructifies

All of us must preserveLIC PhotoId card

All of us must preserve,take copies ofLIC Letter, after they receive Family Particulars Form,mentioning FFP Sum Assured chosen & covered for which premium is received/recovered.

It is a pity that LIC does not convene a Group Meeting of LIC, TPA,New India where procedures & processes can be discussed,apart from what CO has done, & a get-together creates common WAVELENGTH & better understanding & appreciation of this VEXED issue so that ONCE for ALL, employees/pensioners can smile

RBI is a model Example of this concept where Top Bosses/executives do participate regularly & sort out common problems to alleviate misunderstanding & above all rendering EMPATHY for employees /pensioners .They also arrange Free Health Checkups at that time ,which gels well with all ,creating harmony & tranquillity

All of us ,in this context, must win the elusive issue all these years of a Framework of Consultative Committee ,whereby minutes are jotted, issues noted, fup done, deadline fixed & much better rapid progress takes place in realisation of our goal

Greetings,Goodluck & Godspeed, let us welcome this new announcement & hope all ends well that begins well

R.B.KISHORE