an independent initiative...
 M.Perumal: There may be several suffering retired persons. But this story "plight of a Bank Manager" has been in circulation in social media for more than 3 years! 23 Jun 15, 12:49 PM karunakaran: Oh! What a pity Mr.Perumal. Our good old friend and enlightened leader Mr.CH.Venkatachalam has not seen the story in the social media. Please send the story to him. before he signs another record note. |
J.M. Aboobucker: What a pity. The Mighty Financial Institution of India, the LIC says to comply with the SC Order the money has to be obtained from the Jaipur and Chandigarh HCs where they have deposited ₹19 lakhs and ₹33 lakhs respectively for the 19 pre 1997 retiree petitioners of Jaipur HC and for 33 petitioners of Chandigarh. 
Sl No
|
Description
|
Details of benefit
|
1
|
Policy No for WZO and CO Area
|
12070034150400000001
|
Policy No for CZO Area
|
12070034150400000002
|
|
Policy No for NZO Area
|
12070034150400000003
|
|
Policy No for NCZO Area
|
12070034150400000004
|
|
Policy No for ECZO Area
|
12070034150400000005
|
|
Policy No for EZO Area
|
12070034150400000006
|
|
Policy No for SCZO Area
|
12070034150400000007
|
|
Policy No for SZO Area
|
12070034150400000008
|
|
2
|
Name of the Insured
|
LICI, CO. YOGAKSHEMA, Mumbai-400021
|
3
|
Name of the Insurer
|
The New India Assurance Company LTD
|
4
|
Location of the Insured Persons
|
Anywhere in India
|
5
|
Policy period
|
01.04.2015-31.03.2016
|
6
|
Basic floater Sum Insured
|
3.0L,4.0L,6.0L
|
7
|
Optional SA on Floater Basis
|
4.0,5.0,6.0,8.0,10.0,12.0,15.0,20,.0
LAKHS
|
8
|
TPA
for WZO & CO/ CZO/NZO
|
MD India Health care services (TPA)
Pvt.Ltd, Web site:www.mdindiaonline.com, email:customercare@mdindia.com,
Toll free Tel no:18002335588
|
TPA
for NCZO
|
Raksha TPA Pvt. Ltd.
Web site:www.rakshatpa.com
email:jyotiawasthi rakshatpa.com
Toll free Tel no:18001039533
|
|
TPA
for EZO / ECZO
|
Heritage Heallth TPA Pvt.Ltd.
Toll free Tel no: 18001024547
|
|
TPA
for SCZO
|
Medi Assist India TPA Pvt.Ltd.
Toll free Tel no: 18004191160
|
|
TPA
for SZO
|
Vidal Health TPA Pvt.Ltd.
Toll free Tel no/ Kerala: 18004256268
Toll free Tel no/ Tamilnadu:18004257595
|
|
9.
|
List of Hospitals covered under network
of TPA
|
It is available on respective TPA’s
website and also in LIC’s intranet website
|
10
|
Procedure for availing CASHLESS
facility
|
i)
Cashless
hospitalization can be available only at TPA’s network of hospitals.
ii)
Pre admission
authorization to the Hospital/NH by TPA is essential.
iii)
In case of
change of residence outside Zone original TPA will provide services based on
PAN India’s network hospital.
|
11
|
Documents required
|
i)
E-Card of
patient issued by TPA & any photo identity card such as employee ID Card,
PAN, Driving License, Voter ID, Passport, Aadhar Card, School/College ID Card
or any other photo ID Card by State/Central Government.
ii)
In absence
of TPA ID Card Certificate by respective OS Deptt will do.
|
12
|
Room Rent / Boarding Expenses limit
|
1.5% of total SA (Basic+ Additional) per day
subject to maximum Rs7, 500/- for A Class cities; Rs 5,000/- for B Class
cities; Rs4, 000/- for C class cities. ( Reimbursement will be reduced
proportionately in case limit exceeds)
However in case of ICU/CCU there is no
capping/ ceiling on ICU/ICCU Expenses.
|
13
|
Expenses relating to Diagnostics Tests
without hospitalizations.
Restrictive conditions:-
1)
The Maximum
limit 65,000/- for the family during the Policy Year
2)
MD or
EQUIVALENT Doctor must advice for the same
3)
In case of
prescription by Govt Hospital, the above condition can be waived.
4)
Allowed for
only once per insured in a policy year
|
Diagnostics Tests Maximum amt payable
MRI Charges Rs8000/- each insured
CT Scan Charges Rs5000/- each insured
Sonography Rs2000/- each insured
Biopsy Rs3,000/- each
insured
Tread Mill Test Rs1200/- each insured
Echo Rs1500/-
each insured
Gastroscopy Rs4000/- each insured
Colonscopy Rs6000/- each insured
EEG Rs1000/-
each insured
EMG Rs2000/-
each insured
Holter Monitor Rs5000/- each insured
PAP SMEAR Rs750/- each insured
PSA(Prostate Specific Rs750/-
each insured
Antigen)
Mammography Rs5000/- each insured
|
14
|
ORGAN TRANSPLANT
|
Hospitalisation expenses (excuding the
cost of the organ) during the course of organ transplant to the insured
person
|
15
|
LASIK LASER TREATMENT
|
Maximum amount
payabe Rs.35000/- per eye
|
16
|
MATERNITY BENEFIT
|
Maximum 65000/- for Normal Delivery
Maximum 125000/- for Caserian section Delivery
Lawful Medical Termination of pregnancy included.
|
17
|
Limitation of 24 Hrs. hospitalisation.
|
Not applicable for certain surgeries ,
procedures and eye surgeries.
|
18
|
Pre and post hospitalisation expenses.
|
30 days and 60 days respectively. The
above limitaions may be waived in cases of renal failure snd/or organ
transplantation.
|
19
|
Surgeon/Anesthetists Payment
|
Restricted to 25% of SA. Payment must
be paid by cheque and numbered bill and not
receipt on letter head is required. However fees paid by cash may be
reimbursed up to following limit, provided numbered bill is obtained.
Surgeon Rs 30,000/-
Assistant Surgeon Rs12,000/-
Anesthetists Rs20,000/-
|
20
|
Limit for payment on cataract
|
Rs60,000/- for each eye( all
inclusive) or actual cost, whichever is less.
|
21
|
Ambulance charges
|
Limited to maximum Rs5,000/- per
insured.
|
22.
|
Dental treatment
|
Not allowed, except arising out of
accident.
|
23
|
Dependent children
|
Insurance cover is restricted to
Retired employee, spouse, dependent male children up to 25 years of age
dependent female children unmarried, widow and divorcee residing with the
insured parents and having income less than Rs3,500/- per month.
|
24
|
Submission of claim
|
Must be submitted within 20days from
discharge of the Hospital.
|
25
|
Settlement of claim
|
The Insurer must settle the claim,
including rejection within 30 days from receipt of the last document. Once
claim is settled by TPA fund will be transferred to LICI within seven working
days.
|
26
|
Claim intimation forms
|
Claim form, Doctor/consultant’s
prescription,
Discharge Summary/Discharge card,
Bills cash memo and money receipts, pathological test reports, Surgeon’s
certificate, attending Doctor’s bill and receipt and claimant’ s details
|
