MEDICLAIM POLICY TRAVELLED THUS IN LIC
The following information is collected from various circulars issued by Central Office on MediClaim matters. The information available is presented in a tabular form for the benefit of Pensioners. I would like to place on record the help and guidance received from Sri K T Hamanna ji, Retd. M(P&IR), Bengaluru DO 1. He has rich knowledge of OS & P&IR matters as he has worked in these departments for more than 12 years in various capacities. He has provided me lot of inputs to enable me to bring out this write up.
Sl No. Circular details etc. Details of Changes in MediClaim Policy of LIC.
1 Introduction of MediClaim Policy for LIC employees and Retirees. 01-01-1988 with FOUR categories based on Basic Salary. The Cat VI was below Rs.1800/-. Other Cat B P given in page 4&5. The reimbursement was depending on Room rent limit, Non-Surgical / minor Surgeries, Major Surgeries / Major diseases, Domiciliary Hospitalisation & Maternity Exp. There was no Sum Insured.
Employee, Spouse and 2 dependant Children. Prem. did not depend on Age.
2 Pers/IR/3788/ASP/90 dtd. 08-09-1990. Special Entry rules were set up – for those who did not join the Scheme in 1988 (employee or other member) because they were covered by other Scheme. Now want to join on cessation of such Scheme.
For Retired Employee : Total benefit reduced by 10% between age 70 to 75 and by 20% for age 76 and above.
3 *CO/ZD/857/ASP/96 dtd. 12-09-1996 Premium sharing between Employee and LIC for Class 2, 3, 4 is 25% : 75%.
4 *CO/ZD/881/ASP/97 dtd. 12-04-1997 1. Policy year changed from Calender year to Financialyear wef 01-04-1997.
2. Sum Insured for Category I, II, III spelt out
Category Basic Pay Sum Ins. Dom Hosp Limit
III Up to 9714/- 50,000/- 10,000
II Rs.9715/- to Rs.13294/- 60,000/- 14,000
I Rs.13295 & above 1,10,000 21,500
Sum Ins includes Dom Hosp Limit.
3. Completed Age on 1st April to be taken to decide the Age Group (OS/PA/SB/552 F dtd. 13-10-1997).
5 *CO/ZD/892/ASP/99 dtd. 27-01-1998. 1. Dependant Parents allowed to be included. 2. Age of the parents less than 75 yrs.
3. Decided to allow coverage to the employees :
i) who retd prior to 1-1-1988 & could not exercise option ii)Retd after 1-1-1988 but could not join scheme then.
6 *CO/3857/ASP/2000 dtd. 07-01-2000 Decided to deposit the amount directly to Hosp. For Major deseases under High Cost Scheme.
7 N A Parents and Parents-in-Laws were allowed to be included till the retirement of the employee wef 01-05-2006. No subsidy for them.
8 ** Source : Our Voice Special Issue Feb, 2009 effective date is 01-04-2009. Optional Sum Insured concept was introduced. The Sum Insured :
Category Basic Pay Sum Insured Optional S I
III Up to Rs14240/- 60,000 1,00,000
II Rs.14241/- to Rs.19769/- 80,000 2,00,000
I Rs.19770/- & above 1,20,000 3,00,000
9 Personnel / ER/A ZD/1179/ASP/2011 dtd.09-03-2011. Those who are not members of Group MediClaim Scheme are allowwed one-time option to join the Scheme wef 01-04-2011.
For details refer the Circular.
10 CO/OS/MedClm/2012-13 dtd. 15-03-2013. For Class 1 Officers also subsidy in MediClaim premium enhanced from 2/3 to 3/4.
11 CO/PER/ER-A/031/2013 dtd. 05-04-2013. 1. Group MediClaim Policy for 2012-13 renewed with NIA.
2. Premium reduced slightly.
3. Cataract Operation Rs.40,000/- for all places.
4. Sum Insured enhanced for all Categories.
Category New Sum Insured Old Sum Insured
III 85,000+15,000 60,000
II 1,10,000+90,000 80,000
I 1,65,000+1,35,000 1,20,000
12 CO/PER/ER-A/CL 14 dtd. 22-06-2013. LIC subsidy to Disabled Dependant 2 Children of Retired employee is allowed wef 01-04-2013.
13 CO/PER/ER-A/058/2014 dtd. 04-03-2014. 1. Family Floater MediClaim Policy introduced.
2. Sum Insured under all three categories increased :
Category New Sum Insured Old Sum Insured
III 3,00,000 85,000+15,000
II 4,00,000 1,10,000+90,000
I 6,00,000 1,65,000+1,35,000
Option was given to increase the Family Floater Sum Insured to 4, 5. 6. 8. 10. 12. 15 & 20 Lacs.
14 CO/Per/ER-A/CL 20 dtd. 18-03-2014. Clarification issued that Retired employees Family Floater Basic Sum Insured depends on the Basic Pay drawn before
retirement.
15 CO/Per/ER-A/CL 22 dtd. 28-03-2014. Upper Age limit for Coverage of 90 yrs has been removed from 2012-13.
For Retired employee the Category is same as he was in before retirement. Rectified CL 20 clarification.
16 CO/PER/ER-A/066/2014 dtd. 28-04-2014. Family Floater Scheme introduced. Optional Increased Sum Insured is applicable from 01-07-2014.
Family Floater Scheme rules spelled.
Option Annexures sent with the Circular.
17 CO/PER/ER-A/091/2014 dtd. 17-12-2014. 1. Option to opt for Increased Sum Insured given up to 28-022015.
2. For retired employee Option to include Parents / Parents in Laws in the Scheme is given from 2015-16 policy year. The only condition is that they should have been covered under the Schem before Retirement of the employee.
18 CO/PER/ER-A/096/2015 dtd. 13-04-2015. Group MediClaim policy renewed with NIA.
Cashless facility extended all deseases and treatments.
Room Rent limits for A, B and C class cities differed(1.5%).
A – Rs.7500/- ; B – Rs.5000/- and C – Rs.4000/- per day.
In effect Room Rent for B & C class places reduced.
For the first time a) Categorisation of Cities in to A, B and C was done as per Annexure I. b) List of Non-Medical expenses, 199 items, which are not payable was added as Annexure II and c) List of Ombudsman was published as Annexure IV.
19 CO/PER/ER-A/098/2015 dtd. 22-06-2015. One more option to include Parents / Parents-in-Laws of Retired employee was given up to 28-02-2016.
20 CO/ER-A/MediClaim/2015/ 16/8 dtd 14-01-2016. Deduction of MediClaim Premium from Pension started wef Feb, 2016 pension for the Policy year 2016-17.
21 CO/Per/ER-A/MedClm/15-16 dtd 18-01-2016. Submission of Form A dispensed with if there are no changes.
22 CO/PER/ER-A/120/2016 dtd 26-02-2016 Option for Increased Sum Insured for the year 2016-17 is irrevocable. But those employees / Retirees who have opted for Increase S I, can revoke the Option, within 15 days from the Circular of Prem Rates for 2016-17, if he feels the Premium is unaffordable. However, the SI should not be less than the S I in 2015-16.
23 CO/PER/ER-A/121/2016 dtd. 11-03-2016. The Last date for excercising the Option for increased S I is extended up to 21st March, 2016.
24 CO/PER/ER-A/124/2016 dtd. 16-04-2016. Renewal of Group MediClaim Policy 2016-17 announced.
1.Premium increased by 43.5%. 2. SI extended up to Rs.30
Lacs. 3.Last date to revoke option of Increased SI is 30-04-
2016. 4.Regtn / Admission Charges & Service
Tax/Surcharge are now payable. 5. Reimb for ARMD
added. 6. Ambulance Charges double to Rs.5000/-.
25 CO/Per/ER-A/MedClm/16-17 dtd. 17-01-2017. 1. Premium to be deducted from Pension, if consent given.
2. Form A need not be submitted if there are no Changes.
26 CO/PER/ER-A/153/2017 dtd. 05-04-2017. Renewal of Group Medi Claim Policy for the year 2017-18.
27 CO/PER/ER-A/164/2017 dtd. 23-09-2017. 1. Total Floater S I of 40 Lacs & 50 Lacs introduced.
2. Total Floater S I can be reduced to next lower limit onthe exit of any member due to death or otherwise.
3. Extension of coverage to Independant Children allowedon non-subsidy basis.
28 CO/PER/ER-A/172/2017 dtd. 26-12-2017. Sum Insured under all three categories increased.
Category New Sum Insured Old Sum Insured
III 5,00,000 3,00,000
II 6,00,000 4,00,000
I 10,00,000 6,00,000
29 CO/PER/ER-A/184/2018 dtd. 19-04-2018. For A class Cities for SI of 40 L & 50 L Room Rent increased to Rs.8500/-.
30 1. Group MediClaim Policy f0r 2019-20 renewed.
2. ISMO scheme introduced.
3. Room rent for A class cities for 40L & 50L increased toRs.9000/-.
31 CO/PER/ER-A/247/2020 dtd. 13-04-2020. 1. Grou MediClaim Policy for 2020-21 renewed with NIA.
2. Increase in Premium by 14.7%. 3. Room Rent for Aclass cities for 40 L and 50 L Sum Ins. Increased to Rs.10000/-. B Class City to Rs.6000/-. 4. Upward revision in 6 Tests done. 5. Angio CT test added. 6. For ARMD reimbursement increased to Rs. 1 Lac for each eye per member per year.
CATEGORISATION OF EMPLOYEES BASED ON BASIC SALARY
It is already known that a Retired employee continues in the same Category in which he was at the time of retirement (CO/PER/ER-A/CL 22 dtd/ 28-03-2014). Following chart gives the Category to which an employee belongs to depending upon his date of Retirement. It is to be noted that since MediClaim benefit cannot be from restrospective effect, in the Settlements of 1997, 2002, 2007 and 2012 the effective date is specified from 1st April of the year in which settlement is notified or from 1st April of next year. In 1992 settlement, it is stated that instructions in respect of MediClaim will be given separately. I could not trace that circular.
For the purpose of MediClaim categorisation, Basic Salary includes (Basic Pay + Fixed Personal Allowance + Graduation Allowance + Technical Allowance).
RETIRED BETWEEN CATEGORY III SUM INS. 5,00,000 CATEGORY II
SUM INS. 6,00,000 CATEFORY I
SUM INS. 10.00.000
01-01-1988 to 31-12-
1989 UP TO Rs.2499/- Rs.2500/- TO Rs.3799/- Rs.3800/- and ABOVE.
01-01-1990 TO UP TO 4019/- Rs.4020/- TO Rs.5949/- Rs.5950/- & ABOVE.
TO 31-03-2000. UP TO Rs.5,909/- Rs.5,910/- TO Rs.8,049/- Rs.8,050/- & ABOVE.
01-04-2000 to 31-032005. UP TO Rs.9,714/- Rs.9,715/- TO Rs.13,294/- Rs.13,295/- & ABOVE.
01-04-2005 to 31-032010. UP TO Rs.14,240/- Rs.14,241/- TO Rs.19,769/-. Rs.19,770 & ABOVE.
01-04-2010 to 31-032016. UP TO Rs.22,145/- Rs.22146/- TO Rs.30,749/- Rs.30,750/- & above.
01-04-2016 onwards UP TO Rs.42,195/-. Rs.42,196/-
Rs.58689/- TO Rs.58,690/- & above.
Sources :
• THE STREAM booklet of ZTC, Akurdi. Page 290, 291, 292 & 293.
VIJAYAPUR Compiled by 06-08-2020 C T JOSHI.
(NOIP, BMS)
Mobile No:+91 9731955044
Mail id : joshi.chidambart@gmail.com
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