Medi Claim Policy for the year 2022 – 23.

Re : Medi Claim Policy for the year 2022 – 23.

The Personnel Dept of Central Office LIC has issued a circular ref : CO/Per/ER-A/286/2022 on 08th

March, 2022, where in it has been proposed – 1) Option to increase the Family Floater Total Sum

Insured (Basic+Optional) upto Rs.75 Lakhs and 2) One time option to add Independent Children – Son

or Daughter - whether Married or Unmarried – whether employed or not - up to Age 45 in our

Mediclaim Policy. Also the Circular has published the Tentative Premium rates for the year 2022 – 23.

Final Premium Rates will be known only in the first week of April.

Please note the following points :

1. That there is NO CHANGE in the Basic Sum Insured. For Category I it is Rs.10 Lakhs;

Category II it is Rs.6 Lakhs and for Category III it is Rs.5 Lakhs.

2. A Pensioner will continue to be in the same Category in which he was at the time of retirement.

3. Optional Sum Insured was first time introduced from Policy year 2012-13.

4. From 1-4-2022 option is given to increase the total Sum Insured upto Rs.75 Lakhs.

5. Those who have NOT exercised the Option to increase the Sum Insured earlier, can also

exercise the option and choose the Total Sum Insured from their Basic Sum Insured to Rs.6L,

8L, 10L, 12L, 15L, 20L, 25L, 30L, 40L, 50L and 75Lakhs.

6. Form to exercise this option is in the above circular, which is sent separately with this circular.

7. Option for Increased Sum Insured form along with Form A giving full details of the Family

members covered, to be covered wef 1-4-2022 is to be submitted to Office.

8. Option once exercised cannot be revoked. Only when any person covered under the policy goes

out of the coverage (either by Death / Crossing the Age), the Total Sum Insured can be reduced

to next lower Sum Insured from next Policy year.

9. The Cover to Independent Children shall cease on expiry of employee / retired employee and

spouse of deceased employee or retired employee.

10. From the Policy year 2018-19 option to include Independent Children was allowed till their

Marriage. Full premium to be borne by the Pensioner.

11. From 1-4-2022, vide above CO Circular Independent Children can be added / continued upto

their Age 45 years irrespective of their marital status.

12. For adding such Independent Children (Son & or Daughter) Form A should be submitted to OS

Dept of respective Divisional Office.

13. Sons/Daughters who are abroad can also be added in our MediClaim Policy. But reimbursement

of Claim is available only for treatment taken in India, as per our Medi Claim Policy conditions.

14. The Last date for submission of 1) Option to Increase Sum Insured and 2) Option to Add

Independent Children is 25-03-2022.

Our take on the above CO Circular :

1. We advise Pensioners / Family Pensioners to add their Independent Children (Sons and/orDaughters), who are below 45 years, in their Medi claim Policy – whether they are covered by

their respective employer or not. This is because, the cover by their employer may not be to the

tune of Cover offered under our MediClaim Policy.

2. Marital Status for Independent Children is totally removed. Even married Sons / Daughters can

be added.

3. There is no restriction of number of Independent Children to be added.

4. This Option may not be given again. (We are experiencing the same for those who are left out

of Medi Claim / who did not include their Parents/Parents-in-Laws when option was given.)

5. Every body has to work out his own Tentative Premium for the year 2022-23. Use Table A

premium rates for Self and Table B premium rates for Spouse, dependent / Independent

Children. Option may be exercised for Increasing Total Sum Insured of their choice(as listed in

5 above). It is always better to opt for Highest Sum Insured. (we have worked out a case of a

Retired DM and in his case the increase in the Premium is less than Rs.10/- per day for

increasing the Sum insured from Rs.50 Lakhs to Rs.75 Lakhs for Pensioner+Spouse).

6. So we can say there will be increase in Premium on THREE counts viz. a) likely increase of

25% premium as compared to last year; b) if Sons/Daughters are added; c) if option is exercised

to increase the Total Sum Insured.

7. In future if Insurer allows reimbursement of Medical expenses for treatment taken outside India

then one requires highest Sum Insured. Hence exercise the option to increase the Total Sum

Insured Judiciously.

General Information :

1. Sharing of Premium by LIC : Sharing of Premium is for Basic Sum Insured only.

A) For In-service Employees : LIC bears 75% of Premium of BSI in respect of Employee,

Spouse and Two Dependent Children. So employee will bear 25% of the Premium for BSI.

B) For Retired employees (Pensioners) : LIC bears 75% of the Premium of BSI in respect of the

Retired employee and Spouse. Two Disabled and Dependent Children also get the benefit of

Sharing of Premium for BSI by LIC. So a Pensioner is required to bear 25% of Premium of

BSI.

C) Premium in respect of : a) Additional (Optional) Sum Insured b) For Parents, Parents-in￾Laws and c) Independent Children added to the MediClaim Policy :

is to be fully borne by the Employee / Prensioner.

2. Under Definitions section (G) of the Policy Document item number 7 defines

CONTRIBUTION as : Contribution is essentially the right of the Insurer to call upon other

Insurers, liable to the same insured, to share the cost of an indemnity claim on ratable

proportion.

3. Whos is a Dependent Child : It is defined under item 19 of the Definitions (G) of the Policy

Document as :

a) Legitimate / legally adopted children;

b) Male child up to the age of 21 yrs and up to age 25 years of age if unemployed;

c) Unmarried / Widowed / Divorced Female child depending on and staying with the employee;

on Marriage / remarriage of such child cover will remain for THREE months or Policy expiry

date, which ever is earlier;

d) Mentally Retarded and e) Physically Handicapped children fully dependent on the

employee / retired employee;

f) Dependent children upto age 25 yrs studying abroad during their visit to India, provided the

Premium in respect of such children are paid.

g) Financially dependent on the employee / retired employee and their income is not more thanRs.10,530/- pm.

4. The attention of the Members is also invited to Conditions (H) section Serial number 5 of the

Policy Document on CONTRIBUTION which is as under : If 2 or more policies are taken by an

Insured Person from One or More insurers to indemnify treatment costs, the Insurer (NIA) shall

not apply Contribution clause, but Insured Person shall have the right to require a settlement of

his/her claim from any of his Insurers.

a) In all such cases the NIA is obliged to settle the Claim without insisting on Contribution, if it

is within Sum Insured.

b) If the amount of Claim is more than the Sum Insured under this Policy, then the Insured

Person shall have the right to choose Insurers by whom the Claim is to be settled. In such cases,

the Insurer(NIA) may settle the claim with Contribution clause.

c) Except in benefit policies (like LIC's Jeevan Aarogya), the insured person shall be

indemnified the Hospitalisation costs, as per Policy terms and conditions.

Hence, Insured Person must disclose such other insurances held by him at the time of

making Claim under the Policy.

For any further clarification the following persons can be contacted :

1. Sri Vijay Dutta - Mob No:+91 9371026483

2. Sri M A Kulkarni - +91 9920180089

3. Sri Partha Chatterjee - +91 9038634932

4. Sri A J Joshi - +91 9561084182

5. Sri K T Hemanna - +91 8123066679

6. Sri C T Joshi - +91 9731955044.

NASHIK Vilas V Purkar

10-03-2022 General Secretary, NOIP.