NATIONAL ORGANISATION OF INSURANCE PENSIONERS
Regn No.PN 4769 (Regd under Indian T U Act, 1926)
(Affiliated to Bharateeya Mazdoor Sangh)
BMS Office, Vishwakarma Bhavan, 185, Shaniwar Peth, Pune 411030.
President: T.C. Gunesh Kumar Working President: Vilas V. Purkar General Secretary: Ashok J. Joshi
Mob No: 9880683639 Mob No: 9922166599 Mob No: 9561084182 & 9945104570
Date: 26-02-2023
Cir No 08/2023
The Executive Director (Per),
LIC of India, Central Office, Yogakshema,
MUMBAI,
Dear Sir,
Re: Mediclaim related issues
Every year we suggest some important changes in our Group Mediclaim policy with a view to smooth
functioning and hassle-free servicing. We have requested you that ROOM RENT should be exclusive one
and delete other charges and/or PROPORTIONATE DEDUCTION clause vide our detailed submission
dtd.15-01-2023.
We are mentioning here two cases, to show how eligible amounts are deducted by TPAs on the pretext
of higher room rent and proportionate deduction clause:
Case 1.
CNN NO. MDI749048, Total bill amount Rs.1,47,953. Deduction amount Rs.50,036/- The deduction
amount was mainly due to wrong interpretation of Room rent and proportionate deduction clause. On
our intervention, helped the honorable member to prepare a representation, Rs31,000 approx. was paid
and further representation will be made for the rest of amount.
Case No. 2.
MD ASSIST ID 4015521017, Total bill amount Rs.4,25,647/-, Deductions Rs.2,27,702/-.
Reason for deduction, wrong interpretation of Room rent and Proportionate deduction clause. After
representation total deduction was reduced to approximately rupees TWENTY THOUSAND from
Rs.2,27,702.
In both the cases room rent was within the allowable limit, still TPA harassed our honorable members
(Senior citizens).
If the room rent is not made exclusive one and the sky high medical expenses continue, then the limit of
Rs10,000/- for Metro, 7,500 for A category, 6000 for B category and 4000 for other cities will be
insufficient after considering Boarding, Nursing (including injection/Drugs and Intra venous Fluid administration Expenses), DMO/RMO/CMO/RMP charges. In that case we have to be treated in general
wards only, else, have to face huge deductions mentioned in above two cases.
Hence, we reiterate our demand to delete other charges and/or PROPORTIONATE DEDUCTION CLAUSE
and ROOM RENT SHOULD BE EXCLUSIVE ONE.
Expecting your positive response,
With thanks and regards
Encl: TPA letters
Yours Sincerely,
General Secretary
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