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 General Secretary: Ashok J. Joshi
Mob No: 9880683639 Mob No: 9561084182 & 9945104570
Date: 02-06-2024
Cir No 16/2024
The Chairperson,
L I C of India, Central Office,
“Yogakshema”, Jeevan Bima Marg,
Mumbai – 400021
Dear Sir,
Re: - Certain Changes in our Group Mediclaim Policy
Our Group Mediclaim Policy, for the benefit of employees and Retired employees, was renewed with New
India Assurance Company Ltd for one year with effect from 01.04.2024 to 31.03.2025 (b.d.i) for a total
premium of Rs 864,53,88,000/- (including GST).
Recently, certain changes have taken place in the Health Insurance Industry but those have not been
incorporated in our policy conditions. The major two such important changes, amongst others, relevant
to our employees/retired employees are given below.
• Guidelines on providing AYUSH coverage in Health Insurance Policies vide IRDAI circular Ref:
IRDAI/HLT/CIR/GDL/31/01/2024 dated 31.01.2024, wherein it has been clearly stated to
consider AYUSH treatments at par with other treatments. The circular states that, the policy shall
also contain the parameters as well as procedure for enrolling AYUSH Hospitals/Day care Centers
as network providers for the purpose of providing cashless facility. The circular to come into
force w.e.f 01.04.2024, as mentioned in the said circular. But in our GMC Policy Bond at page no
18, vide serial no 4, where AYUSH has been explained, this provision has not been considered.
Moreover, the maximum reimbursement under AYUSH has been restricted to 25% of sum
insured during the policy period. This is not as per guideline of IRDAI circular as mentioned above.
• Cashless Everywhere: Till now a health insurance policyholder can get cashless treatment only
at network hospitals with whom the insurance company has tied up. If it is a non -network
hospital, the policyholder has to pay the entire amount from his pocket and then go through the
cumbersome reimbursement process. The General Insurance Council (GIC) in consultation with
general and health Insurance Companies has launched ‘Cashless Everywhere’ initiative to extend
the cashless treatment at all hospitals. Health Insurance policyholders can now avail of cashless
facilities even at hospitals that are not in the network of the insurers. The cashless facility at nonnetwork hospitals will be effective immediately as per General Insurance Council statement on 24.01.2024. Several Private General Insurance Companies e.g Bajaj Allianze, TATA AIG have
welcomed this proposal. Surprisingly, our Insurer NIA is silent on this issue till date. Hence, we
request “The procedure for availing cashless access service” as enumerated in page no 13 and
14 at serial no 4 of the same GMC Policy Bond should be suitably revised by our Insurer NIA
immediately by way of administrative instruction.
We, therefore, strongly urge upon you to take up the matter with the New India Assurance Company Ltd
at the earliest so that uniform procedure is followed throughout the country and due benefit is provided
to the employees and retired employees of LIC of India.
Copy of the relevant documents are attached for your ready reference.
With thanks and regards,
Yours Sincerely,
General Secretary
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