LIC employees, Retired employees and spouse of deceased employee/retired employee are covered
by Group Mediclaim policy for more than three decades. The Spouse and dependent Children can be
included by them in their policies. Over the years many improvements have taken place, with the
efforts of NOIP. We give here below a gist of the Mediclaim policy for the use of our retired members.
Independent Children, till their age 45 (whether married or unmarried / employed or not), can also be
included from Policy Year 2022-23. Every year the Insurer will do a review of Premium to be paid
based on Claims experience.
For Retirees the premium recovery from Pension commences from February Pension payable on 1st
March and for in-service employees recovery starts from March Salary.
The Group Mediclaim Policy of LIC is currently with New India Assurance Company Ltd., The same is
serviced by Mumbai Divisional Office, whose address is given below :
New India Assurance Company Ltd.,
Divisional Office 120700,
8
th Floor, New India Centre,
17/A, Cooperage Road, MUMBAI – 400 001.
Tel Nos: 022 - 22049763 / 22814663. email :nia.120700@newindia.co.in
SDM is Sri Bhupendra Patil & his mobile Number is +91 9820434330; 022-22892776;
email id : bhupendra.patil@newindia.co.in;
Person looking after Mediclaim : Smt. Dipali Kadam, AO, 022 – 22846889
email id : dipali.kadam@newindia.co.in;
Eight(8) TPAs have been enlisted by New India Assurance Co., Ltd., for 8 Zones of LIC of India through
out India. The Zone wise list of TPAs are below with Toll Free Number dedicated to LIC :
Sl
No.
ZONE T P A Policy Number
1 West Zone & C O MD India Healthcare Services TPA Pvt
Ltd., Toll Free No(LIC):1800 209 7600
12070034230400000001
www.mdindiaonline.com
2 Central Zone Health India Insu. TPA Services Pvt Ltd.,
Toll Free No(LIC):1800 226 970
12070034230400000002
www.healthindiatpa.com
3 Northern Zone Good Health Insurance TPA Ltd.,
Toll Free No(LIC):1800 102 8673
12070034230400000003
www.ghpltpa.com
4 North Central
Zone
Raksha TPA Pvt Ltd.,
Toll Free No(LIC):1800 180 1555
12070034230400000004
www.rakshatpa.com
5 East Central Zone Vidal Health TPA Pvt Ltd.,
Rajeev Agarwal : 9931107825
Toll Free No(LIC):1800 102 7477.
12070034230400000005
www.vidalhealth.com
6 Eastern Zone Heritage Health TPA Pvt Ltd.,
Toll Free No(LIC):1800 102 4547
12070034230400000006
www.heritagehealthtpa.c
om
7 South Central
Zone
Medi Assist India TPA Pvt Ltd.,
Toll Free No(LIC):1800 419 1154
12070034230400000007
www.mediassist.in
8 Southern Zone Vidal Health TPA Pvt Ltd., 12070034230400000008
Toll Free No(LIC):1800-425-6268(Ker)
1800-425-7595 (T N)
www.vidalhealthtpa.com
For South Central Zone the TPA is Medi Assist India TPA Pvt., Ltd.,.
The details of the TPA are as under :
The Policy Number will be : 12070034230400000007
Toll Free Number(dedicated for LIC) 7022085000 / 1800 419 1154
Common Toll Free Number 18004259449
Email id l ic.scz@mediassist.in
Fax number 18004259559
Telephone number 18004191160
Website address www.mediassistindia.net
Contact for Claims Level 1 Smt. Ashwitha V : +91 7022970406
Contact first escalation Level 2 Smt. Usha C B : +91 9686791657
Contact Second Escalation Level 3 Smt. Shashikala G : +91 7022972053
A retired employee continues to be in the same category, even after retirement, that he was at the
time of his retirement. There are TWO categories :
Category Basic Sum Insured Additional Optional Total Sum Insured(BSI+ASI)
II Rs.10,00,000/- 12L, 15L, 20L, 25L, 30L, 40L, 50L, 75L.
I Rs.15,00,000/- 20L, 25L, 30L, 40L, 50L & 75L..
Premium Sharing : For BSI : 75% paid by LIC and 25% to be borne by Insured.
This sharing is for all those who are covered(spouse & dependant 2 children for in service
employees) & for retired persons, Retired employee, Spouse & disabled dependant children
(CO/PER/ER-A/CL 14 dtd. 22-06-2013). LIC & Principal Insured will bear GST on the above Premium
in this proportion.
For ASI : 100% to be borne by Insured. For Parents / Parents-in-Laws, Dependant
children and Independant Children :100% borne by Insured. Insured will bear the
GST on this full premium.
The Policy document is divided into 8 parts (A to H) and contains 4 Annexures.
Part A : COVERAGES
1. Reimbursement of Medical Expenses/Surgery at any Hospital/Day Care Center in India.
2. Room, Boarding expenses as provided by the Hospital including nursing charges not exceeding
1.5% of Total SI per day is payable. For “A” Class cities the limit is Rs.7500/- (Rs.10,000/- for
those who have opted for 40L/50L/75L SA), for “B” class cities the limit is Rs.6,000/- and at all
other places it is Rs.4000/- per day. [Room rent + Boarding Charges supplied by Hospital +
Nursing Charges (including Injection/Drug & intravenous Fluid administration charges) +
DMO/RMO/CMO/RMP charges of the Hospital, are included].
Propotionate Deduction Clause : If one chooses a higher room rent category than he is
eligible, then Proportionate deduction will be applicable on Associate Medical Expenses.
However, this clause is NOT applicable to i) Cost of Pharmacy and consumables, ii) Cost of
Implants and Medical Devices and iii) Cost of Diagnostics.
3. However, there is NO CAPPING / CEILING for admission in ICU/ICCU.
4. Associate Medical Expenses : Surgeon, Anesthetist, Med. Practitioner, Consultants and
Specialists Fees, Anesthesia, Blood, Oxygen. OT charges and procedure charges such as
Dialysis, Chemotherapy, Radiotherapy and similar expenses.
5. Cost of Pharmacy such as Medicines, Drugs, Surgical appliances and Consumables, Cost of
Implants and Medical Devices including prosthetic devices implanted during surgical
procedure such as Pacemaker, Cost of Diagnostics such as Relevant Laboratory/Diagnostic
tests, Diagnostic Materials such as X-rays and other similar expenses are reimbursable.
6. Pre-hospitalisation medical expenses for a period of 30 days and Post-hospitalisation medical
expenses for a period of 60 days are reimbursable (in case of Renal failure and / or Organ
Transplantation or Cancer related ailments this period may be waived. The only condition is
that the Reimbursement amount on each occasion should not be less than Rs.5,000/-).
7. Non-medical expenses are NOT covered. Annexure II gives full list of Non-medical expenses.
8. From 2019-20 International Second Medical Opinion services clause has been incorporated in
the Policy (for details refer Pages 5 to 9 of Policy) for selected ailments ( see separate note).
Part B : CASHLESS / REIMBURSEMENT THROUGH TPA
1. The Insurer provides Cashless and Reimbursement facility through TPA. Cashless is available in
the networked Hospitals only. For Reimbursement admission in any Hospital will do.
2. If a retired employee shifts his residence from one place to another place/employee is
transferred out of Zone, the original TPA only will provide services based on Pan India
network hospitals.
3. Procedure for Availing Cashless Hospitalisation Services: a) available only at TPA network
hospitals. b) E-card and a Photo ID of the patient to be submitted to TPA. c) If no e-card is
available then a Certificate issued by OS Dept of the Division will do. d) A pre authorisation
form is to be filled in completely duly signed by claimant and the treating doctor. e) All the
above three requirements are to be sent to TPA on its mail id or by Fax. On receipt TPA will
issue a pre-authorisation letter to the Hospital. f) Bills over and above the amount paid by TPA
will have to be paid by the claimant to the Hospital. g) In case TPA refuses to give pre
authorisation, then the full bill has to be settled by the Claimant. h) However, claimant can
submit the requirements for reimbursement to the TPA through OS Dept of the Division.
Part C : Diagnostic Tests without Hospitalisation
(A)
1. The following (16) Diagnostic Tests without hospitalization are payable to the extent of the
limit mentioned here in, for each insured under the policy, per person per year:
Diagnostic Test Max. payable Diagnostic Test Max. Payable
MRI charges
Contrast MRI
Rs.8,500/-
Rs.12,000/-
CT Scan charges
Contrast CT Scan
Rs.6,500/-
Rs.9,000/-
Sonography (excluding
Maternity related)
Rs.2,500/- Biopsy Rs.4,500/-
TMT Rs.2,000/- Echo test Rs.2,000/-
Gastroscopy Rs.5,500/- Colonoscopy Rs.7,500/-
EEG Rs.1,000/- EMG Rs.2,000/-
Holter Monitor Test Rs.5,000/- PAP Smear Rs.1,500/-
Mammography Rs.5,500/- PET Scan Rs.20000/
Prostate Specific
Antigen
Rs.750/- Angio CT
Contrast Angio CT
Rs.6,500/-
Rs.9,000/-
2. Maximum amount reimbursable under this benefit is Rs.85,000/- per family per year.
3. An MD doctor should have recommended the Test, giving reasons for the same.
4. The cost of Consultation is NOT reimbursable.
5. Pre and Post expenses in respect of Diagnostic Tests are not reimbursable.
6. This benefit can be availed only once during the Policy year per insured per Test.
7. For MRI/contrast MRI, CT Scan/contrast CT scan/CT Angiography, Sonography and Biopsy the
same are allowed twice during the policy period, per insured person, if done for a different
Organ / Body part.
(B)
FACILITY OF TELE CONSULTATION
From Policy Year 2022-23 facility of Tele Consultation has been provided by the Insurer Free of Cost.
To avail this facility is made available to all persons insured under the Family Floater Mediclaim Policy.
The facility is available 24x7 through MediBuddy (MB) Application of MediAssistIndia TPA Pvt Ltd., To
avail this facility one has to activate MB Gold in MediBuddy App.
The flow chart is as follows :
1. Download MediBuddy App (about 51MB) from Playstore / Appstore.
2. Click on “I have Corporate Account” and Log-in giving your Email ID, click on proceed it will ask
you to keyin Password : your DOB in DDMMYYYY format.
3. Key in your Mobile Number. You will receive an OTP. Key in the OTP for verification.
4. Click on MB Gold Banner. Click on Activate sponsored annual subscription. It is FREE for LIC
employees / Retirees and their Family Members.
5. Click on “Talk to Doctor”. Choose your Doctor’s Speciality and enter your health symptoms.
6. You will receive a call from the Doctor shortly.
Also Insured person can go to the following Google Drive Link for detailed nevigation guide :
MB Gold Navigation Guide Deck Link :
https://drive.google.com/file/d/1ewyM6q08GUA-mhdploul7Q3yGtw-L1Ue/view
(C)
FACILITY OF MEDICAL EXAMINER
The Insurer has provided a facility of Placing a Medical Examiner at each Zonal Head Quarters and at
Central Office for consultation by Employees / Retired employees on all working days between 11-00
am to 4-00 pm FREE OF COST. However, this facility is NOT available for dependent/independent
Family members.
Details of Medical Examiner placed at Hyderabad for SCZ is Dr. Syed Mukthar Mohiuddin,
MBBS,MD. Who will be available in CRM department of Zonal Office, Hyderabad.
He can also be contacted on Phone Number : 040-23230346 on all working days between 11-00 am
to 4-00 pm for consultation.
Part D : Sub-Limit Clause
1. Payment is made for admission in ICU/ICCU as part of hospitalization bill only.
2. Bills raised by Surgeon/Asst. Surgeon/Consultant/Specialist/Anesthetist directly are payable as
below : a) Max. 25% of the Total Sum Insured Max of Rs.10,00,000/- is payable, provided a
numbered Bill is given and if it is paid by Cheque/UPI/Netbanking/debit-credit card. b) If paid
by Cash reimbursement is restricted to Surgeon/Consultant/Specialist : Rs.30,000/- ; Asst.
Surgeon : Rs.12,000/- ;
Anesthetist : Rs.20,000/-. Provided a numbered bill is submitted for all above.
3. Claim relating to Cataract operation is Actual or Rs.60,000/- whichever is less for each eye,
inclusive of all charges excluding Service Tax.
4. Hospitalization in Ayurvedic/Homeopathic/Unani hospitals is restricted to 25% of Total Sum
Insured, provided it is a Govt or Recognised or accredited hospital. However, Steam Bath,
Shirodhara & Panchakarma and similar Ayurvedic treatments are NOT payable except when it
is part of treatment required to treat such illness / disease/injury.
5. Actual or Rs.5000/- ambulance charges (per trip) is payable for shifting the patient from Home
to Hospital / from one hospital to another, on production of proper bill. For Cardiac patients
Cardiac Equipped Ambulance the Charges are Rs.10,000/- for admission to the Hospital only.
A trip means One Side Journey.
6. In case of Organ Transplantation, hospital charges of both donor and recipient is payable,
within the Total Sum Insured of the recipient. Cost of the Organ is NOT reimbursable.
7. For Lasik Laser Treatment Rs.35,000/- per eye is payable, some restrictions apply.
8. ARMD and/or treatment for retinal disease by intravitreal/intraocular injection/intervention is
admissible up to Rs.1,00,000/- per member per eye per year.
9. Robotic Surgery for Malignant Cancer / Cancer, Brain, Heart & Spine only are payable.
However, if insured undergoes Robotic Surgery for other ailments, cover under the Policy
shall be limited only to the applicable conventional charges.
10. For Cochlear Implant surgery (including cost of Cochlear implant), Rs.10,00,000/- per member
is payable with first Rs.1,50,000/- to be borne by Insured member.
11. For Psychiatric and Psychosomatic disorder – only Hospitalisation expenses are reimbursable
to the limit of Rs.50,000/-, per member per year. Pre & Post-hospitalisation expenses NOT
allowed.
Part E : Maternity Expenses Benefit
1. Maternity medical expenses traceable to childbirth are reimbursable.
2. Normal Delivery : Actual or Rs.65,000/- ; Caesarian Section : Actual or Rs.1.25 Lacs whichever
is less (Payable only if expenses are incurred as in-patient in Hospital).
3. Claim in respect of first TWO living children and / or Operations associated there with will be
considered. Delivery of Twins is considered as Maternity for Single Child.
4. Reimbursement for Lawful MTP is payable, voluntary MTP expenses are NOT payable.
5. Expenses in respect of new born Child, during delivery confinement period is covered under
Family Floater Sum Insured, even if the Child is shifted to another Hospital. However,
expenses in respect of new born child of independent children are not covered.
6. New born Child is added to the Policy of the Insured once the child is declared for insurance by
the Insured and premium is paid. This however, is applicable only after the child is discharged
from the Hospital.
7. Congenital Internal defects/diseases are covered. Congenital External defects/diseases are
NOT covered.
8. Pre-natal and Post-natal expenses are NOT covered, unless admitted in Hospital and treatment
is taken as inpatient.
Part F : EXCLUSIONS
The Group Mediclaim Policy lists 24 Exclusions. They are as under :
i. Injury/illness directly or indirectly attributable to War, invasion or warlike situation.
ii. Circumcision, cosmetic or aesthetic, plastic surgery unless required to treat illness/injury.
iii. Vaccination & Inauculation.
iv. Cost of Braces, eye glasses, cost of spectacles / contact lenses, hearing aids.
v. All types of Dental treatments except arising out of accident.
vi. Convalescence, general debility, 'run-down' condition or rest cure, obesity treatment,
infertility, sterility, use of intoxicating drugs/alcohol, use of tobacco leading to Cancer.
vii. Bodily injury due to Deliberate exposure to danger, intentional self inflicted injury, attempted
suicide.
viii.Treatment of any Bodily injury / illness sustained whilst or actively involved in any hazardous
sports.
ix. Treatment of any Bodily injury/illness sustained whilst or as a result of participating in any
Criminal act.
x. Charges incurred at Hospitals primarily for Diagnosis, X-ray or Lab exams or other diagnostic
studies not consistent with or incidental to the diagnosis and treatment for which hospitalised.
xi. Vitamins and tonics unless forming part of treatment for injury/disease as certified by
attending Doctor.
xii. Naturopathy treatment/
xiii. External and durable Medical/Non Medical equipment of any kind used for diagnosis.
xiv. A) Genetic Disorders. However, treatment for THALESSIMA, Haemophilia, Sickle Cell Anemia,
Hemolytic anemia, myeloma requiring Hospitalisation are covered with Pre & Post
Hospitalisation both as inpatient and OPD subject to a max of 75% SI.
B) Stem cell implantation / Surgery. (i) Restricted to HSCT for certain Cancers of Blood, Bone
marrow to the extent of 75% of the SI. (ii) Stem Cell transplantation treatment for Cerebral
Palsy and multiple Scerosis covered max of 50% of SI.
xv. Treatments taken outside India.
xvi. Experimental / unproven treatment.
xvii. Change of treatment from one system to another, unless recommended by treating
Doctor under whom the treatment is taken.
xviii. Any other charges except Registration/Admission charges & GST/Surcharges.
xix. Treatment such as RFQMR, Ozone Therapy, ECP, EECP, Hyperbaric Oxygen Therapy are
admissible only as Hospitalisation expenses.
xx. Voluntary Medical Termination of Pregnancy.
xxi. Acupressure, Acupuncture, Magnetic therapies.
xxii. Treatment arising from or traceable to miscarriage, abortion or complications. Except
abdominal operation for extra uterine pregnancy.
xxiii. Physiotherapy, pre or post-hospitalisation is restricted to Rs.40,000/- per person per
year. Treatment taken in Physiotherapy centres or at clinic only payable. However, if the
patient is permanently or temporarily disabled, with a prescription of Doctor, Physiotherapy
taken at home is payable, minimum 15 are required. The pre & post Hospitalization of 30/60 days shall not be applicable for patients who are totally and permanently
disabled/paralyzed.
xxiv. Congenital external Defect / diseases / deformities.
xxv. Any expenses relating to the cost of items detailed in Annexure II.
One has to go through them carefully. Lot of claims are rejected as they come under Exclusions.
Part G : Definitions
Thirty seven definitions are given under this part for the terminologies used in the Policy. Important
ones are Domiciliary Hospitalisation, who are covered under the Policy, what is Day Care Center etc.,.
A dependent is one whose monthly income is not more than Rs.12,420/-. In case of Parents and
Parents -in-Laws the income of both should be considered to decide eligibility. The Income Limit to
decide the dependency is reviewed every year.
Part H : Conditions
1. Notice of Hospitalisation to be given to TPA through OS Dept., of the Division within 7 days.
2. Claim with all the requirements to be submitted to TPA through OS Dept., of the Division
within 20 days of the date of discharge.
3. The Insurer may ask for Physical Examination of the Insured, in respect of whom claim is
preferred, by a Doctor specified by the company.
4. When claim is repudiated, the TPA has to inform the reasons for repudiation.
5. Mid-term inclusion of employee / dependent not allowed. Exception is New born child and
recruitment of the employee.
6. Insurer has to settle / reject the claim within 30 days of the receipt of last document.
7. Hospitalisation falling in to two policy years, then the Date of Admission, which will be in the
previous policy year will be taken into account. The Sum Insured under the new policy will not
be available for the claim (including Pre and Post Hospitalisation expenses). Claims are settled
on per event basis.
8. Claim Documents :
a) Claim form duly completed and signed.
b) Prescriptions and original Cash bills for purchase of drugs/medicines.
c) Original Discharge Summary / Card.
d) Original Numbered Bill / Cash Memo and Money Receipts.
e) Diagnostic / Pathological Test Reports (Original or Attested)
f) Surgeon's certificate stating nature of operation performed.
g) Attending Doctor's/ Consultant's/ Specialist's/ Anesthesist's Bill and receipt and certificate
regarding diagnosis.
h) Contact number, email id and correspondence address of the Claimant.
All the above requirements are to be sent to TPA. Also an authorisation to the TPA/Company to
obtain Medical and other records from any Hospital, lab or other agency.
GRIEVANCE REDRESSAL
For any grievances Claimant can approach this authority on the following address :
Grievance Cell, The New India Assurance Co., Ltd.,
Mumbai Regional Office III, 3rd Floor, 17/A Cooperage Road, MUMBAI – 400 001.
Phone Nos : 022-22822604 / 22821833 /22892701.
Head Office of NIA : customercare.ho@newindia.co.in
seniorcitizencare.ho@newindia.co.in
INSURANCE OMBUDSMAN : Claimant can also approach Insurance Ombudsman on the following
address for SCZ employees / Pensioners :
Insurance Ombudsman,
Office of the Insurance Ombudsman,
6-2-46, 1st Floor, Moin Court,
A.C. Guards, Lakdi-ka-pool,
HYDERABAD, 500 004.
Tel No:040-65504123. Fax :040-23376599.
Email : insombudhyd@gmail.com
ANNUXURE I
Gives list of “A” & “B” class cities. In our Zone Bengaluru and Hyderabad(including Secunderabad)
are A class cities. Vishakhapatnam, Vijayawada & Guntur are B class cities. All others are C class
cities.
ANNEXURE II
Contains list of Non-medical items which are either NOT PAYABLE or partly payable. The list runs into
11 pages containing 198 items. I only list below the items which are payable either partly or fully.
Ite
m
No.
Details of the
Items
Suggestions Ite
m
No.
Details of the
Items
Suggestions
12 Razor Payable when used
for Operation site
Preparation.
15 Belts / Braces Payable for thorasic
or lumbar spine
surgery.
23 Disposable
Razors
Payable. 31 Leggings Payable in bariatric or
Vericose Vein
surgery.
45 CLINIPLAST Payable during
Hospitalisation.
46 Crepe Bandage Payable during
Hospitalisation.
47 Curapore --- do --- 49 DVD, CD
charges
Payable.
51
52
53
Face Mask
Flexi Mask
Gauze soft
Payable during
Hospitalisation.
54
56
Gauze
Hansaplast /
Adhesive
Bandage
Payable during
Hospitalisation.
58 Slings Reasonable cost of
One sling for Upper
Arm fracture.
66 Psychiatric &
Psychosomatic
disorders.
Payable refer to D
(11).
67 Eye Surgery for
refractive error
correction.
Payable refer D (7). 70 Admission /
Registration
Charges.
Payable.
75 Ward & Theatre
booking Charges.
Payable under OT
Charges.
76 Arthroscopy &
Endoscopy
Instru.
Rental Charged by
Hosp. Payable.
77 Microscope
Cover
Payable under OT ch. 78 Surgical Blades,
Harmonic
Scalpel, Shaver.
Payable during
Hospitalisation.
79 Surgical Drill Payable during Hosp. 80
81
Eye Kit
Eye Drape
Payable under OT
charges.
82 X-ray Film Payable as Radiology
Charges.
83 Sputum Cup Payable during
Hospitalisation.
84 Boyles Apparatus
Charges.
Payable during
Hospitalisation.
85 Blood grouping
& donors
matching.
Part of cost of Blood.
86
87
Antiseptic or
disinfectant
lotion.
Band aids,
bandages, sterile
injections,
needles, syringes.
Payable during
Hospitalisation.
88
89
90
91
93
Cotton
Cotton Bandage
Micropore/
surgical tape
Blade
Torniquet.
Payable during
hospitalisation.
94 Ortho/Gynaec
bundle.
Part of Dressing
Charges.
95 Urine Container. Payable during
hospitalisation.
96
97
Luxury tax
HVAC
Actual Govt., charges
payable as part of
Room rent.
98
99
House Keeping
charges.
Service Charges
where Nursing
Ch. also charged.
Within room rent
eligibility, payable.
100 TV & AC
charges.
Part of Room charge. 101 Surcharges. Payable.
102
106
Attendant
charges.
Blanket
Part of Room charge. 105 Extra Diet of
Patient.
Diet provided by
hosp. is payable.
118 Cost of Medicine
on Discharge.
Payable as post-
hospitalisation.
129 Mortuary
Charges.
Payable upto 24 hrs.
Shifting ch not paid.
134 CPAP/CAPD
equipments.
Rental payable during
hospitalisation.
135 Infusion pump –
cost.
Payable during
hospitalisation.
149 Lumbosacral
Belt.
Payable for surgery of
Lumbar Spine.
150 Nimbus, Water or
Air Bed.
Payable for any ICU
patient for more than
3 days in ICU,
Paraplegia/quadripleg
ia patients @ Rs.200/-
per day.
154 Abdominal
binder.
Payable in post-
surgery for major
Abdominal
155 Betadine, spirit,
hydrogen
peroxide
Payable if prescribed.
158 Sugar free tabs. Sugar Free variant of
Medicines payable.
159 Creams,
Powders,
Lotions.
Payable if prescribed.
160 Digestion gels. Payable if prescribed. 161 ECG electrodes. One set every second
day is payable.
162 Gloves All types of Gloves
Payable during
hospitalisation
163 HIV Kit Payable for Pre-
surgery screening.
164 Listerine,
antiseptic mouth
wash.
Payable when
prescribed.
165
166
Lozenges
Mouth Paint
Payable when
prescribed.
167 Nebulization Kit. Payable if used during
hospitalisation.
168
169
170
Novarapid
Volini, Analgesic
Zytee Gel
Payable when
prescribed.
171 Vaccination
charges.
Post bite vaccination
charges payable.
180
182
185
Exam. Gloves.
Mask
Oxygen Mask
Payable during
hospitalisation.
187 Pelvic traction
belt
Payable in case of
PIVD requiring
traction.
194 Ambulance
charges.
Payable. Refer D (5).
195 Tegaderm /
Vasofix Safety.
Payable. Max. 3 in 48
hrs, then 1 in 24 hrs.
196 Urine Bags. Payable where
medically necessary.
Max 1 per 24 hrs.
198 Stockings. Payable for case like
CABG etc.,
68 Treatment for
STD &
HIV/AIDS.
Payable.
73 Any expenses when the patient is diagnosed with Retro Virus + or
suffering from HIV/AIDS etc., is detected directly / indirectly.
Payable.
ANNEXURE III
List of 189 surgeries / procedures, for which 24 hour Hospitalisation is not necessary. The list runs into
6 pages. Any other Surgery / Procedures agreed by New India / TPA which requires less than 24
hours hospitalisation due to advancement in Medical Technology can be considered.
ANNEXURE IV
Gives list of Ombudsmen with their Addresses. Ombudsman address for our Zone (Karnataka, Andhra
and Telangana states) is given above on page 8 above.
22-A NOTE ON INTERNATIONAL SECOND MEDICAL OPINION SCHEME
The Family Floater Medi Claim Policy for LIC employees / retirees envisages International Second
Medical Opinion scheme from 2019-20 year policy. For the current year also the same has been
continued. This facility is available FREE OF COST to the employee/retiree. This scheme is available in
the Policy Document from Page 5 to Page 9. Let us discuss in brief about this service.
1. An insured under the Policy is entitled to have an expert opinion from World Leading Medical
Center (WLMC) that specialises in the medical condition with which the member is diagonised.
2. This year this facility is provided through MDIndia Healthcare Networx Pvt. Ltd., whose
address and contact details are given below :
Name & Address of this
Service Provider.
MDIndia Healthcare Networx Pvt Ltd.,
S.No.46/1, E-space, A2 Building,
2
nd Floor, Pune Nagar Road,
Vadgaonsheri, PUNE-411 014.
MAHARASHTRA.
EMAIL ID 2ndmedicalopinion@mdindianetwrox.com
Mobile No/Whatsapp No. +91 9607017817
3. For obtaining this facility the Service provider has to be contacted on the above mobile
number or by Email to the above email address by the member, who is eligible to receive the
facility during working hours of New India Assurance company.
4. Once intimation is received, the service provider with members diagnosis by attending
Physician along with Qualifying Medical Condition, will list the best in the world THREE
WLMC's who are expert in diagonising and treating that particular illness. The service provider
will work directly with Attending Physician to collect and assemble all Medical Records for
onward transmission to WLMC.
5. The expert in WLMC will verify the correctness of the Diagnosis on going through the Records
presented. Also it will send the originally proposed treatment plan, treatment options,
international standards of care, newly available and proven treatment approaches.
6. The Opinion will be sent to the Member and attending Physician in writing within 10 working
days. If the service provider fails to obtain the required medical records, then it is the
responsibility of the member to collect the same.
7. The service provider will pay for all costs of Medical Second Opinion process.
8. All benefits under this Program are available only when the Member (Insured) is diagonised
with one or more of the following 17 Medical Qualifying Condition.
9. Qualifying Medical Conditions :
A. Open and Close Heart Surgery including CABG.
B. Cardiac ailments neessitating :
1. Pacemakers (including biventricular Pacemakers).
2. AICDs with or without biventricular pacemakers.
3. Radiofrequency ablation.
4. Device closures of ASDNSD/PDA etc. with Valvulopasty(BNV/BAV/BPU).
5. Valve replacements.
C. Angioplasties :
1 Coronary and Peripheral (including Carotid/Renal/Aorto-iliac).
2 Including Stent Implantation (with drug-eluding stents).
D. Cerebra or Vascular Strokes/Paralysis due to any cause.
E. Neurosurgery / Ailments requiring Brain Surgery.
F. Major operations of the spine and vertebrae including correction of congential spinal
deformity.
G. Renal diseases / Failure / Kidney transplants / Dialysis.
H. Malignancy including Leukaemia.
I. Lung Surgery :
1. Lobectomy.
2. Pneumonectomy.
3. Decortication.
4. Removal of Mediastint Tumours.
J. Encephalitis (viral), Visual / Hearing loss.
K. Gall Bladder / Pancreatic Calculi or Nesidioblastosis.
L. Diseases of the Liver leading to failure or transplantation.
M. Surgery of portal hypertension.
N. Organ transplants.
O. Aplastic Anaemia.
P. Cerebral Palsy.
Q. Mysthenia Gravis.
10. Following Exceptions are there where International Second Medical Opinion is not available :
When a Member has not received a Diagnosis – Member must receive official
daignosis from his/her treating Physician. This is pre-requisite for reference to WLMC.
Member has not been evaluated by treating Physician in the last 12 months. Recent
Medical reports are required by WLMC to give treatment recommendations.
If a member has developed an Acute or life threatening condition. There is no point in
waiting for Second Opinion.
Where physical evaluation of the patient is required. Certain cases require physical
evaluation (eg. Mental illness) in such cases remote second medical opinion will not be
given.
This is only a gist in short. For further details policy document should be referred.
Compiled by
VIJAYAPUR C. T. JOSHI
18-05-2023 Mobile : +91 9731955044
email id : joshi.chidambart@gmail.com
