Circular 10 - 23 dated 9.3.23

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: 09-03-2023

To All the Members

Meeting with Shri. Prakash Javadekar ji

We had been trying for an appointment with Shri.Prakash Javadekarji, Chairman, Ethics

Committee of the Rajya Sabha since 15 days. Ultimately, today at 4 pm we were given the

appointment to meet him in his residence at Pune.

The delegation was led by the undersigned and consisted of Smt.Anagha Sant, Secretary, NOIP,

Smt. Vijayalakshmi Sondur, C C Member, Shri.Sanjay Wani, C C Member, Shri.Devidas Patil,

President, Pune Unit, Shri.Rajendra Desai, Secretary, Pune Unit & Smt.Pradnya Dharap, activist

and family pensioner.

We greeted Shri.Javadekarji on his appointment as the Chairman, Ethics Committee of the

Rajya Sabha.

We submitted the copy of letter dtd.25-02-2023 addressed to the Finance Minister along with

the copy of anomaly chart. We expressed our anguish over the inordinate delay in the

notification of enhancement of family pension and other pending issues recommended by the

LIC. We also stressed the need for updation of pension. He clarified that any extra monetary

benefits would be related to the profitability of the industry. He further said that wage revision

in LIC has been delinked from the revision in Banks and now there is a need to delink General

Insurance industry from the LIC, while granting any monetary benefits including wage/pension

benefits.

He assured that he would put a word in DFS (Dept of Financial Services) to hasten the process

of enhancement of family pension and other items recommended by the LIC. He said that he

may be contacted any time through WhatsApp/email for any further help in the matter. He also

advised us to continuously follow up at the Joint Secretary/Under Secretary levels from our

end.

We also brought to his kind notice that the pension case is lingering in the Court since 25 years

and that the LIC and Govt combined have subjected the pensioners to a long drawn litigation,

though the NDA govt has also continued to adopt the National Litigation Policy. We demanded

that the Govt should not become a compulsive litigant in the matters related to senior

citizens/pensioners. We urged for the updation of pension saying that the pension is not revised in the last 30 years. He said that the govt is wary of the ramification of pension

updation, quoting that many state govts have resorted to reintroduction of old pension

scheme.

The meeting lasted for 45 minutes and the discussions were held in a cordial atmosphere. His

assurance of help gave us a further boost in our endeavours.

With greetings,

Yours Brotherly,

General Secretary

NOIP delegation submitted memorandum regarding pending issues of pensioners to Sri Javadekarji at Pune.

From left to right- Smt. Pradnya Dharap, Smt. Anagha Sant, Shri. Ashok Joshi, Shri. Javadekarji, 

Shri. Rajendra Desai, Shri. Devidas Patil, Shri. Sanjay Wani & Smt. Vijayalakshmi Sondur were in the NOIP delegation

NOIP team meets Shri. Saurabh Mishra ji, Joint Secretary, Insurance

Noip team consisting myself, Mohantyji and Saini ji (both VPs of Noip) were in the DFS office and had a talk with PA to Addl Secretary, DFS Shri. Suchindra Misra for appointment. As per her advice again sent mail requesting appointment. Both Secretary and Addl Secretary are in some parliamentary meeting.

In the meantime Shri. Surendranji, Organising Secretary, BMS has talked to FMO and requested appointment with Secretary DFS. A mail is being sent by BMS to DFS mentioning the names of persons in the delegation. We are liaisoning with BMS.

We hope to get the appointment in a day or two. Let us hope for the best.

Ashok joshi

Camp New Delhi

1-3-2023

From left to right S/Shri. S. K. Saini, VP, NOIP, M.P.Chauhan, President Delhi Unit NOIP, Ashok Joshi, GS, Saurabh Mishraji, Joint Secretary Insurance, Jagajit Kumar ji, Director, Insurance, Vinod Kumar ji, Under Secretary, Insurance and U. C. Mohanty, VP, NOIP.

NOIP Circular No 09/2023

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: 02-03-2023

Circular No 09/2023

NOIP ZINDABAD- BMS ZINDABAD

To All The Members

It was the most satisfying day today for NOIP (BMS). The undersigned and Shri.U.C.Mohanty, VP, NOIP 

were camping in Delhi since 28-02-2023 to meet the DFS officials, especially Shri. Vivek Joshiji, Secretary, 

DFS. It was a tough task since DFS officials and BMS are fully busy in arranging of F-20, W-20 and L-20 

respectively. BMS top leaders are camping in Delhi for planning the L-20 arrangements. For 3 days NOIP 

team ably supported by our Delhi office-bearers made innumerable visits to DFS office and BMS Central 

Office to arrange for the appointment with DFS. We insisted on the BMS leadership that appointment 

with DFS officials should be arranged on any day from 1st to 5th March, since we have camped in Delhi 

from 28th February and up to 5th March. Frustration has set in because of inordinate delay in the 

notification of family pension, I pleaded with the BMS leadership. Despite his busiest schedule, 

Shri.B.Surendran ji, All India Organising Secretary, BMS, took some time in between and phoned to FMO 

(Finance Minister’s Office) and requested for appointment with the Joint Secretary, Insurance. (Since 

Secretary, DFS and Addl Secretary, DFS were busy in meetings of parliamentary committee etc). Under 

instructions from FMO, immediately meeting was scheduled at 5 pm today. Since Shri.Surendranji was 

extremely busy and Shri.Girish Aryaji was absent due to illness, NOIP team led by the undersigned and 

consisting S/Shri.U.C.Mohanty, VP, NOIP, Bhubaneshwar, S.K.Saini, VP,NOIP, Delhi & M.P.Chauhan, 

President, NOIP Delhi unit went to DFS. Prior to that the team had a courtesy meeting for half an hour 

with Smt.Richaa Kapoor, Chief (Liaison) (ZM), who is a liaising officer between LIC & DFS.

We entered the chamber of Shri. Saurabh Mishra ji, Joint Secretary, Insurance at 5-15 pm. Since the 

meeting was scheduled under the instructions from FMO, our team was given a respectful welcome by 

Shri.Mishra ji and his Deputies, Shri.Jagajit Kumar, Director, Insurance and Shri.Vinod Kumar, Under 

Secretary, Insurance. 

Immediately discussions ensued, pointwise in detail about each point; and perhaps this is the first time 

that all the 8 pension related issues were ever discussed in such minutest details by any pensioners’ 

union in LIC. The sole credit goes to NOIP and BMS that the issues were discussed in all details. We felt 

so happy that Shri.Mishraji evinced a lot of interest in knowing certain unknown facts regarding some of 

the issues. Entire team gave a patient hearing and Shri.Mishraji elaborately discussed all the issues 

taking us into full confidence, which made us feel comfortable and satisfied. Though we feel it not 

necessary to share all that transpired, we give here below the main gist point wise, to make it clearer. 

Please refer to the letter dtd 25-02-2023 addressed to the FM Smt. Nirmala Sitharamanji (enclosed here 

with) for pointwise deliberation.

1) Revision of pension with every wage revision- We gave all the details as to how non revision 

has created the greatest anomaly and submitted the anomaly chart for all cadres as on 01-02-

2023. Though Mishraji acknowledged the fact, he was reluctant to commit anything in this 

regard. He further revealed that the Finance Secretary, Shri.T.V.Somanathan , a master on the 

subject, has been entrusted with the work of conducting in depth study of the whole pension 

system in the country, encompassing the entire work force and to come out with a detailed 

research paper. Unless this study is completed, the govt would not commit anything in this 

matter, he averred. He also suggested us to watch Shri.Somanathan’s UTube videos on the 

subject, saying they would give us a lot of insight.

2) Revision of family pension- This was discussed for about 15 minutes. He confirmed that though 

the LIC has replied to their queries, they were not supported by mathematical figures. 

Shri.Mishraji requested us to furnish some mathematical calculations from our side. We pointed 

out as to how the spouse of our ex-Chairman is getting a paltry family pension (basic family 

pension) of Rs.2600+. We also appreciated the steps taken by the Modi govt to help the women 

of our country and requested to improve the quantum of family pension to 30% of last pay 

drawn. We also explained as to how the pension funding is made by the LIC- “LIC is purchasing a 

single premium immediate annuity policy from its P&GS unit and as such, LIC has to eke out a 

very large sum at once per each retiring person. This information appeared to be unknown to 

them and Shri.Mishraji advised his Deputies to note this fact. We further said that the LIC has 

made it out to be a big outgo if pension updation is given, through their affidavit to the SC in our 

pension case. Same thing applies to the family pension enhancement. Whereas in Banks, the 

pension is paid out of the pooled pension fund. It is also argued by the retirees’ unions of banks 

that the interest earned every year would take care of, even if the pension updation is given.” 

Hence, we appealed to immediately notify the family pension enhancement without any further

delay, saying it is pending since more than 3 years at DFS. We hinted retrospective effect from 

2019. Shri. Mishraji was highly positive and for our query whether family pensioners would get a 

Holi gift, he laughed and said that it would be notified at the earliest and also did not spell out 

the effective date. We got an inkling that the notification may come through anytime during this 

month itself. We hope for the best.

3) Computation of basic pension- We discussed in detail this anomaly which is adversely affecting 

those retirees who retire during the wage revision period and requested to adopt the system 

revised during the 6th Pay Commission. Mishraji got it confirmed from the Under Secretary and 

advised the latter to note it for further consideration about the feasibility.

4) Enhanced pension to senior pensioners of age 80+ - Here again, the mathematical implication 

was referred by them and neither he rejected our demand nor was emphatic about granting. 

Ultimately anything may happen, we felt. Let us wait and see.

5) OMOP to left over persons- We discussed this issue for about 10 minutes in all its details saying 

LIC has already recommended offering OMOP to less than 100 persons belonging to ex￾servicemen and directly recruited SEs. Shri.Mishraji was highly positive on this and asked the 

Under Secretary to note this. We felt assured that this would come through.

6) Full pension for service of 20 years or more- This issue was also elaborately discussed by us, 

though LIC has not recommended. We gave the example of ex-servicemen, SC/ST/OBC employees recruited at higher ages, Agents recruited as Development Officers, persons 

recruited with specialized qualification such as Actuaries, CAs, Cost Accountants, directly 

recruited SEs etc. We also appreciated PM Shri.Modiji’s concern for the defence personnel and 

appealed to consider full pension for the service of 20 years or more. We also quoted RBI’s 

notification of granting this in 2013 and also granted by the 6

th Pay Commission long back. The 

point was appealing to the Joint Secretary and he instructed his Deputy to make a note of it. 

Since LIC has not recommended this, more efforts at the LIC level too, would have to be made, 

we feel.

7) OMOP to those PF Optee retirees of aged less than 55 years- None had brought this anomaly to 

the notice of DFS, though we have written several letters about it to DFS. The atrocious 

provision in the Staff Rules ever since 1960, stipulates that one who takes VRS before reaching 

the age 55, it is treated as resignation. It is paradoxical to note that the Pension rules provide for 

pension for a minimum service of 20 years and more. Hence to a few such employees who are 

mostly ladies, OMOP was not offered in 2019. We requested to offer them too, the OMOP since 

they have put in 20-36 years of service. Shri.Mishraji instructed his Deputies to examine this.

8) Increased family pension in case pensioner/employee dies before age 67- We demanded 

double the family pension for 7 years or up to age 67, whichever is earlier. Shri.Mishraji was 

highly positive on this.

This is the first time that such a detailed discussion was held on all the 8 pension related issues 

pending at DFS for more than an hour.

It is our fond hope that item Nos 2, 4, 5 and 8 may get resolved satisfactorily at the earliest. And 

NOIP, thereafter would follow up vigorously the remaining 4 items with the help of BMS Central 

Office.

We once again thank Shri.B.Surendranji for his timely intervention to get the appointment.

We wish a Happy Holi to one and all.

With greetings,

Encl: As above

 Yours Brotherly,

 General Secretary

NOIP Circular No 8 - 2023

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

NOIP Circular No. 7 - 2023

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: 19-02-2023

Circular No 07/2023

To,

The Chairperson,

LIC of India, Central Office,

YOGAKSHEMA, Mumbai

Dear Sir,

Re: Various Cut-off dates- A big blow on the gullible, hapless pensioners

Regarding the captioned matter, time and again we have brought to your kind notice, as to how the

various new benefits are being denied to the section of pensioners by prescribing the cut-off date for

every new benefit. Ironically, these cutoff dates are plaguing the old retirees in every aspect. No doubt,

the future retirees would be benefited. But what is the sin the earlier retirees have committed, as they

are losers of every new benefit extended to the pensioners. We are happy that LIC has been

magnanimous nowadays, in extending various new benefits and improving upon existing benefits to in-

service employees/future retirees. We, old retirees, especially above the age of 65 are the worst

sufferers. In every benefit, we are being excluded by way of cut-off dates. In the initial decades after

LIC’s coming into being, old retirees have strived a lot to make the LIC as to what it is now. Even the

Indian ethos/culture advocates- taking proper care of elderly people. Even the LIC has adopted the

slogan- ‘Yogakshemam Vahamyaham’, taking cue from the great epic Bhagavad-Gita. No doubt, LIC

cares for the Yogakshema of its policyholders, who are our masters. As a matter of equity, old retirees

too, deserve to be treated well by our great organization. That is the least we expect.

Hence, it is expected of the policy makers/rule makers to keep the above in mind, while framing new

benefits/improving the existing benefits for the employees/retirees. And also to see that the

discrimination based on the date of retirement, should be kept at bay .We are really fed up with the

plethora of cut off dates and every time a new benefit is declared, we curse our fate (cannot do anything

except this) because a large section of retirees is deprived of the benefit. We implore upon you to stop

forthwith the prescription of cut off dates for granting of benefits. This can only ensure justice, equity

and fair play to the retirees of all times.

We request you to have a cursory glance at the following few cut off dates which have marred the

fortunes of old retirees from time to time. Some more cut off dates too, might be staring at us?? Who knows.

Cut off date Benefit

1) 01-11-1993 Pension updation not effected till date whereas future retirees get

updated pension till their date of retirement

2) 01-08-1997 100% neutralization of DR, earlier retirees getting truncated DR

3) 01-04-2011 Mediclaim option not given thereafter to join the scheme

4) 16-06-2018 Continuation of coverage of Mediclaim to PF optees resigning on the

reason of self illness

5) 01-04-2018 GIS (Group Insurance Scheme) to retirees

6) 01-12-2021 Conversion of extended cadre loan (housing) into Basic Loan (new name

for cadre loan.

We request you to remove the above cut off dates, wherever feasible and which are within your

powers, so that old retirees can take a pleasant sigh and feel blessed.

We anticipate your positive response,

With thanks and regards,

 General Secretary

Circular 1 - Pending issues

 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: 11-01-2023

Circular 01/2023

The Executive Director (Personnel),

LIC of India, Central Office, Yogakshema,

MUMBAI

Dear Sir,

Re: Pending issues

You may please recall our meeting held with you on 19-10-2022, wherein we discussed various pending

issues. We are yet to get the expected positive response from you regarding some of the following

major issues.

1) Reckoning ADO’s period of retired development officers for calculation of gratuity and

pension

We had urged you to issue clarificatory circular regarding this issue, after you regretted to

consider the period spent on apprentice by the development officer, for the calculation of

gratuity and pension. The earlier letter by the Chief (Personnel) in this regard, clearly says that

ADO’s period (training period) is to be considered for calculating gratuity; and Pension Rules

1995, provide for considering the period spent on training for calculation of pension. As such,

we once again implore upon you to issue a clarificatory circular in this regard to the operating

offices forthwith and oblige.

2) GIS to all the retirees irrespective of date of retirement- Please refer to our earlier letter dtd.

15-11-2022. We once again request you to offer GIS to all the retirees irrespective of the date of

retirement, since the entire premium would be borne by the retiree.

3) Exclusive App for the pensioners- We were thankful to you for having acceded to our request

for an exclusive App for the pensioners. We request for the early release of the same.

4) One more option to join the group Mediclaim scheme- As discussed in detail, one more option

to left over retirees may please be given to join the scheme, at least from 1-4-2023.

5) Exclusive Portal for the pensioners- On the similar lines of an App for pensioners, we request

you to take steps to design and develop an exclusive portal for the pensioners, to cater to their

various needs.

In anticipation of positive response from your end,

Thanking you,

 General Secretary

Circular 02/2023 - Improvement/addition in Group MediClaim policy for the year 2023-24.

 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: 15-01-2023

Circular 02/2023

The Executive Director (Per),

LIC of India, Central Office, Yogakshema,

MUMBAI,

Dear Sir,

Re. Improvement/addition in Group MediClaim policy for the year 2023-24.

We wish you and all staff members a VERY HEALTHY AND HAPPY NEW YEAR.

We reiterate below some of our long pending demands regarding Group mediclaim 

policy.

Shortly discussions may start at your end with the New India Assurance company Ltd., 

for renewal of the Policy wef 01.04.2023. Hence, we felt it appropriate to place our 

reminder request for your kind consideration and taking up with NIA.

1. One time option for inclusion in the Policy for all left out cases (for what so ever 

reason), also to include son in law and daughter in law (as is allowed for GIC retirees).

2. ADD ON COVERES:

a. Reimbursement of OPD TREATMENT. Retirees and pensioners may be allowed 

OPD EXPENSES.

Else, a separate Policy for OPD may be chalked out as in case of RBI Pensioners.

b. Hospital cash benefits 1% of S.A., for maximum 30 days, as available in general 

mediclaim policy.

c. Preventive health checkup benefit, every year. This will reduce claims.

3. Increase basic Floater Sum Insured from 5lac, 6lac and 10lac to 10lac, 15lac and 

20lac with 100% contribution from LIC.

Increase Optional Total Sum Insured 75 lac to One Crore, with an option to Insured 

member/family Pensioner, can reduce the sum assured from next annual renewal date.

4. Coverages:

a. Room rent should be based on S.A, since the Insured pays the same premium

irrespective of his place of stay (whether Metro/City/Village).

For other than A and B cities, the Room rent limit is not at all increased for a long time.

This should go up.

We suggest Rs.12,500/- room rent per day up to 30 Lacs and Rs.15,000/- for 40 Lacs

and above Sum Assured.

b. Presently NURSING CHARGES are also included in the Room rent. The same

should be reimbursed separately (not as a part of room rent).

c. If one gets admitted in a room with higher rent than eligibility, then all other charges￾except Medicine and Implants- are reduced proportionately. Our request is, in such

cases, Room rent should be reduced proportionately and all other charges are paid in

full.

5. Please delete " *However the following expenses are not payable” mentioned in page

no.4, clause 7 a, b and c as most of the items mentioned are payable as per the

annexture II (item no.75,76,134,84,96,102,155,12, 78, 45, 56 91,23, 87, 104, 189, 78,

12,91,23,135,15,149,58,150,198), some items are used by Doctors for Diagnosis and

Ambulatory devices, is very much part of the treatment as it is advised by treating

doctor. They are not used for personal comfort. Hence unless this part is deleted, it will

create contradiction and confusion, which leads to wrong settlement of claim.

We also request you to overhaul the annexture II and allow more items as payable.

Item no129 Mortuary charges be increased from 24 hours to 48 hours.

6. Pre and post hospitalization Medical expenses be allowed 60/120 days.

7. In case of Renal Failure, Organ Transplantation and Cancer related ailments, pre and

post hospitalization limit of 30/60 days is waived. We propose more Life-Threatening

diseases, such as Open Heart Surgery, Brain and Central Nervous system related

diseases, Osteoporosis, Spine surgeries, cost of Botex injection, may be included in

above list.

8. Cashless Reimbursement through TPA.

TPA should give total Cashless Reimbursement and Hospital should not be allowed to

receive any amount from Insured.

TPA should arrange 24×7 hours service and their NETWORK HOSPITALS should not

ask lump sum deposit amount during non-working hours/days.

9.All Zonal TPA's should co-ordinate among each other and provide their network

hospitals for treatment of insured member of other OTHER ZONES, on cashless basis.

10. Examination relating to Diagnostic Tests without hospitalization:

List should be more comprehensive and the cost of the tests mentioned in the list be

increased by at least 25%, Include Sleep Apnea, allergy reports and more diagnostic

tests; and conditions may be liberalized. We propose all tests which cost Rs.1000/- or

more be reimbursed along with doctor’s fees. MD DOCTORS ARE NOT AVAILABLE IN

RURAL/REMOTE CENTERS or at the time of emergency situations. Hence conditions

may be relaxed and MBBS DOCTORS be allowed to prescribe for above tests.

11. Sub-limit Clause:

a. Present limit of Cataract Operations is Rs.60,000/- per eye which is not reasonable.

Limit should be removed and reimburse full cost of treatment and cost of spectacles.

b. AYUSH:

As per Government policy, Ayush treatment is to be promoted and our Insured

members are very much inclined to it. As such, we request to liberalize the conditions,

remove restriction of reimbursement of 25% of sum insured and TPAs be advised to

enroll more and more network hospitals for Ayurvedic and Homeopathy treatment and

allow cash less facilities. Treatment like Shirodhara, steam bath and Panchakarma

should be allowed.

c. Ambulance charges be revised upward and restrictions are liberalized. Ambulance

charges from Hospital to home be allowed.

d. Age Related Macular Degermation (ARMD) and treatment for retinal diseases by

intravitreal/intra occular injection/intervention are admissible only up to 1 lakh per

member per eye per year, which is very insufficient. Our members are facing hardship

because of the ceiling. The ceiling limit to be removed and actual amount be

reimbursed.

e. Psychiatric and psychometric disorders are payable up to a limit of Rs.50000/- as per

Chapter D (11). Whereas the same is shown as Not payable under Serial no.66 of

Annexure II. It is contradictory, needs correction. The limit of Rs.50000 be removed.

f. Pre and post hospitalization Physiotherapy limit of 40,000 be removed and limit of

30/60 days pre and post hospitalization expenses be waived, allow Physiotherapy

treatment at home for all such patients as per the advice of treating Doctor.

12. MATERNITY EXPENSES BENEFITS: Normal and caesarian delivery benefit cap

be removed and expenses other than hospitalization also be reimbursed.

13. EXCLUSION CLAUSE, list contains 26 items, this should be overhauled to reduce

as much as possible.

a. Reimbursement of all types of dental treatment and costs of dentures, root canal

treatment be reimbursed.

b. Now HCPT reimbursement is allowed for treatments taken outside India. Many

retirees/pensioners visit foreign country (as their siblings are in foreign country).

Reimbursement of expenses incurred in Hospitalization treatment out of India should be

included in the policy (removed from exclusions).

c. PRP (Platelet Rich Therapy)- This is less expensive and less painful compared to

joint replacement surgery,mshould be included for reimbursement in lieu of joint

replacement.

d. Robotic surgery be allowed wherever this facility is opted by a treating doctor.

14. General:

a. Senior citizens be given preferential treatment by TPA AND NIA.

b. Insisting for KYC for each and every claim should be dispensed with. (Since all

claims are processed through D.O.)

c. Submission of Claim form is to be allowed by TPA through soft copies, instead of

hard copies.

d. PPN must not be made applicable by NIA for LIC policy holders/members under our

MediClaim policy.*

e. A and B class cities for mediclaim purpose should be on the basis of CCA cities as

applicable in LIC.

f. More diseases be included, such as, Sebaceous cyst surgery, in Annexture III where

24 hours hospitalization is not mandatory.

g. Option to join the scheme be given to all resignees who resigned on health grounds,

irrespective of their date of retirement (the cut off date prescribed is 16-1-2018)

We vehemently appeal to you to consider our suggestion/improvements, and call NOIP

delegation for discussions, at the time of negotiations with New India Assurance

Company Ltd., for the year 2023-24.

Thanking you,

Yours Sincerely,

General Secretary