Life Insurance Corporation of India - Mediclaim highlights - excellent group mediclaim scheme

1. Prepared by Harishkumar R Desai , development officer, Br.888, Mumbai-III: Only for broad, general information and simple understanding only:
Colleagues are cautioned that final interpretation as given by New India Assurance company in their policy document and the policy terms and
conditions as mentioned in the policy document available with LIC of India and New India Assurance Co Ltd will hold good and will be supreme for
any interpretations.
Highlights of LIC staff Mediclaim 2018-2019
1. Validity: From 1-4-2018 to 31-3-2019 and anywhere in India only.
2. Type: Floater.
3. Eligible insured: Self (in service or retired), spouse, independent children till their marriage, dependent male
child up to age 21 and up to 25 if student; Female dependent child: Unmarried, widowed or divorced,
Dependent parents or parent- in- laws of an in service employee; Spouse & dependent children of deceased
employee; physically handicapped or mentally retarded fully dependent children. Financial dependence means
income up to Rs.9,450/- pm.
4. Types of cover : All illnesses/ diseases/surgeries as approved as also the following:
i. Maternity, New born child
ii. All pre existing disease covered.
iii. Diagnostic test without hospitalization covered.
5. 1.5% of SA as room charges. Maxi Rs.7500, Rs5000/- and Rs.4000/- per day depending up on the type of city
classification. (Maxi Rs.8500 per day for Class A with 40 or 50 lakh floater) for ICU NO Capping.
6. Hospital should have mini 15 beds /more than 10 lacs population and 10 beds for up to 10 lacs population cities.
7. Pre hospitalization expenses up to 30 days payable. Post hospitalization expenses up to 60 days payable.
8. Cashless :: ADMISTRED by TPA as per Zone. E card issued by TPA with photo identity needed.
9. Diagnostic test covered. Rs.75,000/- per family payable only ONCE during policy term per insured.
a. MRI / CT scan,
b. Sonography /Echo test
c. Biopsy( external or internal)
d. Treadmill
e. Gastorscopy/colonoscopy
f. EEG/ EMG and many more.
10. Surgeon fees and anesthesia fee: limited to 25% of Sum assured.
11. Cataract Charges: Maxi. Rs.60,000/- per eye.
12. Ayurvedic/ Unani/ homeopathic ONLY from GOVT/NABH/QCA approved institution.25% SA.
13. Ambulance charges Maxi Rs.5000/-
14. Lasik laser treatment: Maxi. Rs.35,000/- per eye.
15. Maternity Delivery charge Normal: Rs.65,000 and caesarian: Rs.125,000/-for 1st two child.
16. Ambulance charges Rs.5000 maxi.per occasion.
17. Cochlear implant Rs.10 lakh with Rs1.50 lakh co sharing.
18. Physiotherapy (part of pre/post hospitization) Rs.40,000 per person per year
19. Thalessima treatment 75% of sum assured.
20. Domiciliary hospitalization 20% of sum assured.
21. Robotic surgery- Allowed only for cancer, brain and spine cases.
22. Claim intimation: within 7 days of hospitalization to LIC office.
23. Claim submission: within 20 days of discharge from hospital.
24. TPA names ( For cashless)
i. Western, North MD India 18002335588
ii. North central Raksha TPA 18001039533
iii. Central Zone Health India 1800220102
iv. East , East Central Zone Heritage Health 18003453477
v. South Central Zone Medi Assist 18004191154
vi. South Zone Vidal Health 18004258565
Additional requirement for NON CASHLESS CASES:-given below:
Claim documents required (Basic and Normal case):
a. Claim form b. Discharge summery (Original)c. Doctor prescription (Copy only. Duly verified by Class I officer of LIC), d.
Bills/cash memos and receipts (Original), e. Diagnostic reports (Copy only. Duly verified by Class I officer of LIC), f. Dependent
certificate. g. Contact number, email id, & correspondence address of claimant.