The Changes that can be suggested to the management for Mediclaim
- The basic sum assured should be increased from existing to Rs.8 lakhs, 9 lakhs and 10 lakhs for the existing categories. (the rationale being due to floater scheme SA being increased to 30 lakhs, the loading on HCPT funds has been considerably reduced and the accrued benefits should percolate down to the class three and four employees in the form of enhanced basic SA and subsidized premium on the increased SA.
- In view of our social practices, minor and /or “divyaang” siblings are the responsibility of their normal siblings, in case the parents have deceased. Similarly an unmarried sister is also the responsibility of her brother or sister. They should be treated as dependents of the employee and allowed cover under mediclaim policy. Moreover the premium of such other dependents (parents, 3rd child, parents-in-law) remains unsubsidized by LIC and is paid by the employee himself.
- The TPA appointed should be a single entity across LIC as it will ensure proper, timely and better coordination for Medi-claim settlement.
- The caps on individual items like room rent, nursing charges etc. should be removed and the claim settled should be considering the overall limit. Charges like Registration, Generator charges and other miscellaneous charges should be paid to the employee.
- There should be payment for dental treatment. For example “Root Canal” is a treatment for infected tooth and is not a cosmetic treatment.
- Bariatric surgery should be included in medi-claim policy.
- The mediclaim bill of an employee should preferably be settled in house and the final settlement should be between LIC and New India Assurance.
- The following diseases should come under domiciliary treatment
a. Diarrhoea and all types of Dysentries
b. Viral fever of more than 5 days duration
c. Urinary Tract Infection.
- In case the second delivery of an employee is twins, the third child should be covered under subsidized premium.
- Mediclaim should not be disallowed for children till they get gainful employment after they complete their education.