OPD Scheme for RBI Pensioners Age 70 and above
Group Mediclaim Policy for OPD to Pensioners for the period April 01, 2022, to March 31, 2023 has been placed with New India Assurance Co. Ltd.
The salient features of the policy are given in Annex I.
OPD expenses incurred by members will be reimbursed by the Insurance Company up to their respective grade wise sum insured amount.
|Sum Insured (in ₹) Age 70 and above
|Sum Insured (in ₹) Age 75 and above
|Grade F & ED
Grade wise limits
This policy will additionally cover those dependent children of the retired employee (pensioner of 70 years of age and above) who have permanent or temporary physical / mental disability as defined under Rights of Persons with Disabilities Act 2016 and are incapable of being gainfully employed, under the combined sum insured. The Bank shall confirm the eligibility of such cases.
The insurance policy will be administered by Third Party Administrators (TPAs) at all centres. All claims pertaining to pensioners attached to respective offices will be settled by the designated TPAs, irrespective of the place where the treatment is taken. Contact details of location wise relationship managers of TPAs, insurance company and the broker are given in Annex II.:
Claim is to be lodged with TPA within a period of 60 days from the date of treatment/procedure taken by the pensioner or spouse or dependent children (as defined in para 4 above), by submitting original documents (except where exempted).
Pensioners attaining the age of 70 years during a particular month will be added in the Group Mediclaim Policy from the first of the succeeding month and in the event of death of a pensioner, his/her spouse will continue to be covered.
Allotment of TPAs
Names of designated TPAs for the policy and Offices/Departments allotted to them are as under:
|Name of the TPA
|Medi Assist Insurance TPA Pvt. Ltd.
|Ahmedabad Bengaluru Bhopal CAB-Pune Chennai Hyderabad Kochi Mumbai (Central Office / MRO / Belapur) Nagpur Panaji Thiruvananthapuram
|Health Insurance TPA of India Ltd.
|Agartala Aizawl Bhubaneswar Chandigarh Dehradun New Delhi Gangtok Guwahati Imphal Jaipur Jammu / Srinagar Kanpur Kolkata Lucknow Patna Raipur Ranchi Shimla Shillong
Allotment of Offices/departments to TPAs
Improvements in the Policy:
- Enhanced limit for medical appliance purchase, without the need to submit doctor’s prescription, from ₹3,000/- to ₹5,000/-.
- Extended coverage of the policy to include dependent children (mentally/physically disabled) of the retirees who are 70 years of age and above.
- Allowing the retirees covered under the policy to avail reimbursement towards repair/exchange of hearing aids up to a maximum of ₹10,000/- per policy year on cumulative basis.
- Appliances such as steamer, elastic crepe bandage, heating pad, spine support etc., have been newly included in the list of eligible appliances.
- Local ambulance charges for admission, transfer to another hospital and / or discharge under critical condition as advised by the doctor for only outpatient treatment up to a cumulative limit of ₹2,000/- has been included within the assigned monetary limit.
- The improvements are minimal. Grade wise sum insured amount has not been revised upward despite constant rise in costs of treatments and equipment.
Source: All India RBI Oers Pensioners Forum