The United India Insurance Company has clarified that "The Domiciliary Cover of Rs.40000 or Rs.30000 reimbursement is within overall sum insured. The retiree / claimant has to use the same within the overall sum insured he is entitled for. With Domiciliary Expenses and Hospitalisation claim the sum insured should not exceed Rs.40000 and Rs. 30000 respectively."
The insurance company has sent the list of 59 ailments covered under domiciliary treatment, which is given below.
Sr.
No. Treatments
1 Cancer
2 Leukemia
3 Thalassemia
4 Tuberculosis
5 Paralysis
6 Cardiac Ailments
7 Pleurisy
8 Leprosy
9 Kidney Ailment
10 All Seizure disorders
11 Parkinson’s diseases
12 Psychiatric disorder including schizophrenia and psychotherapy
13 Diabetes and its complications
14 Hypertension
15 Hepatitis –B
16 Hepatitis - C
17 Hemophilia
18 Myasthenia gravis
19 Wilson’s disease
20 Ulcerative Colitis
21 Epidermolysis bullosa
22 Venous Thrombosis(not caused by smoking) Aplastic Anaemia
23 Psoriasis
24 Third Degree burns
25 Arthritis
26 Hypothyroidism
27 Hyperthyroidism expenses incurred on radiotherapy and chemotherapy in the treatment of cancer and leukemia
28 Glaucoma
29 Tumor
30 Diptheria
31 Malaria
32 Non-Alcoholic Cirrhosis of Liver
33 Purpura
34 Typhoid
35 Accidents of Serious Nature
36 Cerebral Palsy
37 Polio
38 All Strokes Leading to Paralysis
39 Haemorrhages caused by accidents
40 All animal/reptile/insect bite or sting
41 Chronic pancreatitis
42 Immuno suppressants
43 Multiple sclerosis / motorneuron disease
44 Status asthamaticus
45 Sequalea of meningitis
46 Osteoporosis
47 Muscular dystrophies
48 Sleep apnea syndrome(not related to obesity)
49 Any organ related (chronic) condition
50 Sickle cell disease
51 Systemic lupus erythematous (SLE)
52 Any connective tissue disorder
53 Varicose veins
54 Thrombo embolism venous thrombosis/venous thrombo embolism (VTE)]
55 Growth disorders
56 Graves’ disease
57 Chronic Pulmonary Disease
58 Chronic Bronchitis
59 Physiotherapy and swine flu shall be considered for reimbursement under domiciliary treatment.
Source: Circular by Bank of India
Very good. There have been so many blogs/views on the
ReplyDeleterenewal of Mediclaim Policy by UIIC, and enough is enough because by now all the retirees, who need to be covered
under the Policy, must have got their accounts debited
by now with the renewed premium amount. It is time to
move on with all the remaining issues, particularly
those pertaining to the follow-up the Kolkatta High
Court judgement on the DA treatment to all the retirees
(including those retired prior to the year 2002),
maintaining that there should be no discrimination but
total uniformity and the pension to all the left-over
classes who are yet to any paisa as pension. Thanks for the understanding by all the Retirees' bodies who can
concentrate on more productive issues.
Further, We have received clarifications by way of answers for the queries raised by AIURBF.
ReplyDeleteGroup Insurance Medical Policy: Reply of T.P.A.Paramount Inc.
DOMICILIARY TREATMENT – CLARIFICATIONS
We have in our earlier communication informed the members that the Federation has requested The Paramount Health Services Pvt. Ltd, the Third Party Administrator (TPA) of UIIC to clarify the rules and procedure for reimbursement of domiciliary treatment expenses to remove uncertainty.
We have received the reply from TPA which is appended here below for the information.
No.
AIUBRF’s query
Reply of T.P.A.
ReplyDelete1
Why is the procedure for reimbursement of domiciliary treatment not clearly outlined? It is being confused with the domiciliary conditional clause of individuals unable to be hospitalized or lack of space in hospitals?
It is a Domiciliary Treatment and not a Domiciliary Hospitalization.
2
Whether the rules and procedure followed/adopted in respect of in-service employees for sanction of reimbursement of domiciliary treatment is the same for retirees?
YES
3
How frequently can the retired employee be permitted to claim the reimbursement for domiciliary treatment i.e. weekly, monthly, or quarterly?
Monthly
4
ReplyDeleteWhether the retired employees would be sanctioned reimbursement for domiciliary treatment as per the list of 59 diseases circulated by the Bank, such as Diabetes, hypertension etc., on self certification or based on prescription of the general / family doctor or is it compulsory to obtain prescription from the hospital?
To Claim Domiciliary will need Doctor Consultation, prescription, Medicine bills/Investigation reports all in original.
5
How often must the retiree get fresh certification from the doctor/hospital?
Valid upto 90 days i.e. 3 months and if the prescription says LIFE LONG TREATMENT the same will be valid for 180 days.
6
Are those who retired from the Bank in the last year, entitled to Opt under this new Scheme?
Only who were covered in last year policy.
7
An important advantage of the Scheme is the Cashless facility available for treatment in hospitals. But many hospitals are not covered by tie-up and hence employees are asked to pay for the treatment and then seek reimbursement. How can retires avoid such difficulties to avail cashless treatment facility?
We would request those retirees to check on the portal www.paramounttpa.com/iba
the Network list before getting hospitalized.
8
The Settlement and the Scheme clearly provide that retirees would submit the Bills to the Banks and in turn the Banks to submit the Bills to the TPA to get the reimbursement. But in many some of the managements are asking the employees to submit the Bills directly to the TPA.
Should be submitted at your branch office from where you collect your pension.
9
There are instances of death occurring during treatment in hospital and if it happens to be Sunday or holiday, the hospital/TPA does not come to the rescue and the family is facing problems in getting the body of the patient in time.
We are processing the Cashless on week days and on national holidays also so there is no question that TPA doesn’t help during crisis; only issue is there when the Sum Insured is exhausted.
10
Treatments like Dialysis, etc. are disallowed by the TPA though covered by the Scheme and the employees are forced to pay the cost to the hospital. How can the scheme be implemented by the TPAs so that employees are not put into such hardship.
Day care list is already shared to all by Union Bank of India - Day Care List, and we have settled lot of Dialysis cases so where is the question of disallowing the same.
11
In the case of Bills submitted to the Banks for domiciliary treatment, there are many complaints of undue delay by the TPAs and managements are not taking steps to liaise with them to expedite the claims. Special attention is required in this regard.
Last year there was no Domiciliary treatment so where the question of delay and delay is only happens when the documents are not proper or there is a deficiency. So we would request all to submit proper documents and in the given time frame.
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I have given the clarification in 3 parts since it is somewhat big and blog do not allow such big comments. Kindly pardon me.
ReplyDelete