Tuesday, October 18, 2016

Clarifications on Domicilary Cover by United India Insurance Company

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. 

 Domiciliary Hospitalization / Domiciliary Treatment
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


  1. Very good. There have been so many blogs/views on the
    renewal 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.

  2. Further, We have received clarifications by way of answers for the queries raised by AIURBF.

    Group Insurance Medical Policy: Reply of T.P.A.Paramount Inc.


    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.
    AIUBRF’s query

  3. Reply of T.P.A.

    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.

    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?

    How frequently can the retired employee be permitted to claim the reimbursement for domiciliary treatment i.e. weekly, monthly, or quarterly?

  4. 4
    Whether 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.

    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.

    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.

    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.

    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.

    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.

    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.

    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.

  5. I have given the clarification in 3 parts since it is somewhat big and blog do not allow such big comments. Kindly pardon me.