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NLC India Post Retirement Medical Insurance Scheme
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NLC India Post Retirement Medical Insurance Scheme
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[QUOTE=ijt.jency;301216][B][U]Name of the Organisation [/U][/B]: Neyveli Lignite Corporation Ltd [B][U]Type of Facility [/U][/B]: Post Retirement Medical Insurance Scheme [B][U]Location [/U][/B]: India [B][U]NLC Website [/U][/B]: [URL]http://www.nlcindia.com/[/URL] [B][U]NLC Ex-Employees' Portal [/U][/B]: [URL]https://web.nlcindia.com/retir_portal/main.php[/URL] [B][U]Post Retirement Medical Insurance Scheme [/U][/B]: ** All the PRMA members (retired employees and their Spouses or either one living - whose PRMA membership is renewed and newly joined members) are covered under a Tailor Made Medical Insurance Policy. ** This Policy will cover all the expenses required to be incurred by the PRMA Members and their spouses at the time of taking treatment as in-patient in any Hospital subject to a maximum expenditure of Rs.2.00 Lakhs per 'Unit' on Floater Basis per year. A 'Unit' is defined as the family of the retired employee, consisting of only retired employee and the spouse [B][U]Floater Basis means [/U][/B]: * Both PRMA Member and Spouse can incur medical expenditure as in-patient up to a maximum of Rs.2.00 Lakhs OR * Any one of the Unit (i.e. either PRMA member or Spouse) can take treatment in a year to the maximum limit of Rs.2.00 Lakhs or part there of. ** Category wise Policies :- three different policies under the same tender. ** All retirees retired before 01-01-2007. ** Executives and Non-Unionised supervisors retired on or after 01-01-2007. ** Inter & Lower and Labour retired on or after 01/01/2007. ** The entire cost of premium towards this Insurance Policy will be borne by N.L.C. ** This Health Insurance Scheme does not cover Domiciliary Hospitalisation Expenses. ** The tender for nomination of Insurance agency is done every year. ** Period of insurance coverage is 1st September to 31st August of every year ** Current Insurance Agency : M/s National Insurance co. Ltd., Blk-25, Neyveli-3 ** Third Party Administrator : M/s VIDAL Health TPA Pvt. Ltd., Chennai (formerly TTK) ** All those members covered under the insurance are given a VIDAL Health ID Card. [B][U]Applicability & Limitations of the Scheme [/U][/B]: ** The scheme shall cover all diseases including all existing diseases prior to retirement. ** The treatment shall be restricted to Allopathy only (including physiotherapy) and all other forms of treatment - Viz. Ayurvedic, Acupuncture, Siddha, Unani, etc. shall not be considered. ** Extension of benefits to any Member (retired employee/spouse) on account of remarriage after retirement shall not be permitted. ** The Insurance need not be covered for Minor Illness such as those requiring medical attention through consultation of a Physician/Specialist and/or requiring clinical tests including X-ray etc. leading to intake of drugs or otherwise, but not hospitalization and excluding surgical intervention, Laproscopic, Lazer treatment etc. [B][U]Treatment [/U][/B]: [B][U]Salient Features [/U][/B]: ** Cashless Treatments ** Reimbursement of Treatment Expenditures ** 24 Hour Help Line Service through Toll Free Numbers ** Pre-hospitalisation expenses. ** Post-hospitalisation expenses. ** Treatment for all Pre-Existing Diseases. [B][U]This Health Insurance scheme covers [/U][/B]: ** Hospitalisation expenses for illness/ diseases or injuries sustained including Burn Injury. ** Life threatening illness like Stroke, Heart Attack, Kidney failure etc. ** Cataract/IOL, Chemotherapy, Dialysis etc. ** Treatment for Benign, Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, Sinusitis. ** Surgical intervention including laser, Laparoscope etc. replacement of vital organs like Kidney, liver, denture work and replacement of hip/joints/ bones/kneecaps etc. ** CAPD Dialysis ** EECP Specialised OP Treatment ** Specialised TRIOGENIUM Eye Treatment ** Avastin Injection for eye treatment [B][U]The expenses covered also includes [/U][/B]: - ** Room rent. ** Nursing Expenses. ** Diet charges for patient only. ** Transport from one hospital to another hospital for better treatment on recommendation of Chief Medical Officer of the hospital or at the discretion of the patient. ** Surgeon, Anesthetist, Medical Practitioner, Consultants Specialist Fees. ** Anesthesia, Blood, Oxygen, Operation Theater charges, Surgical Appliances, Medicines and Drugs, Diagnostic Material and X-ray, Dialysis, Chemotherapy, Radiotherapy, as well as Cost of Pacemaker, Artificial Limbs and cost of Organs and similar expenses. ** Ambulance charges from the spot of accident to the hospital or Transportation of Dead body from hospital to residence. [B][U]Procedure for Treatment [/U][/B]: The members can avail cashless treatment from the list of network hospitals including Multi-Specialty Hospitals/Polyclinics available throughout India recognized for treatment under cash free facility. [B][U]Claim Settlement procedure [/U][/B]: ** In case, the members avail treatment from the non-network hospitals, then the claim for reimbursement is to be sent to the Third Party Administrator (i.e M/s VIDAL HEALTH TPA Pvt, Ltd., Chennai) within 30 days of date of discharge from the hospital. ** The claim form should accompany all original - reports, bills and discharge summary [B][U]Grievance Handling Mechanism [/U][/B]: [B][U]a. General [/U][/B]: NLCs Retired Employees Grievance Cell functioning under Welfare section will handle all grievances pertaining to this Scheme in Liasion with the Insurance Company and / or the Third Party Administrator. [B][U]b. Legal [/U][/B]: NLC will not be bound by any legal action from the Members/Dependents of Members/Hospitals, on account of the execution of the Scheme or treatment. It is the risk and responsibility of the Insurance Company to handle and settle all Legal issues/claims. [B][U]Restrictions on Reimbursement [/U][/B]: 1. Sum Insured [Floater Basis] Rs.2.00 Lakhs per year 2. Treatment restricted to Allopathy only 3. Room Rent Rs.1000/-(In respect of reputed hospital minimum room rent shall be applicable) 4. Diet Charges Rs. 2000/- per illness 5. Pre & Post - Hospitalisation expenses Rs. 10000/- per year 6. Ambulance charges from spot of accident to the hospital or Transportation of Dead body from hospital to residence Rs.2000/- 7. Pre - Hospitalisation Expenses 30 days before Hospitalisation 8. Post - Hospitalisation Expenses 60 days after Hospitalisation 9. Dental Treatment Dental treatments covered only when Hospitalised. [B][U]Contact Us [/U][/B]: Benefit Co-Ordination Cell , PRO Building , Neyveli Lignite Corporation Limited , Neyveli - 607 801 , Cuddalore , Tamilnadu . [B][U]E-Mail Id [/U][/B]: [EMAIL="retireeportal@nlcindia.com"]retireeportal@nlcindia.com[/EMAIL][/QUOTE]
