Name of the Organisation : Neyveli Lignite Corporation Ltd
Type of Facility : Post Retirement Medical Insurance Scheme
Location : India

NLC Website : http://www.nlcindia.com/
NLC Ex-Employees' Portal : https://web.nlcindia.com/retir_portal/main.php

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Post Retirement Medical Insurance Scheme :
** 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

Floater Basis means :
* 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.

Applicability & Limitations of the Scheme :
** 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.

Treatment :
Salient Features :
** 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.

This Health Insurance scheme covers :
** 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

The expenses covered also includes : -
** 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.

Procedure for Treatment :
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.

Claim Settlement procedure :
** 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

Grievance Handling Mechanism :
a. General :
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. Legal :
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.

Restrictions on Reimbursement :
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.

For More Details, Click Here : https://www.vidalhealthtpa.com/home.html
Contact Us :
Benefit Co-Ordination Cell ,
PRO Building ,
Neyveli Lignite Corporation Limited ,
Neyveli - 607 801 ,
Cuddalore , Tamilnadu .

E-Mail Id : retireeportal@nlcindia.com