For Exservicemen AFGIS Clarification by MoD Authority

For Exservicemen AFGIS Clarification by MoD Authority

AFGIS is likely to start medical / health insurances in addition to ECHS facilities already exist for the veterans of IAF. In this regard a clarification on various aspects of the proposed health insurance has been published and reproduced below :-

FAQs ON THE PROPOSED HEALTH INSURANCE SCHEME FACILITATED BY AFGIS – FOR AIR VETERANS

SL NoQUERY CLARIFICATION
NO  
 
 Who will be the insurance agency     /TPA    for                the proposed health insurance scheme?AFGIS while working on     this                                                               concept of health insurance,      had        discussions      with      all                   the    leading insurance companies providing medical insurance viz Star Health.       HDFC        Ergo,        Care                               health    and     ICICI Lombard. Finally, after comparing all plans, premium and conditions, ICICI Lombard was zeroed in as Third Party Agency (TPA) and they will be providing the insurance cover
 What age group will the insurance        policy be covered?The insurance policy premium worked out isfor age group 57 to 80 years. However for Short Service Commission     officers    and       airmen                         retiring     early, a category of 35 to 56 and for veterans above 80 years, separate premium can be worked out depending on response & willingness from the Air Veterans.
 What     does          OPD                    cover include?OPD          cover         will   include    dental,            vision,   pharmacy, diagnostics and consultations and will be on floater basis i.e. amount can be utilized by both husband & wife during the term of policy.
 How      will             OPD             bills bereimbursed?Reimbursement of OPD bills will be faceless through “IL app of ICICI Lombard. Further the app will also provide other services such as consultation, customer care help, settlement of claims status etc.
 Is   the   health      Insurance cashless &what will be the claim settlement process? Is    there      any    limit        of expenditure     for           particular disease?Hospitalization    expenditure       will    be                                                            on         cashless basison the basis ofa card issued by the TPA to the policy holders. All diseases will be covered and there will     be              no  limit on      expenditure    on any             particular disease.      Only     condition    for                 reimbursement      of expenditure is that the expenditure should be within the overall limit of the plan selected.
 Benefits      of                   proposedBenefits of scheme include OPD cover, tax deduction

The proposed Health Insurance – Dpubt clear

scheme  under 80 D, faceless reimbursement of claims through IL app, best in class claim settlement ratio, wide range of hospital network etc. Also, after negotiations, the requirement of medical examination was waived off and many other benefits including reduced premium as compared to plans available in the markets was arrived at.   
Why PED for one year & whether policy starts from day 1?  As regards Pre Existing Diseases (PED), generally the insurance companies have a clause of waiting period up to 4 years.However after negotiation with the insurance company, they have agreed for PED clause for a period of onlyone year for those diseases for which individuals are already on medications. However. PED doesn’t debar from reimbursement of hospitalization expenses for diseases contracted after commencement of the policy. So, technically the policy starts from Day 1. 
Will the proposed scheme will have effect on existing medical arrangements?  For the proposed scheme 2 adults that are eligible are husband and wife.   
Is the          scheme also applicable for parents / In laws?  This proposed scheme is in addition to the existing ECHS and in no way would dilute or discontinue existing medical arrangements which presently Air Veterans have through ECHS.   
 Note:Presently, only opinion of the Air Veterans is being sought on the scheme. Based upon the response, a final proposal will be made and circulated for acceptance by the Air Veterans.   
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