Detailed clarifications for GMP for OPD to RBI Pensioners -70+

This is in  continuation of our earlier post dated 10th November.
RBI has now issued detailed clarifications for GMP for OPD to RBI Pensioners by their circular dated January 1, 2018.  Policy Period is – January 1, 2018 to December 31, 2018.
As the circular  consists of  16 pages, it has been divided into 9 sections, for the sake of simplicity and  convenience of the members/subscribers. click and view each part.

Part 1. Forwarding letter. 

Part 2. TPAs names and Zones allotted

Part 3. Relationship Managers with email addresses and details.-Location wise

Part 4. Insurance Brokers and Company details.

Part 5. Grade wise List of Amounts 

Part 6. Frequently Asked Question.

Part 7. Coverage of the Scheme.

Part 8. List of appliances. 26 appliances are covered

Part 9. Claim sheet format.

Some of the important features are listed below:

1. OPD policy takes care of expenses on services like OPD consultations, Diagnostics referred by consultants but not leading to hospitalisation, Pharmacy Bills, i.e. Bills related to Medicines, Dental treatment, Spectacles, hearing aids etc.
   A Member needs to pay the expenses for OPD treatment at the clinic/hospital and then submit a reimbursement claim for claiming the expenses incurred.
   2 Health Insurance TPA Pvt Ltd. (North & East Zone) & Medi-Assist TPA Ltd. (South & West Zone) for the period starting January 01, 2018 to December 31, 2018.All the pensioners, irrespective of MAF membership, are covered under the OPD policy.

3. Personal Promotion (PP) will not be taken into consideration for the scheme viz. Grade B (PP) will be entitled for Grade      A  limits only.
4. Spouse will continue to be covered even after the demise of the pensioner.
5. All the Pensioners will be issued TPA Cards along with welcome letter giving details of the scheme. The TPA Cards will be posted to the registered address of the pensioner available with RBI from January 15, 2018 onwards. If your Card Welcome kit is not received by January 31, 2018, please approach the Regional Office/COD of RBI from where the pension is drawn.
5. the OPD scheme will be applicable to homeopathic medicine obtained from registered homeopathic doctors.
6. Following are the instructions to file a claim:-
• Collect all the original documents post completion of the OPD treatment;
• Fill the OPD claim form;
• Submit or courier the claim documents in a sealed envelope to the Medical
Section of RBI or the TPA address; and
• Consultations/documents provided should be attested/ signed by the
authorized/ treating doctor. The attestation should include Doctors Name,
Degree and Registration Number.
Following are the documents which are required to be submitted:
• Duly filled Claim form.
• Copy of TPA Health ID card.
• Payment Receipts in original.
• Doctor’s Prescriptions in original.
• All investigation reports in original
• All investigations to be supported by doctor’s advice for the same.
• All pharmacy bills to be supported by doctor’s advice for the same.
• NEFT Mandate / Cancelled Cheque – at the time of first claim only.
• KYC document – at the time of first claim only.

All the documents have to be submitted IN ORIGINAL.
The claim should be submitted within 30 days from the date of last treatment/procedure for a particular ailment. In case of delay the claim may be rejected. It may be noted that claims will be entertained on completion of treatment and any claim towards advance payment/ future treatment/annual-monthly membership expenses will not be entertained.
It would be ideal to collect all the bills up to minimum of RS.5000/- or on monthly basis, and submit it collectively for administrative purpose
Bank will make all efforts to ensure TPAs do not harass and claims are settled at the earliest.
There are no limits to the number of treatments. One can claim the amount till the limit is exhausted, provided the treatment/benefit availed is covered under the OPD scheme.