SAIL Mediclaim Policy Extended upto 31st March 2015

Advice: Since the Policy has been issued by SAIL pl. contact for clarification the concerned person of your Plant / Unit or Vaani Kapoor in SAIL Corporate Office. Details are provided in the last page of this Circular.

No. PER/ITB&Med./Ren/Mediclaim

                                      Dated: ­­­31^st December, 2014

Name of the Member

Address

Sub:  Extension of SAIL Mediclaim Scheme for period 1^st January, 2015 to 31^st March, 2015

Ref:  Mediclaim Index Number (MIN) Self …….………..…… Spouse ………………….

Dear Sir/Madam,

At the outset we wish you a very happy and fulfilling new year.

As you are aware, the existing Mediclaim Scheme - 2014 expires on 31^st December 2014. It has been decided to extend the current SAIL Mediclaim Scheme for a period of three months i.e. for period 1^st January, 2015 to 31^st March, 2015. The benefits under the scheme being :

·        Hospitalization coverage (IPD) upto Rs. 2.00 lacs per member with clubbing facility between the Mediclaim member and his/her spouse, for all members.  

·        The OPD coverage, for members below 70 years of age as on 31.12.2014, is Rs. 4,000/- per member (no clubbing facility).  

·        The OPD coverage, for members who have completed 70 years of age as on 31.12.2014, will be Rs.8,000/- per member (no clubbing facility).

It is hereby informed, that SAIL Mediclaim Scheme has been extended with M/s National Insurance Co. Ltd. for a period of further THREE MONTHS ONLY FROM 1^ST JANUARY – 31^ST MARCH, 2015.  From 01.01.2015, a Mediclaim member can avail of the cashless/reimbursement facility under hospitalization, as was being done earlier. OPD facility will continue to be under reimbursement system. The administration of the Mediclaim Scheme under cashless as well as on reimbursement basis will be done by Third Party Administrator (TPA). The cashless facility under hospitalization will be available in the hospitals empanelled by the TPA. For other hospitals, members can avail of the hospitalization facility, on reimbursement basis. The claims on account of reimbursement of OPD/IPD claims for the period will have to be lodged with TPA. The TPA for the period 1^ST JANUARY – 31^ST MARCH, 2015, will be M/s E-Meditek (TPA) Services Ltd.  Booklet of 2014 will be valid for the period 1^st January – 31^st, March, 2015.

Cappings/Ceilings in the following areas will continue:

·        Room Rent Charges / Procedural Charges

·        Implants/ Stents for Coronary Angioplasty

·        Lenses for Cataract Surgery

·        Implants for Knee/ Hip joint replacement

·        Cappings on certain Procedures/ Packages

Members are further requested to strictly adhere to the following:

i)          Inform/Intimate, in writing to the TPA at least 48 hrs. prior to any elective/planned Hospitalization/Admission.

ii)       In case of Emergency Admission/Hospitalization, the TPA to be informed in writing within 24 hrs. of such hospitalization.

iii)     Claim intimation to be considered mandatory for both Cashless and Reimbursement claims for IPD.

iv)     Claim intimation to be sent via Letter/E-mail/Fax/Personally at TPA offices.

v)       Reimbursement claims with respect to IPD to be submitted to the TPA, within 30 days from the Date of Discharge from Hospital.

vi)     Reimbursement claims pertaining to Post Hospitalization (IPD) treatment to be submitted to the TPA, within 30 days after the completion of permissible post Hospitalization treatment period of 60 days.

vii)  OPD Claims to be submitted to the TPA, when the expenses exceed Rs. 2000/- per person per policy period or within 90 days from the date of treatment, whichever is earlier.

viii)                        To facilitate payment of reimbursement of claims through ECS, members are advised to fill in the details as indicated in the attached Form.

The premium payable for a member under 70 years of age, as on 31.12.2014 is Rs.484/- (Rupees Four Hundred Eighty Four only) per member, for a member who is aged between 70-80 years as on 31.12.2014, premium payable is Rs.434/- (Rupees Four Hundred Thirty Four only) per member and for members aged 80 years or above as on 31.12.2014, the premium payable is Rs.289/- (Rupees Two Hundred Eighty Nine only) per member. You are requested to refer the indicative table enclosed herewith, and arrive at the premium amount as per the date of birth of member and spouse.  You are requested to pay your premium for renewal of your Mediclaim membership for the period as per the procedure for premium payment, detailed in the enclosure. The premium receipt and the renewal details as per the enclosed format (Application Form) are to be sent to the concerned SAIL Plant/ Unit, positively by 31^st January 2015 extended by SAIL upto 28th February 2015. Your membership for the period 1^st January – 31^st March, 2015 will only be activated/renewed, once SAIL receives your filled-in Application Form along with your premium payment receipt.

You are   requested to submit all your pending Mediclaim Bills pertaining to the year 2014 to M/s. E-Meditek TPA Services latest by 15^th January 2015 positively. The TPA for SAIL Mediclaim Scheme-2014 will not entertain any claims received by them after 15^th January 2015.

Thanking you,

Yours sincerely,

IRP

PROCEDURE FOR PREMIUM PAYMENT

SAIL Mediclaim Scheme (extended for period : 1^st January – 31^st March, 2015)

I.       New Payment Options

·        SAIL has a tie-up with SBI for facilitating the medical insurance payment.

·        Premium can be paid online through Credit Card/ATM-cum-Debit Card/Internet Banking etc.

·        Payment can also be made at any of the SBI Branches along-with pre-filled-in, computer generated, challans (having State Bank Collect Reference No. printed on the challan form). The payment maybe made by the member or his/her representative for self/spouse/both, as the case may be.

·        Facilities /transaction charges for chosen option are detailed below at Para III in Table A.

II.         State Bank of India (SBI)

SBI- Collect - Link: www.onlinesbi.com

a)     On the first screen click on the tab “State Bank Collect”.

b)    Next Screen–check/click the box “I have read and accepted the terms and conditions stated above” and click on the Proceed Button.

c)     Next Screen - Select “National Capital Territory of Delhi” from the drop-down menu for “State of Corporate/Institution” and select “Industry” from the drop-down menu for “Type of Corporate/Institution”.

d)    Select “Steel Authority of India Limited” from the drop-down menu for Industry Name and then click GO button.

e)     Next Screen - From the drop-down menu, select either “Mediclaim Self/ Mediclaim Spouse / Mediclaim Both”, as the case may be.

f)      Next Screen - Enter MIN No. (Medical Index Number):-For option “Mediclaim self” or “Mediclaim both”, enter the MIN No. of the SAIL Ex-employee. For option “spouse” only, enter the MIN No. of the spouse.

g)    Click the “Submit” button. Next Screen displays member details. Fields marked with * (asterix) are mandatory/compulsory fields. Applicable amount will automatically be displayed in the Amount field. {In case of discrepancy in applicable premium amount, pls. contact IRP(Internal Resource Person) of your concerned plant/unit}

h)    In the second part of the same Screen- The person making payment may enter his/her Name, Date of Birth & Mobile Number. This is required to reprint the challan, if the need arises. Once done, click on the Submit button.

i)       Next Screen - All details of the member are displayed. Please check/verify the data on this screen and then proceed to the payment screen.

j)       The options for payment along with the applicable transaction charges are displayed on the next screen. The applicable transaction charges are also indicated in the table below.

k)    Members may choose to make payment directly through Credit Card/Debit Card/ATM card/Internet Banking;

l)       Apart from the above payment options, concerned member can also take a print out of the computer generated challan (having a pre-printed State Bank Collect Reference No.) and use the same for making payment through cash or cheque at any of the SBI Branches. Please note that for payment through cash or cheque, the member is required to submit the computer generated challan (mandatory) along with the payment.

m)  On successful payment, the member shall be prompted to print the e-receipt. However, in case of ‘challan’, there will be an option to print challan.

III.       The convenience charge/ transaction charges for availing the above services, are as follows:

Table-A-SBI

Transaction/ Convenience charges for Payment using SB Collect option – www.onlinesbi.com
SBI ATM cum Debit Card	Debit/Credit Card (other than SBI ATM-cum-Debit card)	Payment through system generated pre-filled-in challan at SBI Branch	Internet Banking
Rs.10 per transaction	1.8% of transaction value + Rs.10 per transaction	Rs.34 per transaction	Rs.10 per transaction for Internet Banking of SBI. Rs.15 per transaction for other banks.

IMPORTANT NOTES:

·        Once payment is successful and acknowledgement / receipt has been obtained, members are required to send the photocopy of the same along with the duly filled-in application form to the respective  IRPs of the concerned Plant/Unit, to activate the membership for the period 1^st January – 31^st March, 2015.

·        SAIL shall bear no responsibility in case the member has filled incomplete/wrong data/details while proceeding for premium payment for renewal for the period 1^st January-31^st March, 2015.

  

SAIL Mediclaim Scheme for the period 1^st January – 31^st March, 2015

1.0               OBJECTIVES OF THE SCHEME:

To extend the Medical Benefits to the retired employees of SAIL and their spouses.

2.0               PERSONS COVERED

a.     Retired employees of SAIL and their spouses

b.     The employees who have taken voluntary retirement and their spouses

c.      The employees who cease to be in employment on account of permanent total disablement and their spouses

d.     The spouse of an employee who dies in service

e.      Employee who resign from the Company at the age of 57 or above and their spouse 

This scheme is optional and those who opt for this scheme, are referred to as “members".

3.0               POLICY COVERAGE

                     a.        The policy covers reimbursement of Hospitalisation and also Cashless Facility and/ or Out-Patient Department (OPD) expenses within the prescribed limits under the policy for illness/diseases contracted or injury/ sustained by the insured person. In the event of any claim becoming admissible under the policy, the Insurance Company will pay to the insured member (Reimbursement)/ Hospital (For Cashless Treatment), the amount of such expenses as reasonably and necessarily incurred anywhere in India. For the purpose of SAIL Mediclaim Scheme, the ex-employee and his/her spouse, to be treated as two distinct members.

o   IPD (Hospitalization) Benefits: Rs. 2 Lakhs per member per policy period with clubbing (floater) facility under hospitalization with his/her spouse which means that hospitalization benefit of Rs. 2 Lakhs per member can be clubbed between the Mediclaim members & their spouses (max. clubbed limit Rs.4 Lakhs for the extended period).

o   OPD Benefits:

o   Rs.4,000/- per member, for members below 70 yrs. of age as on 31.12.2014

o   Rs.8,000/- per member, for members aged 70 yrs. or above, as on 31.12.2014

Note: Persons completing 70 years of age on 01.01.2015 will also be considered for enhanced OPD. Unlike IPD facility, the OPD facility cannot be clubbed between the ex-employee and his/her spouse.

                     b.        The retiring employees including their spouses who opt for mediclaim membership are assigned a number by our plants/units. These numbers are called Mediclaim Index Number (MIN). The system will continue to facilitate the smooth functioning of the scheme for the period 1^st January – 31^st March, 2015.

4.0         DEFINITIONS

a.     Hospital/ Nursing Home means any institution in India established for Indoor care and treatment of sickness and injuries and which has been registered either as a Hospital or Nursing Home with the local authorities and is under the Supervision of a registered and qualified Medical Practitioner.

For the purpose of O.P.D. treatment, "Hospital" shall mean:

                                               i.          A Government Hospital,

                                             ii.          Dispensaries/Clinics run by local Government authority/Municipalities,

                                          iii.          SAIL Plant Hospitals/Dispensaries

                                          iv.          SAIL Approved Hospitals/ Nursing Homes

                                             v.          Franchisee of major Hospitals viz. Apollo, Max, Escorts, Fortis, etc. anywhere in India.

Note: The terms "Hospital" shall not include an establishment which is a place of rest, a place for the aged, a rehabilitation centre for drug addicts or alcoholic, a hotel or a similar place.

b.     HOSPITALIZATION (IPD):

                                               i.          Hospitalization facility can be availed from any Hospital or Registered Nursing Home in India. However, the Mediclaim member can avail Cashless Facility under Hospitalization, only in Hospitals, having 50 beds or above, which are empanelled by the Insurance Company for the purpose. However, this minimum Bed criteria of 50 Beds, shall not apply to Single speciality Eye Care Hospitals, for empanelment of Hospitals for Cashless treatment for eye diseases, by the Insurance Company.

                                             ii.          When treatment/surgeries such as Dialysis, Chemotherapy, Radiotherapy, Opthalmic Surgeries(Cataract/Glaucoma Surgeries etc.), Lithotripsy, Laproscopic surgeries,  Microsurgery etc., is taken in the Hospital/Nursing Home and the insured is discharged on the same day, the treatment will be considered to be taken under Hospitalization Benefit Section. Indicative List of such procedures is enclosed.

                                          iii.          In addition to the indicative list of Day-care procedures,  any other surgeries / procedures agreed to by SAIL, Insurance Company and TPA, requiring less than 24 hours hospitalization will also be considered under hospitalization.

c.      OPD TREATMENT: OPD Means treatment taken as an out-patient in any Govt. Hospital/SAIL Plant Hospital or SAIL approved Hospital/ Nursing Home. The Charges incurred for treatment taken from Registered Medical Practitioners or other than SAIL approved Hospital/Nursing Home will not be reimbursed. The Medicine should be prescribed by the Doctors on the letter heads of the hospital. Even though a medical practitioner is attached to any of the Govt. / SAIL plant hospital or SAIL approved hospital and if the treatment is taken by him/her privately, the OPD Claim amount will not be reimbursed, under any circumstances.

d.     Claim Settlement - The claims under SAIL Mediclaim Scheme are to be settled and recommended amount to be paid within 15 days of submission of all claim documents.

e.      MEDICAL PRACTITIONER: Means a person who holds a degree / diploma of a recognized institution and is registered by Medical Council of respective State of India. The term Medical Practitioner would include Physician, Specialist and Surgeon.

f.       QUALIFIED NURSE: Means a person who holds a certificate of a recognized Nursing Council and who is employed on recommendations of the attending Medical Practitioners.

5.0         HOSPITALISATION BENEFIT

Reimbursement: Reimbursement of actual charges upto Rs. 2,00,000/- per member per policy period (with clubbing facility between employee & spouse) is permissible. Claim under hospitalization benefit shall be admissable only when the patient is admitted in a hospital for a minimum period of 24 hours. Hospitalization expenses for Ayurvedic/Homeopathic/Unani Treatment are admissible only when the treatment is taken in a Government Hospital/Medical College Hospital.

Pre-hospitalization: Relevant medical expenses incurred during the policy period, upto 30 days prior to the hospitalization specifically for that particular disease/ illness, for which hospitalization has taken place, shall be considered as part of claim under hospitalization. However, during pre-hospitalization period, medicines prescribed under regular OPD treatment for diseases/ illness not related to the said hospitalization, shall not be reimbursable under hospitalization claims.

Post-hospitalization: Relevant medical expenses incurred during the policy period, upto 60 days after the hospitalization, specifically for that particular disease/ illness for which hospitalization had taken place, shall be considered as part of claim under hospitalization. However, during post-hospitalization period, medicines prescribed under regular OPD treatment for diseases/ illness not related to the said hospitalization, shall not be reimbursable under hospitalization claims.

Cashless: Insurance Company/ TPA shall offer Cashless Service to the Insured, where treatment can be obtained without payment, subject to the terms and conditions of the policy, from empanelled hospitals. Insurance Company/ TPA to settle the hospital bills directly on behalf of Insured.

6.0         OPD BENEFIT

6.1               Under no circumstances, the clubbing (Floater basis) of individual OPD limits of Rs. 4000/- or Rs. 8000/- (as the case may be) per member per policy period, will be permitted.

6.2               OPD treatment if availed in SAIL Plant Hospitals, the members are not required to pay any expenses. SAIL Plant Hospitals will make claims for any Treatment given to the member.

6.3               Dental Treatment can also be availed of within the existing limit under O.P.D. treatment. Cost of dentures will not be reimbursed.

6.4               Preventive Health Check-ups & Ophthalmic consultations for refractory error will be covered under OPD Benefits only.

6.5               In case of expenses on Eye Treatment, cost of spectacles/contact lenses shall not be reimbursed.

6.6               OPD Claims to be submitted by the Mediclaim member, to the TPA when the expenses exceed Rs. 2000 per person per policy period or within 90 days from the date of completion of the treatment, whichever is earlier.

6.7               In case of treatment of ear, cost of hearing aid is not reimbursable.

7.0         MANDATORY CLAIM INTIMATION/ SUBMISSION:-

7.1    Claim Intimation for Hospitalization treatment on Cashless/ Reimbursement basis

i)    The Mediclaim member shall be required to inform / intimate, in writing, the Insurance Agency / TPA at least 48 Hrs Prior to any elective / planned Hospitalization / Admission.

ii)  In case of Emergency Admission / Hospitalization, the Insurance Company / TPA, to be informed by the Mediclaim member, in writing within 24 hrs of such hospitalization.

iii)          The Claim Intimation by the Mediclaim member, is mandatory for both Cashless & Reimbursement claims.

iv)          Claim Intimation can be sent via Letter/ Email/ Fax/ Personally delivered at TPA offices.

The above must be adhered to, so that the claims are not rejected

7.2               Claim Submission for Hospitalization treatment on Cashless/ Reimbursement basis

                                                    i.     The reimbursement claims with respect to IPD/ Hospitalization to be submitted to the TPA within 30 days from the Date of Discharge from the Hospital.

                                                  ii.     The reimbursement claims pertaining to Post Hospitalization (IPD treatment), to be submitted to the TPA within 30 days after the completion of permissible post Hospitalization treatment period of 60 days.

The above must be adhered to, so that the claims are not rejected

8.0         Cappings in Mediclaim Scheme:

8.1               Cappings in the area of room rent charges, the Implants/Stents used under various procedures like cataract surgery, coronary angioplasty, joint related disorder requiring knee/hip joint replacement excluding the associated procedure charges under the Scheme will be as given below:

a)     Maximum entitlement of room to be restricted to:

o   For Metro Cities (Hyderabad, NCR, Bangalore, Mumbai, Chennai, Kolkata) - Ceiling of 2%, i.e Rs.4000/- of the sum insured per member or a single AC non-deluxe room per day, whichever is lower,

o   For non-metro cities which are State capitals - Ceiling of 1.5%, i.e Rs.3000/- of the sum insured per member or a single AC non-deluxe room per day, whichever is lower,

o   For rest of the country - Ceiling of 1%, i.e Rs.2000/- of the sum insured per member or a single AC non-deluxe room per day, whichever is lower;

In case a member goes for a higher category room, the consultation charges/ investigation charges/ procedural charges/ surgical Charges/ package rates etc. shall be limited to actuals or as per their corresponding rates for single AC non-deluxe room of the concerned hospital, whichever is lower.

b)    Ceiling rates for different types of Intra Ocular Lens (IOL) Implants to be as per actuals or Rs. 10,000/- whichever is lower and shall be reimbursable in addition to the package rates for cataract surgery procedure.  It should be mandatory for the operating surgeon of all hospitals to attach the empty IOL sticker, bearing the signature and stamp of the operating surgeon on it alongwith the bill in support of the type of IOL used containing its batch number. Incase the same is not followed, the claim with regards to IOL implant, may be rejected.

c)     Ceiling rates for different types of Coronary Stents to be as per the actuals or the rates as mentioned below, whichever is lower.

S.No.	Name of Drug Eluting Stent / Bare Metal Stent	Ceiling Rate
1.	Cypher Stent	Rs. 95000 + VAT
2.	Taxus Stent	Rs. 67300 + VAT
3.	Element Stent	Rs. 95000 + VAT
4.	Endeavor	Rs. 85000 + VAT
5.	Xience V EECSS	Rs. 95000 + VAT
6.	Yukon choice	Rs. 55000 + VAT
7.	Pronova	Rs. 50000 + VAT
8.	Supralimus	Rs. 55000 + VAT
9.	Bare Metal Stent	Rs. 45000 (all inclusive)

Ceiling rates for Coronary Stents other than the Stents mentioned above, to be as per actuals or Rs. 95000/- plus VAT, whichever is lower.

d)    A maximum of three Coronary Stents shall be permitted on the advice of the specialist, of which not more than two shall be of Drug Eluting Stents (DES). However, DES shall be permitted only for patients where re-stenosis will involve high risk to patient’s life i.e

i)        Osteal/Proximal LAD lesions;

ii)      Stenosis of a coronary artery, which is giving collaterals to another blocked artery, thus supplying a large area of myocardium; and,

iii)    Stenting of restenotic lesions after previous angioplasty.

It is essential for the hospital to quote the batch number when a Coronary Stent of any type (ordinary metal/Drug Eluting Stent) is implanted in the case of a beneficiary. In addition to this, the outer pouch of the Stent packet alongwith the sticker on it on which the details of the stent are printed shall also be enclosed with the medical bill for claiming reimbursement. In case hospital has not given the batch number and / or outer pouch of the stents in a particular case, the claim with regards to the implant, may be rejected.

e)     Ceiling rates for different types of Knee and Hips implants, to be as per the actual rates or the rates as mentioned below, whichever is lower.

i)        Maximum ceiling for Knee implant  to be Rs 75000/- (including cost of Bone cement)

ii)      Maximum ceiling for Hip implant  to be Rs 75000/- (including cost of Bone cement)

f)      In addition to the aforementioned cappings on Implants/ Stents, the following cappings on procedures/ packages as given below, shall also be applicable:

S. No.	Disease/ Treatment	Cappings
1.	Hernia repair	Rs. 40000
2.	Cholecystectomy	Rs. 45000
3.	Haemorroidectomy	Rs. 25000
4.	Appendicetomy	Rs. 35000
5.	Hysterectomy	Rs. 45000

The above cappings/ ceilings are applicable on ‘per Hospitalization’ basis and only for cases where there are no complications/multiple diseases. Moreover, Pre-Hospitalization & Post-Hospitalization claims pertaining to the above treatments do not come under the purview of the aforementioned cappings.

9.0         IMPORTANT EXCLUSIONS: Under SAIL Mediclaim Scheme, the Insurance Company shall not be liable to make any payment in respect of any expenses whatsoever incurred by the insured person in connection with:

i)               Any Disease/ complication caused due to alcohol intake.

ii)             Any disease/ injury caused by War/Nuclear Weapons/Radiations / Breach of Criminal law.

iii)           Circumcision, cosmetic or Plastic Surgery unless necessitated by an accident or as a part of any disease/ illness.

iv)           Cost of dentures, hearing aid, spectacles, cost of glasses/ contact lenses etc.

v)             Convalescence, general debility, "Run-down" condition or rest cure, congenital diseases or defects, sterility, venereal diseases, intentional self injury and use of intoxicating drugs.

vi)           The Hospitalization charges in which Radiological/ Laboratory investigations/ other diagnostic studies have been carried out which are not consistent with or incidental to the diagnosis of treatment of positive existence or presence of any ailment, sickness or injury for which confinement at any Hospital/ Nursing Home, has taken place.

vii)         Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.

viii)       Treatment traceable to pregnancy/ child birth, voluntary medical termination of pregnancy during first 12 weeks of conception.

ix)           Naturopathy Treatment.

x)             External and/ or durable Medical/ Non-Medical equipment of any kind used for diagnosis and/ or treatment including CPAP, CAPD, Infusion pump etc. Ambulatory devices, i.e walker, crutches, belts, collars, caps, splints, slings, braces, stockings etc., of any kind. Diabetic foot wear, Glucometer/ Thermometer and similar related items etc., and also any medical equipment which subsequently used at home etc.

xi)           Any kind of service charges, attendant food charges, surcharges, admission fees/ registration charges & Non-Medical expenses levied by the Hospital.

xii)         Treatment for age related Macular degeneration with Injection Avastin/ Lucentis/ Macugen.

xiii)       Cytotron Therapy

xiv)       Ozone Therapy

xv)         Enhanced External Counter Pulsation Therapy (EECP)

xvi)       Robotic Surgery/ Robotically assisted surgery

xvii)     Any unproven therapy

xviii)   Ayurvedic treatment if it is not an active line of treatment.

xix)       Rejuvenation therapy/ Massage/ Panchkarma

xx)         Stem cell Transplantation except Haemopoetic Stem Cell Transplant/ Bone Marrow Transplant

Misuse of Scheme: Stringent action to be taken against individuals found to be misusing the system/guilty of any fraudulent activity, viz. debarring member from Mediclaim membership, blacklisting hospitals, initiating suitable legal action etc., as deemed fit by SAIL Management.

INDICATIVE LIST OF DAY CARE PROCEDURES

1.           Suturing - CLW -under LA or GA

2.           Surgical debridement of wound

3.           Therapeutic Ascitic Tapping

4.           Therapeutic Pleural Tapping

5.           Therapeutic Joint Aspiration

6.           Aspiration of an internal abscess under ultrasound guidance

7.           Aspiration of hematoma

8.           Incision and Drainage

9.           Endoscopic Foreign Body Removal - Trachea /- pharynx-larynx/ bronchus

10.      Endoscopic Foreign Body Removal -Oesophagus/stomach /rectum.

11.      True cut Biopsy - breast/- liver/- kidney-Lymph Node/-Pleura/-lung/-Muscle biopsy/-Nerve biopsy/-Synovial biopsy/-Bone/ trephine biopsy/ pericardial biopsy

12.      Endoscopic ligation/banding

13.      Sclerotherapy

14.      Dilatation of digestive tract strictures

15.      Endoscopic ultrasonography and biopsy

16.      Nissen fundoplication for Hiatus Hernia /Gastro esophageal reflux disease

17.      Endoscopic placement/removal of stents

18.      Endoscopic Gastrostomy

19.      Replacement of Gastrostomy tube

20.      Endoscopic polypectomy

21.      Endoscopic decompression of colon

22.      Therapeutic ERCP

23.      Brochoscopic treatment of bleeding lesion

24.      Brochoscopic treatment of fistula /stenting

25.      Bronchoalveolar lavage & biopsy

26.      Tonsillectomy without Adenoidectomy

27.      Tonsillectomy with Adenoidectomy

28.      Excision and destruction of lingual tonsil

29.      Foreign body removal from nose

30.      Myringotomy

31.      Myringotomy with Grommet insertion

32.      Myringoplasty /Tympanoplasty

33.      Antral wash under LA

34.      Quinsy drainage

35.      Direct Laryngoscopy with or w/o biopsy

36.      Reduction of nasal fracture

37.      Mastoidectomy

38.      Removal of tympanic drain

39.      Reconstruction of middle ear

40.      Incision of mastoid process & middle ear

41.      Excision of nose granuloma

42.      Blood transfusion for recipient

43.      Therapeutic Phlebotomy

44.      Haemodialysis/Peritoneal Dialysis

45.      Chemotherapy

46.      Radiotherapy

47.      Coronary Angioplasty (PTCA)

48.      Pericardiocentesis

49.      Insertion of filter in inferior vena cava

50.      Insertion of gel foam in artery or vein

51.      Carotid angioplasty

52.      Renal angioplasty

53.      Tumor embolisation

54.      TIPS procedure for portal hypertension

55.      Endoscopic Drainage of Pseudopancreatic cyst

56.      Lithotripsy

57.      PCNS (Percutaneous nephrostomy)

58.      PCNL (percutaneous nephrolithotomy)

59.      Suprapubic cytostomy

60.      Tran urethral resection of bladder tumor

61.      Hydrocele surgery

62.      Epididymectomy

63.      Orchidectomy

64.      Herniorrhaphy

65.      Hernioplasty

66.      Incision and excision of tissue in the perianal region

67.      Surgical treatment of anal fistula

68.      Surgical treatment of hemorrhoids

69.      Sphincterotomy/Fissurectomy

70.      Laparoscopic appendicectomy

71.      Laparoscopic cholecystectomy

72.      TURP (Resection prostate)

73.      Varicose vein stripping or ligation

74.      Excision of dupuytren's contracture

75.      Carpal tunnel decompression

76.      Excision of granuloma

77.      Arthroscopic therapy

78.      Surgery for ligament tear

79.      Surgery for meniscus tear

80.      Surgery for hemoarthrosis/pyoarthrosis

81.      Removal of fracture pins/nails

82.      Removal of metal wire

83.      Incision of bone, septic and aseptic

84.      Closed reduction on fracture, luxation or epiphyseolysis with osetosynthesis

85.      Suture and other operations on tendons and tendon sheath

86.      Reduction of dislocation under GA

87.      Cataract surgery

88.      Excision of lachrymal cyst

89.      Excision of pterigium

90.      Glaucoma Surgery

91.      Surgery for retinal detachment

92.      Chalazion removal (Eye)

93.      Incision of lachrymal glands

94.      Incision of diseased eye lids

95.      Excision of eye lid granuloma

96.      Operation on canthus & epicanthus

97.      Corrective surgery for entropion & ectropion

98.      Corrective surgery for blepharoptosis

99.      Foreign body removal from conjunctiva

100. Foreign body removal from cornea

101. Incision of cornea

102. Foreign body removal from lens of the eye

103. Foreign body removal from posterior chamber of eye

104. Foreign body removal from orbit and eye ball

105. Excision of breast lump /Fibro adenoma

106. Operations on the nipple

107. Incision/Drainage of breast abscess

108. Incision of pilonidal sinus

109. Local excision of diseased tissue of skin and subcutaneous tissue

110. Simple restoration of surface continuity of the skin and subcutaneous tissue

111. Free skin transportation, donor site

112. Free skin transportation recipient site

113. Revision of skin plasty

114. Destruction of the diseases tissue of the skin and subcutaneous tissue

115. Incision, excision, destruction of the diseased tissue of the tongue

116. Glossectomy

117. Reconstruction of the tongue

118. Incision and lancing of the salivary gland and a salivary duct

119. Resection of a salivary duct

120. Reconstruction of a salivary gland and a salivary duct

121. External incision and drainage in the region of the mouth, jaw and face

122. Incision of hard and soft palate

123. Excision and destruction of the diseased hard and soft palate

124. Incision, excision and destruction in the mouth

125. Surgery to the floor of mouth

126. Palatoplasty

127. Transoral incision and drainage of pharyngeal abscess

128. Dilatation and curettage

129. Myomectomies

130. Simple Oophorectomies

131. Coronary Angiography

132. Dental Surgery (following Accident)

133. Hysterectomy

134. Laproscopic Therapeutic Surgeries

Any other surgeries / procedures agreed to by SAIL, Insurance Company and TPA, requiring less than 24 hours hospitalization will also be considered under Hospitalization.

Renewal Premium for SAIL Mediclaim Scheme (1^st January – 31^st March, 2015)

INDIVIDUAL PREMIUM AMOUNTS
AGE OF MEDICLAIM MEMBER (AS ON 31.12.2014)	RENEWAL PREMIUM AMOUNT PER MEMBER
BELOW 70 YRS	484
B/W 70-80 YRS	434
80 YRS & ABOVE	289
CALCULATION OF RENEWAL PREMIUM FOR SAIL MEDICLAIM SCHEME
AGE OF MEDICLAIM MEMBER (AS ON 31.12.2014)	AGE OF MEMBER SPOUSE (AS ON 31.12.2014)	TOTAL PREMIUM FOR BOTH MEMBERS
BELOW 70 YRS	BELOW 70 YRS	968
	B/W 70-80 YRS	918
	80 YRS & ABOVE	773
B/W 70-80 YRS	BELOW 70 YRS	918
	B/W 70-80 YRS	868
	80 YRS & ABOVE	723
80 YRS & ABOVE	BELOW 70 YRS	773
	B/W 70-80 YRS	723
	80 YRS & ABOVE	578