Agency Section, Marketing Department,

rd
3 floor, Central Office, “Yogakshema”,
Jeevan Bima Marg, MUMBAI 400 021
Ph: - (022) – 66598333,34,38,39, Fax: - 22824386,
e-mail: -co_agency@licindia.com

Mktg./A/ZD/23/2009 29.08.2009

All Zonal Managers and

Sr./Divisional Manager (I/C) of Divisions.

Re: Group Medical Insurance Scheme (Policy Year 2009-2010)

for Club Member Agents (Membership Year 2008-09).

The Mediclaim Policy for the Club Member Agents has been renewed for
the year 2009-2010 (from 01.09.2009 to 31.08.2010) with the New India
Assurance Co. Ltd. Divisional Office, Cooperage Road, Mumbai.

The salient features of the scheme are as follows:-

1. Policy Number is 121400/34/09/87/00002025.

2. The Cover for various Club Member Agent Groups are as follows:
Club Cover
Chairman’s Club Rs. 1 lakh
Zonal Manager’s Club Rs. 60,000
Divisional Manager’s Club Rs. 40,000
Branch Manager’s Club Rs. 25,000

3. The policy will be serviced by –

The New India Assurance Co. Ltd.

Divisional Office – 121400,
Underwriting Hub, MRO-III,
New India Centre, 1st Floor
17-A, Cooperage Road,
Mumbai – 400001.
Phone Nos. 022-22885563, 22882189, Fax No. 022-22823058.
Since this is a welfare scheme, the scheme is mandatory for all the Club
Member Agents up to the age of 80 years.
 4. The TPA allotted to provide service is as following:

• Name Medi Assist India Pvt. Ltd.

• Address No.18, Landsdowne House,
3rd Floor, Landsdowne Road,
Mahakavi Bhushan Marg,
Colaba,
Mumbai- 400 005.

• Tel Nos. +91-22-66376931/32

• FAX: +91-22-66376933
• Web site www.mediassistindia.com

All the claims are to be submitted to the abovementioned TPA for

settlement.

It has been reported that the Club Member Agents are not furnishing
their complete / correct addresses in the claim forms. In such cases,
it is very difficult for the TPA to ensure delivery of the claim cheque
to them. Please ensure that the revised claim form is filled in
correctly and completely with proper address and the same is sent
along with Nodal Officer’s Certificate to avoid delay and
inconvenience to the Club Member Agents. Please note that the
claim papers are to be sent only to the TPA at Mumbai. In no case
the claim papers are to be sent to any other office.
(Revised Claim Form, Nodal Officer’s Certificate and Check List is
attached herewith). Please download the attachment as and when
required.

5. Nodal Officers in Divisions should take care that Nodal Officer’s Certificate
is duly signed, stamped and sent along with the claim forms to TPA, failing
which the claim shall not be admissible.

6. It should be made clear to all the Club Member Agents that all diseases /
injuries, which are pre-existing are not covered and standard features are
applicable as previous year.

7. Only such agents who are joining the scheme for the first time or joined
earlier but discontinued and are again joining are required to fill in
the ‘Health Declaration form (other agents are not required to fill in the
‘Health Declaration Forms’). These are to be sent to the New India
Assurance Co., Ltd. Mumbai by the Divisions by 30th November, 2009.
8. All the Branch Offices are to be advised to deduct the premium from the
Club Member Agents for the MY 2008-09 positively from their
commission in one lump sum latest by December 2009 and the premiums
deducted should be credited to A/c. code No. 113204.

9. Last year, in spite of regular follow up, data in this regard has not been
received by us from some of our Offices. In absence of the data, it has
been very difficult for us to reconcile the accounts and also for the ‘New
India Assurance Co. Ltd’ to settle the claims. All the Zonal offices are
strictly advised to send the data to us and also to the -

The Divisional Manager,

The New India Assurance Co. Ltd.
Divisional Office 121400,
Underwriting Hub, MRO-III,
New India Centre, Ist Floor,
17-A, Cooperage Road,
Mumbai – 400001.
The Division wise data should be sent in the enclosed format on a floppy
(in Excel Sheet) latest by 31st December, 2009 in respect of all the Club
Member Agents of their Zone.

10. The premium to be recovered for the Group Medical Insurance Scheme
for the Club Member Agents (MY 2008-2009)

Age completed Premium to be borne by the Club Member Agent

on last Policy Year 2009-2010 (M.Y.- 2007-2008)
Birthday ( As
on 01.09.2008) C.M’s Z.M’s D.M’s B.M’s
Club Club Club Club
Up to 35 326 182 130 82
36-45 390 209 150 98
46-55 487 256 184 122
56-65 765 429 301 191
66-70 861 496 347 215
71-75 999 564 393 250
76-80 1117 644 448 279
 11. The Corporate Club Member Agents for the M.Y.2008-09 are eligible for
Mediclaim coverage of Rs. 1 Lakh and no premium has to be deducted
for the Corporate Club Members.

Executive Director (Marketing)

Encl: Revised Claim Form, Nodal Officer’s Certificate & Check List