REVIEW OF UNDERWRITING PRACTICES–CHART OF SPECIAL REPORTS

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LIC REVIEW OF UNDERWRITING PRACTICES–CHART OF SPECIAL REPORTS
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     –  1.   CHART OF SPECIAL REPORTS It has been decided to revise the existing chart of Special Reports. The revised chart of Special Reports is shown below:-  ã   If Hbalc is not available, then PGBS (after giving 75 gm of glucose) is compulsory.PPBS will not be accepted. ã   If HIV test by Elisa method is not available at a place, HIV test by Tridot methodwill be accepted upto SUC Rs.24.99 lacs. For SUC beyond Rs. 24.99 lacs, HIV testby Elisa method is to be insisted upon. ã   The above chart is applicable for all plans. Whenever Critical Illness Rider is optedfor, up to age at entry 35 years, special reports will be as per the above chart. Forage at entry above 35 years, rest ECG, Hb% and Fasting Blood Sugar (FBS) will becompulsory. he following points may be noted:- i.   Ranges of SUC for calling for Special Reports have been revised as under:-S), SBT-12 and SBT-18 have been discontinued.ingBloodiv.   HbAlc will be called for older ages and high SUC. If HbAlc is not available at anycenter, then PGBS (after giving 75 gm. of Glucose) will be necessary.v.   Haemogram & X-ray of chest are not called for younger ages and low SUC. here is no change in the formats of other reports. Comterientification of the client and Normal Laboratory Ranges for the test are given on suchrep. TPper enclosenclosed a It is obser instructions given on the Special Report formats for conductingCG and CTMT are not complied with. Before forwarding cases to U&R / ZUS, DO NBDepartments should ensure that the ECG and CTMT have been conducted as per the T  ii.   Post Glucose Blood Sugar (PGB iii.A new special report – SBT-13 has been introduced. It will contain the followtests – FBS, Total Cholestrol, HDL, LDL, S.Triglycerides, S.Creatinine,Urea Nitrogen, S. Proteins, S. Bilirubin, SGOT, SGPT, GGTP, S. AlkalinePhosphatase, and Australia Antigen & Elisa for HIV. (Format for SBT-13 isenclosed). T  puzed reports can be accepted provided the tests were conducted after properidortsAs must obtain the signature of the life to be assured on a separate sheet (ased format) before the tests are carried out. The separate sheet should belong with the computer generated reports.ved that theE  instionwhile condii.   Rest ECG should be 12 leads along with the Standardization slip, each lead withand AVF shows deep Q or T wavechange, they should be recorded additionally in deep inspiration. If V1 shows aucting the following Specialeports:-ructs. Special attention may be given to the following two important instructionsucting ECG:i.   The base line must be steady. The tracing must be pasted on a folder.minimum of 3 complexes, long lead II. If L-IIItall R-wave, additional lead V4R should be recorded.2. REVISED CHARGES FOR SOME OF THE SPECIAL MEDICAL REPORTS It has been decided to revise the fees payable for condR It may be noted that the above charges are the maximum permissible and the amoe reimbursunt toed will be lower of actual cost or the maximum permissible.here is no change in the fee payable for the remaining reports. There is also no change inthe fee payable for conducting FMR and Juvenile FMR.If FMR and Special Reports are done from our empanelled medical examiners, DMR anddiagnostic centers, hospitals etc., the total amount to be reimbursed for FMR and specialreports should not exceed Rs.4/- per Thousand Basic Sum Assured excluding SA underTerm Rider and Critical illness Rider.If FMR & Special Reports are done from TPAs, the upper limit of Rs.4/- per Thousand SumAssured will not be applicable. In addition to the cost of FMR & Special Reports, the TPAswill be paid service charges as under:-a)   Proposal where only FMR is required – Rs.15/- per case. /-.ts) reports are called for separately(i.e. not along with the reports mentioned in the chart of special reports), a servicebT b)   Proposals where Special Reports are required along with FMR – Rs.30/- per report(Charges for FMR will be Rs.15/-), subject to maximum of Rs.100 c)   When additional (other than manual requiremen  charge of Rs.30/- for each report, subject to a maximum of Rs.50/- will bepayable.d)   Service tax will be over and above the service charge payable.Further ã   If SBT-18 done earlier is valid and if SBT-13 is a manual requirement as per the ã   s per therevised Chart of Special Reports, only balance tests are to be called for.The Divshould e that all the empanelled diagnostic centers and TPAs are informed aboute revised format well before the target date.AllThe above instructions come into force with effect from 17th January 2008. However,Special Reports done as per the existing Chart of Special Reports will be accepted till 31 st  January 2008.the following points may be noted:revised Chart of Special Reports, fresh SBT-13 need not be called for.If SBT-12 done earlier is valid and SBT-13 is a manual requirement a ã   If Haemogram done earlier is valid fresh Hb% need not be called for.isional Offices should get the format for SBT-13 printed at the earliest. Theyalso ensurthother existing underwriting rules remain unchanged.
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