Medical Assistance Fund Scheme (MAFS) 2026-27.

The Reserve Bank of India has announced the renewal of the Medical Assistance Fund Scheme (MAFS) Group Mediclaim Policy for Hospitalization (GMP-IPD) for the year, from April 01, 2026, to March 31, 2027. While much of the framework from the previous year remains, there are key administrative updates and continued comprehensive benefits that every member should be aware of.

Key Changes and Policy Details for MAFS-2026-27

The most significant change for the new policy year is the transition to a new primary insurer.

• New Insurance Provider: The policy for 2026-27 has been placed with M/s Bajaj General Insurance Ltd., moving from the previous year’s provider.
• TPAs and Allotment: Claims will be settled by designated Third Party Administrators (TPAs) based on your regional office.
  • MD-India Healthcare Services: Allotted to offices including Bengaluru, Bhopal, Bhubaneswar, Kolkata, Nagpur, and others.
  • Medi Assist Insurance TPA: Allotted to Mumbai (CO/MRO/Belapur), New Delhi, Ahmedabad, Hyderabad, and others.
    
• Transition Period: For any hospitalizations where the admission date is on or before March 31, 2026, claims must be submitted to the 2025-26 TPA allocation.

Sum Insured and Bed Charges

The limit of Bed Charges per day for normal hospitalization  has been increased by 25% while upper cap for ICU Bed charges per day has been removed.

Major Benefits Continued from 2025-26

Retirees will continue to enjoy the extensive coverage improvements introduced recently:

• Cataract Treatment: A uniform cap of ₹90,000 per eye remains, covering advanced laser and multifocal lenses without PPN restrictions.
• Specialized Treatments: Coverage remains for advanced procedures like Robotic Surgery, Cyber Knife treatment, and stem cell therapy (if approved by relevant medical bodies).
• Modern Inclusions: The policy continues to cover immunotherapy for cancer, injections for autoimmune disorders (up to ₹25,000 per injection), and home-based chemotherapy.
• Home Medical Equipment: Purchase of CPAP, Bi-PAP, and Oxygen Concentrators for home use remains covered under medical advice.
• AYUSH & Naturopathy: Ayurvedic treatment is covered up to 50% of the SI, and even up to the full SI for cancer patients at private hospitals.

Important Reminders for Members

1. TPA Cards: You can continue to use your existing TPA/e-TPA cards for admissions and procedures under the new policy.
2. No Waiting Period: There is no 30-day waiting period for any ailment, and pre-existing diseases are covered from day one.
3. Pro-rata Clarity: Investigation and medicine charges are reimbursed in full and are not subject to pro-rata deductions, even if you occupy a room above your eligibility.
4. Escalation: If you face issues, follow the matrix starting with the TPA Relationship Manager for your center.

Stay healthy and ensure you keep a digital copy of the new circular for quick reference during emergencies