After the end of the previous MAFS GMP (2024-25) period, the Reserve Bank of India (RBI) has renewed the Medical Assistance Fund Scheme (MAFS) Group Mediclaim Policy for retired members, effective from April 1, 2025, to March 31, 2026. This renewal has some significant updates to improve healthcare coverage, and broaden the range of benefits available to retirees.

MAFS (25-26) Details:-

MAFS Limits Category wise

1.MAFS Policy Renewal

  • The policy has been renewed with The New India Assurance Co. Ltd.
  • Cashless hospitalization remains effective from April 1, 2025, under the new terms.
  • Members can continue using their TPA/e-TPA cards for admissions.

2. Enhancements in Coverage

  1. Increased Cataract Surgery Limit The cap for cataract surgery has been raised from ₹75,000 to ₹90,000 per eye, covering: No PPN charges for cataract claims.
  2. Laser treatment
  3. Multifocal lenses
  4. Spectacles (if part of the package)

A. Expanded AYUSH Treatment Coverage

AYUSH treatments (Ayurveda, Yoga, Naturopathy, etc.) now cover 50% of the sum insured (up from 25%).Includes curative naturopathy at government/NABH/QCI-accredited hospitals.

B. Attendant & Nursing Charges

  • Attendant charges (in lieu of a special nurse) are now covered for all ages during hospitalization.
  • Post-hospitalization attendant charges are covered for up to 60 days if recommended by a doctor.
  • Intra-vitreous injections (Avastin, Lucentis, etc.) now have a higher limit of ₹1,25,000 per eye (up from ₹1,00,000).

C. Higher Reimbursement for Eye Injections

Reimbursement of cost of intra vitreous injection Avastin/Lucentis/Macugen/Ozurdex etc. increased from ₹1,00,000/- to ₹1,25,000/- per eye during the policy period.

D. New Inclusions for Chronic & Critical Care

  • Autoimmune disorder injections (e.g., arthritis, ankylosing spondylosis) covered up to ₹25,000 per injection.
  • Non-medical essentials (diapers, sanitary pads, bandages) now covered for burns & trauma cases.
  • Home medical equipment (CPAP, BiPAP, oxygen concentrators) reimbursed if prescribed.
  • Immunotherapy for cancer patients now included.

3. Simplified Claim Process

  • Intimation deadline: Inform TPA within 30 days of admission.
  • Claim submission: Submit documents within 45 days of discharge.
  • Settlement time: Claims processed within 15 days if documents are complete.

4. Important Steps and Links

Check your TPA details (Annex I) for regional contacts.
Review the full list of day-care procedures (Annex IV).
Relationship Managers-Location wise

Salient features
Bank’s forwarding letter
Limits/Bed Charges
Settlement of Claims

Ensure timely claim submissions to avoid delays.
Settlement of Claims
TPA-Paramount Health Services & Insurance TPA Pvt. Ltd
Mediassist
MDINDIA HEALTH INSURANCE TPA PRIVATE LIMITED

Final Thoughts

The 2025-26 MAFS policy offers broader coverage, higher claim limits, and faster processing, ensuring retirees get better healthcare support.
Need help? Contact your designated TPA (Third-Party Administrator) for assistance.
Stay healthy, stay covered!