Policy Renewal

The Reserve Bank of India (RBI) has updated Group Mediclaim Policy for OPD (GMP‑OPD) for pensioners aged 60 and above, effective from April 1, 2026.
Cashless via Network Hospitals system has been introduced the details of which shall be intimated by the concerned TPA in their booklets to be sent to each eligible pensioner.
Group Mediclaim Policy for the Financial Year 2025–26 expired on March31,2026.

Key Features of the RBI OPD Policy

Coverage Highlights

The policy reimburses expenses for a wide range of OPD treatments, including:

  • Preventive Care: Vaccinations, physiotherapy, yoga therapy (up to ₹6,000 without prescription), and de-addiction programs costs.
  • Consultations: General physicians, specialists (Allopathy/AYUSH), and teleconsultations.
  • Diagnostics: Lab tests, radiology, and health check-ups.
  • Dental Care: Fillings, implants, dentures, and braces (excluding cosmetic procedures).
  • Vision & Hearing Aids: Spectacles (excluding sunglasses), contact lenses, and hearing aids (repairs up to ₹10,000).
  • Orthopaedical & Mobility Aids: Wheelchairs, walkers, and prosthetics.
  • Health Equipment: CPAP machines, nebulizers, glucometers, and home healthcare services

List of appliances

2. Eligibility

  • Pensioners aged 60+ and their spouses (irrespective of age).
  • Dependent children with permanent/temporary disabilities (certified under the Rights of Persons with Disabilities Act, 2016).
  • Family pensioners (if the deceased pensioner would have turned 60 during the policy period).

Sum Insured by Grade-wise limits (Annexure IV)

RBI OPD Policy 2025-26
RBI OPD Policy 2026-27-Grade-wise limits

(PP = Personal Promotion; higher limits apply)

3. TPA Contacts (Annexure II)

Designated TPAs:

TPAs for 2026–27
The policy is serviced by two TPAs:

MD‑India Healthcare Services (TPA) Pvt. Ltd.
Covers: Bengaluru, Bhopal, Bhubaneswar, Chennai, Guwahati, Kochi, Kolkata, Nagpur, Patna, Thiruvananthapuram, CAB‑Pune, RBSC, and NE states.

Medi Assist Insurance TPA Pvt. Ltd.
Covers: Ahmedabad, Mumbai (CO/MRO/Belapur), New Delhi, Chandigarh, Dehradun, Hyderabad, Jaipur, Jammu/Srinagar, Kanpur, Lucknow, Panaji, Raipur, Ranchi, Shimla.

Each TPA has dedicated Relationship Managers for RBI pensioners.

Full TPA contact / RMs list here .

How to File a Claim?

Pay upfront for treatments and collect original bills/prescriptions.
Fill the OPD Claim Sheet .
Submit to your designated TPA via courier or drop-box at RBI dispensaries.
Processing Time: Typically 15–30 days.

Tips for Pensioners

Keep Copies: Photocopy all bills before submission.

Track Claims: Follow up with TPA weekly via email.
Maximize Benefits: Use yoga (₹6K) and OTC (₹2K) limits.
Bundle bills (min. ₹5,000) for faster processing.

6. Claim Process for reimbursement

  • Submit claims within 90 days of treatment.
  • Required documents: Original bills, doctor’s prescription (with registration number), and investigation reports (photocopies accepted).
  • OTC medicines (up to ₹2,000/year) and yoga therapy (up to ₹6,000/year) do not require prescriptions.
  • No TPA card needed; use your PF Index/Samadhan Number for claims.
  • Grade‑wise Sum Insured (Annual OPD Limit)
  • Claim Process (Simple & Paperless)
    No prior intimation required
    Just complete treatment and submit documents within 90 days.
  • Two ways to claim
  • Cashless (via network hospitals/centres)
  • Reimbursement (upload documents; originals kept for audit)
    Documents needed
  • Claim form
  • Original bills
  • Doctor’s prescription (with registration number)
  • Test reports (self‑attested copies allowed)

Escalation Matrix
If any issue arises, the circular prescribes a clear escalation path:

TPA (Level I)
Insurance Broker – Marsh India (Level II)
Regional Office / COD (Level III)
Employee Health Section, HRMD CO (Level IV)

FAQs for Pensioners

Comments/feedback
Comment or email us at support@airbiopf.in for clarifications.

RBIPension #Mediclaim #OPDPolicy #HealthcareForSeniors

Important Notes

Automatic renewal: No re-enrollment needed for subsequent years.
GST reimbursement: Included if within the sum insured.
Fraud penalties: Misuse leads to a 3-year ban (permanent for repeat offenses).

Our View

This policy ensures holistic outpatient care for RBI pensioners. Stay informed, keep documents handy, and utilize the benefits wisely. For full details, refer to the Welcome Booklet or contact your TPA.
Stay healthy.