Policy Renewal

The Reserve Bank of India (RBI) has renewed the GMP RBI OPD Policy 2025-26 for pensioners aged 60 years and above with New India Assurance Co. Ltd, covering the period from April 1, 2025, to March 31, 2026. This policy ensures comprehensive outpatient care for eligible members, their spouses, and dependent children with disabilities.

Group Mediclaim Policy for the Financial Year 2024-2025 expired on March31,2025.

Key Features of the RBI OPD Policy

1. 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.

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).

3. Sum Insured by Grade-wise limits (Annexure IV)

RBI OPD Policy 2025-26

(PP = Personal Promotion; higher limits apply)

4. TPA Contacts (Annexure II)

Designated TPAs:

  • MD India TPA: For Ahmedabad, Bengaluru, Chennai.
  • Email: rbiopd@mdindia.com | Helpline: 8956660174.
  • Medi Assist TPA: For Mumbai, Chandigarh, Jaipur.
  • Email: nazia.sayed@mediassist.in | Helpline: 9035052397
  • Paramount TPA: Manages Hyderabad, Kochi, Kolkata, etc.
  • (Refer to the policy for your TPA’s contact details.)

Full TPA contact / RMs list here .

5. How to File a Claim?

  1. Pay upfront for treatments and collect original bills/prescriptions.
  2. Fill the OPD Claim Sheet .
  3. Submit to your designated TPA via courier or drop-box at RBI dispensaries.
  4. 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.

7. Exclusions (items Not reimbursable)

  • Cosmetic treatments (e.g., teeth whitening, cosmetic spectacles).
  • Sunglasses, riding glasses, and travel expenses.
  • Acupuncture/acupressure.

FAQs for Pensioners

Q1. Can I claim for pre-existing diseases?

Yes! No waiting period. Submit bills with diagnosis proof.

Q2. Are over-the-counter (OTC) medicines covered?

Yes, up to ₹2,000/year without prescription (e.g., Dettol, ORS, Vicks).

Q3. What if I exhaust my sum insured?

No additional reimbursement. Plan treatments wisely!

Q4. How to escalate delayed claims?

  1. TPA → 2. Broker (Aon) → 3. Regional Office → 4. HRMD (healthsection[at the rate]rbi[dot]org[dot]in)

Full FAQS Annexure III

Comments/feedback

Comment below 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.

Disclaimer: This blog summarizes key points; always refer to the official circular for complete terms.

Related posts: