Major Restriction on Use of Restored Sum Insured under Staff GMC Policy 2026-2027

 📢 NIARAS Kerala – Member Guidance Circular

Subject: Major Restriction on Use of Restored Sum Insured under Staff GMC Policy

Dear Members,

👉 1️⃣ Minimum Sum Insured should be ₹25 Lakhs & above to be eligible for Restoration benefits. Policies with Sum Insured below ₹25 Lakhs will not be eligible for restoration benefits.

👉 2️⃣ Under the Family Floater Staff GMC Policy, the original Sum Insured is available to the insured member and all covered family members for admissible hospitalization expenses during the policy period.

👉 3️⃣ An insured person can avail reimbursement for a particular disease/illness multiple times, provided the claims are within the limits of the available original Sum Insured.

👉 4️⃣ In other words, expenses relating to the same disease are admissible from the original Sum Insured until it is fully exhausted.

👉 5️⃣ Upon full exhaustion of the original Sum Insured, the policy provides for Restoration of Sum Insured, subject to policy terms.

👉 6️⃣ However, a key restriction applies after such restoration:

The restored Sum Insured cannot be utilized by the same insured person for the same disease/illness for which a claim has already been made during the same policy period.

👉 7️⃣ Therefore, the restoration benefit does not operate as a continuation of coverage for:

* the same insured person,

* for the same disease,

* within the same policy year,

after exhaustion of the original Sum Insured.

👉 8️⃣ The restored Sum Insured is permissible only in the following cases:

(a) For other insured family members, or

(b) For the same insured person for a different disease/illness,

strictly in accordance with policy conditions.

👉 9️⃣ In the subsequent renewal policy period, the insured person will again be eligible to claim for the same disease, subject to the terms and conditions then in force.

👉 🔟 Conclusion (for clear understanding):

Same disease → Claim allowed from original Sum Insured (till it is available)

After exhaustion → Restored Sum Insured cannot be used by the same person for the same disease during that policy period

👉 1️⃣1️⃣ In short:

The restored Sum Insured cannot be used by the same insured person to make a second claim for the same illness during the same policy period.

This clarification is issued for proper guidance of members and to avoid any misunderstanding regarding the scope of the restoration benefit.

A NIARAS KERALA VISION

GMC POLICY RENEWAL 2026-27 – SALIENT FEATURES ( FOR RETIREES)

 📢 NEW INDIA ASSURANCE – RETIRED EMPLOYEES

🩺 GMC POLICY RENEWAL 2026-27 – SALIENT FEATURES (RETIREES)

👉 Para 1 – Free Medical Check-up Enhanced

✅ Free medical check-up limit increased

✅ Now: 1% of Average Family SI up to ₹10,000

✅ Available once after block of four claim-free years

👉 Para 2 – Maternity Benefit Limits Increased

✅ Normal Delivery

🟢 A Class Cities – ₹65,000

🟢 Other Cities – ₹55,000

✅ Caesarean Delivery

🟢 A Class Cities – ₹1,20,000

🟢 Other Cities – ₹85,000

⚠️ Waiting Period Introduced

🔸 One year waiting for newly added spouse / child

👉 Para 3 – Maternity Coverage Restriction

⚠️ Maternity allowed only for first two living children

✅ Claims between first & second child admissible

❌ No maternity after second living child

👉 Para 4 – Diagnostic Tests Without Hospitalisation (New)

✅ Diagnostic tests reimbursable without admission

✅ Must be recommended by Specialist / MD

✅ Limit: 1% of SI OR ₹20,000 per family (whichever less)

✅ Once per test per insured in policy year

👉 Para 5 – Sum Insured Modification

✅ Enhancement to higher SI slab permitted

❌ Reduction in SI not permitted

✅ Reduction allowed only if family size reduces

👉 Para 6 – Restoration of Sum Insured (New Benefit)

🟢 Applicable for SI ₹25 Lakhs & above

✅ If SI exhausted, it will be restored

✅ Available for further claims in same year

👉 Para 7 – Room Rent Limit Increased

✅ Higher room rent eligibility introduced

🟢 Up to 1% of SI (up to ₹10 lakh)

🟢 0.5% beyond ₹10 lakh

🟢 Maximum up to ₹17,000

👉 Para 8 – Twins in Second Delivery Covered

✅ Company contribution allowed

✅ Twins in second delivery now covered

👉 Para 9 – Transportation of Mortal Remains (New)

✅ Reimbursement introduced

🟢 Up to ₹5,000

✅ From hospital to residence / funeral place

👉 Para 10 – Mid-term Inclusion (Retirees also eligible)

✅ Newly married spouse can be added

✅ Parents / parents-in-law can be added

✅ Newborn child can be added

🟢 Within 90 days of event

👉 Para 11 – Continuity Certificate for Independent Children

✅ Certificate issued if independent children exit GMC

✅ Helps them take individual mediclaim policy

⚠️ Once excluded – cannot rejoin GMC

📌 Overall Highlights for Retirees

✅ Free check-up doubled

✅ Room rent increased

✅ SI restoration introduced

✅ Diagnostic tests covered

✅ Transportation benefit added

✅ Maternity limits enhanced

⚠️ Maternity restricted to two living children

⚠️ Waiting period introduced for new additions.

A NIARAS KERALA VISION

Family Pension – Revised Rate (Illustrative Explanation for General Guidance)

 📢 CIRCULAR

Enhanced Family Pension (EFP) – Revised Rate

(Illustrative Explanation for General Guidance)

Dear Members,

In view of the revision in the Normal Family Pension rate, the method of calculation of Enhanced Family Pension (EFP) is explained below for the clear understanding of all Family Pensioners.

1. Period of Enhanced Family Pension

As per GIEPS 1995 provisions, Enhanced Family Pension (EFP) is payable:

For 7 years from the date of death of the Service Pensioner, or

Till the date on which the deceased pensioner would have attained the age of 65 years,

👉 whichever occurs earlier.

2. Basic Rule for Calculation of EFP

Enhanced Family Pension shall be the LOWER of the following two amounts:

Method–1

50% of the last drawn pay (Basic Pay + admissible FPA)

Method–2

Two times the Normal Family Pension

3. Revised Normal Family Pension Rate

As per the revised provisions:

Normal Family Pension = 30% of last drawn pay

Enhanced Family Pension = 2 × Normal Family Pension

The condition of “whichever is less” continues to apply

4. Illustrative Example

Assume:

Last drawn pay (Basic + FPA) = ₹82,850

Method–1

50% of last drawn pay

= ₹82,850 × 50%

= ₹41,425

Method–2

Normal Family Pension @ 30%

₹82,850 × 30% = ₹24,855

Enhanced Family Pension

= 2 × 24,855

= ₹49,710

5. Application of “Whichever is Less”

Calculation Method

Amount

50% of last pay

₹41,425

2 × 30% Normal FP

₹49,710

👉 Lower amount = ₹41,425

6. Eligible Enhanced Family Pension

✔️ Enhanced Family Pension (Basic) : ₹41,425 per month

➕ Dearness Relief (DR) as applicable

7. Conclusion

After revision of the Normal Family Pension to 30%, the 50% of last drawn pay becomes the payable Enhanced Family Pension in many cases, even while the “whichever is less” condition remains unchanged.

Members may verify their individual entitlement by applying the above method using their own last drawn pay.

General Secretary.

Important Guidance for Using the NIARAS Family Pension Calculator

This Family Pension Calculator is provided for family pensioners to estimate:

Ordinary Family Pension (OFP) @ 30%, and

Enhanced Family Pension (EFP) @ 50%, wherever applicable,

based on the last drawn Basic Pay of the deceased employee.

✅ What to Enter as “Last Drawn Basic Pay”

Enter ONLY the Basic Pay that the deceased member was drawing at the time of death.

Do NOT include:

Dearness Allowance (DA)

HRA

CCA

Any other allowances

📌 “Last drawn Basic Pay” strictly means Basic Pay alone, as shown in the salary slip.

✅ What This Calculator Computes

Ordinary Family Pension (OFP) @ 30% of the Basic Pay.

Enhanced Family Pension (EFP) @ 50% of the Basic Pay, wherever the family is eligible, and only for the admissible period.

Dearness Relief (DR) is calculated separately as per prevailing Government rates.

✅ Who Can Use This Calculator

This calculator is meant only for family pensioners.

It helps in understanding both OFP (30%) and EFP (50%), wherever applicable.

📝 Important Reminder

Please ensure that all input details are entered correctly.

Entering Basic Pay along with DA or other allowances will give incorrect results.

This calculator is meant only for guidance and estimation.

The final pension payable will be as per official sanction by the competent authority.

CLick on below link to use the Calculator. 

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