Members sick of woes in UTI health scheme

Many subscribers of the Senior Citizens Unit Plan (SCUP), a health scheme by the Unit Trust of India (UTI), find themselves in a soup due to the various problems with the implementation of the scheme.

In a few cases, the subscribers claim that they were reimbursed only half the amount of the total medical expenses even as it had not exceeded the upper limit of Rs 1.5 lakh. In a few others, the subscribers say that money is being deducted from their accounts without being given a reason for it.

Padmanabha Arkalgud, 78, a subscriber from the City, told Deccan Herald that he faced the problem when he went to a private eye clinic. “Amounts of Rs 500 and Rs 600 get deducted from my account and I am not given a justification for the same,” he said.

The scheme, initiated in 1993, is presently implemented in association with the New India Assurance Company (NIAC) and has over 20,000 subscribers. Many of the subscribers reported that when they received treatment at hospitals empanelled under the scheme, they were told that the ceiling was set by NIAC.

Senior subscribers under the scheme are allowed to encash facilities up to Rs 1.5 lakh, provided the illness does not recur within a period of 45 days. However, in most cases, they are expected to bear over 50 per cent of the expenses, despite the bills being within the set limit.

“I had to shell out half the expenses from my pocket for my eye problem. The actual cost was Rs 64,961 and was paid back just Rs 24,000,” Padmanabha said.

Another senior citizen who underwent cataract operation faced similar difficulties.
“We were not aware about the upper limit. However, we had to pay nearly 30 per cent of the expenses for a cataract operation. We were told that the terms had changed,” said a family member of Govindan Kutty, a senior citizen.

 Another subscriber, who alleged that the reimbursement procedure was slow, said, “I get the money refunded very late. Some of it gets deducted without reason. As we are all really old, we cannot even fight for the same. Some of us seek help from others, the rest are helpless,” she said.

Similar complaints from across the country, claiming that the issues persist from 2010, flood complaint sites. An internal circular sent by NIAC states, “The amount payable for any cataract surgery will be a maximum of Rs 24,000.”

A spokesperson for UTI said, “NIAC shall not be liable to make payment under SCUP in respect of any claim, if such claim be in any manner found to be fraudulent, inflated, supported by fraudulent means or device whether by the member or by any other person acting on his behalf.”

She said, “Now that the problems been brought to their notice, we have sought immediate explanation from NIAC as to why the amount is being deducted.”