LIC Rate List - E-Meditek

1 LIC rates List Sr. No Descrition of tests PSP rates Full Medical Report (General medical examination covering Height & Weight 1 Sum Insured -upto Lac 2 Sum Insured Lac to ,99,999 Lac 3 Sum Insured Lac to ,99,999 Lac 4 Sum Insured Lac to ,99,999 Lac 5 Sum Insured ,00,00,000 and above Special Reports 1 ECG 2 Blood sugar (PP& Fasting) 3 HB % 4 HB A1C 5 Haemogram 6 Lipidogram 7 X-ray Chest 8 Urine Analysis- Routine 9 Elisa (HIV) 10 Computerized TMT 11 SBT 12 12 SBT-13 13 SBT-18 Additional Special Reports 1 X-ray Plain of GU tract ( 2 plates) 2 X-ray of Stomach & Deudenum (barium meal)-5 plates 3 X-ray of Caecum & colon ( ) 2 plates 4 Intravenous Pyelography ( 5 plates 5 Cholecystography (5 plates) 6 X-ray Hip (AP & lat) 7 X-ray Dorsal Spine (2 Plates)))

2 8 Echo with color Doppler 9 Special Blood sugar test 2 reading 10 of urine 11 Blood urea 13 LIC rates List Sr. No Descrition of tests PSP rates 12 SGOT 13 SGPT 14 Serum triglycerides 15 Serum Bilirubin 16 Serum, Proteins (Albumin & Globulin) 17 Serum Glycosylated HB% 18 Stool Routine 19 ESR 20 WBC count 21 Australian Antigen test 22 CBC / ESR with Hb % & peripheral smear 23 VDRL 24 Serum Cholesterol 25 Serum Creatinine 26 Serum Amylase 27 Acid Phosphatase 28 Stress Thallium test 29 Angiography 30 Audiogram 31 Scan of brain / Chest 32 GTT 33 Ultra sound Abdomen / pelvis 34 USG of KUB 35 T3, T4, TSH 36 P FT (pulmonary function) 37 Dobutamin Stress test 38 Questionnaire 39 HBSAG 50 40 LFT 250 41 PHY. REPORT 45 E-Meditek (TPA) Services Ltd 14 GUIDELINES TO THE DIAGNOSTIC CENTRE FOR LIC PRE-INSURANCE MEDICAL CHECKUP PROPOSAL FORM.

3 1. The examining doctor should go through the medical information disclosed by the Life Assured in the proposal form before conducting the medical examination. (MER) 2. Life Assured signature should be taken on page 4 / 6/ 8 of proposal form and it should be signed by the examining doctor with IMC Registration No. & Degree. MEDICAL EXAMINATION REPORT (MER) 1. All questions should be answered properly 2. No questions/ column should be kept blank please mention No / NA wherever required. 3. Answer to any question if Yes details should be given. 4. Take the exact measurement for height, weight and girth of abdomen, chest inspiration and expiration, Blood Pressure & Pulse. (Life Assured should be instructed to relax while taking the readings) a. Chest Inspiration & Expiration measurement should be taken at the nipple level.

4 B. Measurement like Height, girth of abdomen, chest inspiration and expiration should be mentioned in Centimeters only. c. Weight should be mentioned in Kgs. 5. Any overwriting or use of white ink should be avoided and if at all done should be countersigned by the examining doctor.( White ink should not be used on any report ) 6. Life Assured Signature along with the signature of examining doctors with his / her rubber stamp along with IMC registration number should be there in the MER form. The date of examination & place should also be mentioned. 7. Medical examination can only be done by MBBS doctor / MD (Med) doctor. Radiologist & Pathologist cannot do the medical examination (MER). 8. Male doctor should examine Male Life Assured only & Female doctor should examine Female Life Assured only. ELECTROCARDIOGRAM (ECG)/COMPUTERIZED TREADMILL TEST (CTMT) 1.

5 Read the instruction on Page 1 of the ECG / CTMT reporting format before conducting the same. 2. All questions on Page 1 should be answered. (If answer to any question is Yes relevant documents should be collected from Life Assured) 3. Height, Weight, Blood Pressure & Pulse rate should be mentioned on page 2 of the ECG format Height & weight should always correlate with the reading mentioned in the MER & the TMT. 4. Life Assured s signature should be taken on ECG strip / CTMT tracing. Mention the date & time of conducting the test on ECG strip / CTMT tracing. 5. Reporting of ECG / CTMT should be in the LIC format only as per the column given in the format. 15 6. Reporting should be done by Cardiologist (MD / DM) only (In case non availability of Cardiologist, reporting should be done by MD Physician) with his / her signature along with rubber stamp & IMC registration number in the format.

6 The date of test should also be mentioned in the format. PATHOLOGICAL TEST 1. All Pathological reporting should be done in the respective LIC format only. 2. Method by which the following test has been performed should also be mentioned a. ESR by Westergreen method. b. HIV I & II by Elisa method. c. Blood Sugar by GOD-POD method. 3. In case of BLOOD SUGAR TOLERANCE report post blood sugar test should be 2 hrs after giving 75gms. Of glucose only. Note: If the Life Assured is found to be Diabetic on taking the History then to conduct Post Lunch blood sugar instead of Post Glucose blood sugar. 4. In case of ROUTINE URINE ANALYSIS a. If pus cells are found then Gram Stain should be done. b. If haematuria is present Ziehl Neelsen Method should be done. Separate report should be attached. 5. The pathologist only with his/ her rubber stamp, IMC registration number, the date, time & place should be mentioned on every report should sign all pathological test report.

7 NOTE: - 1. ID should be checked before conducting medicals and record of the same should be maintained by Diagnostic Centre. (PAN Card, Voter card, Employer card, Driving License) & the detail has to be mentioned in the column provided on 2nd page of MER (Xerox of the photo ID should be attached, without that the report is invalid & will not be accepted). 2. The Client s medicals should be done only on appointment basis. (Medicals on basis of Fax would not be accepted). 3. TAT: Turn Around Time -24 hrs should be maintained. 4. If DC is found to generate deficiencies even after intimation, termination from EMSL panel will be done. 5. The quality of Reports should be upto the standard. 6. Update regarding the Change/Add in doctor, should be informed immediately. 7. Life Assured signature should be taken on the MER only after filling the MER details, ECG tracing including reporting format & the entire blood investigation format.

8 8. The signature of Life Assured should be taken along with the respective doctors signature, IMC Registration Number, date of examination & Place on all the LIC report format including Proposal Form. 9. Life Assured name, age & sex should be mentioned on all the reports. 10. Details mentioned in the LIC Intimation Letter should be complete. 16 Undertaking TO WHOM SO EVER IT MAY CONCERN WE HEREBY CONFIRM THAT: 1. None of our staff or the owners / directors are associated with any Insurance company as agents/employee/directors in any of the 2. IRDA licensed Insurance Company. 3. We will not canvass/pass any information of the insurance proponents referred by E-Meditek to us for medical Examination/medical tests. 4. We will not employ / empanel any medical professionals empanelled by Life Insurance Corporation of India or debarred by any Insurance company for conducting medical examination/tests.

9 We understand that breach of above conditions may entail depanelling of our centre by EMSL and action as per prevalent Law/India medical council rules. Signature Date: 17