LIC Rates List

Sr. PSP
Descrition of tests
No RATES

Full Medical Report

(General medical examination covering Height & Weight
1 Sum Insured -upto Rs.15 Lac 80.00
2 Sum Insured Rs.15 Lac to Rs.24,99,999 Lac 100.00
3 Sum Insured -Rs.25 Lac to Rs.49,99,999 Lac 120.00
4 Sum Insured -Rs.50 Lac to Rs.99,99,999 Lac 130.00
5 Sum Insured -Rs.1,00,00,000 and above 150.00

Special Reports
1 ECG 65.00
2 Blood sugar (PP& Fasting) 55.00
3 HB % 15.00
4 HB A1C 150.00
5 Haemogram 60.00
6 Lipidogram 145.00
7 X-ray Chest 70.00
8 Urine Analysis- Routine 20.00
9 Elisa (HIV) 200.00
10 Computerized TMT 560.00
11 SBT –12 500.00
12 SBT-13 650.00
13 SBT-18 700.00

Additional Special Reports

1 X-ray Plain of GU tract ( 2 plates) 130.00

2 X-ray of Stomach & Deudenum (barium meal)-5 plates 315.00
3 X-ray of Caecum & colon ( Ba.Enema) 2 plates 175.00
4 Intravenous Pyelography ( 5 plates 440.00
5 Cholecystography (5 plates) 360.00
6 X-ray Hip (AP & lat) 120.00
7 X-ray Dorsal Spine (2 Plates) 120.00
8 Echo with color Doppler 600.00
9 Special Blood sugar test – 2 reading 55.00
10 G.T.T. of urine 35.00
11 Blood urea 35.00

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LIC Rates List Continued…
Sr.
Descrition of tests PSP RATES
No
12 SGOT 35.00
13 SGPT 35.00
14 Serum triglycerides 50.00
15 Serum Bilirubin 35.00
16 Serum, Proteins (Albumin & Globulin) 55.00
17 Serum Glycosylated HB% 80.00
18 Stool Routine 20.00
19 ESR 20.00
20 WBC count 20.00
21 Australian Antigen test 50.00
22 CBC / ESR with Hb % & peripheral smear 40.00
23 VDRL 35.00
24 Serum Cholesterol 40.00
25 Serum Creatinine 40.00
26 Serum Amylase 40.00
27 Acid Phosphatase 40.00
28 Stress Thallium test 4000.00
29 Angiography 7000.00
30 Audiogram 70.00
31 C.T. Scan of brain / Chest 1600.00
32 GTT 120.00
33 Ultra sound Abdomen / pelvis 525.00
34 USG of KUB 350.00
35 T3, T4, TSH 350.00
36 P FT (pulmonary function) 280.00
37 Dobutamin Stress test 1050.00
38 Questionnaire 45.00
39 HBSAG 50
40 LFT 250
41 PHY. REPORT 45

E-Meditek (TPA) Services Ltd

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 GUIDELINES TO THE DIAGNOSTIC CENTRE
FOR LIC PRE-INSURANCE MEDICAL CHECKUP

PROPOSAL FORM.

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.
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. 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 i.e. 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.

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 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.
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.

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. 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.

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 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.

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:

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