Punjab Notifies New Cashless Insurance Scheme For Employees And Pensioners
Author(s): City Air NewsChandigarh, October 21, 2015: The Punjab Government today notified Cashless Health Insurance scheme to be known as Punjab Government Employees and Pensioner Health Insurance Scheme ( PGEPHIS) to cover indoor medical...
cityairnews
Oct 21, 2015 09:30
0
Chandigarh, October 21, 2015: The Punjab Government today notified Cashless Health Insurance scheme to be known as Punjab Government Employees and Pensioner Health Insurance Scheme ( PGEPHIS) to cover indoor medical treatment expenses, specified day care procedure and treatment of chronic disease as specified or to be specified by the Government .According to official spokesman this scheme will be applicable to all Government employees (whether covered under old or new pension scheme ) and pensioners on compulsory basis.
However, the scheme will be optional for All India Service officer, serving and ex MLA’s , serving and ex-judicial officers including judges of Punjab and Haryana High Courts . The premium of the main member as well as dependent (s) will be paid by the State Government, the spokesman added.
He clarified that in case husband and wife both are in Punjab Government job or one of them is retired from the Punjab Government , either one of them is eligible for the scheme. However, in case any employee/pensioner is taking medical reimbursement from the other source, he or she will not be eligible under this scheme.
He said that PGEPHIS will cover all the entitlement as specified under the State services rule 1940 this scheme will insure cashless all in door medical treatment, pre or post hospitalisation specified as defined, day care procedure requiring less than 24 hours hospitalisation and OPD medical expenses relating to chronic disease up to a some of Rs. 3 lac per family per year on floater basis. Medicines for chronic disease is also available on cashless basis from designated stores and hospitals in every district and block. All pre existing disease will be also covered.
He further said the treatment can be taken any enrolled beneficiary in Government or empanelled hospitals of Punjab , Chandigarh and NCR areas Gurgaon, Noida and Delhi. No reimbursement will be available to employee/pensioner in the Punjab,Chandigarh and Punchkula where cashless treatment is available . However, reimbursement will be taken by employee/pensioner for medical treatment taken in any other State in India in exceptional circumstances the insurance company will reimburse the bill of employee up to 3 lac as per the package rate defined under the scheme.
Divulging more he said that since the cashless medical treatment is made available to employee/pensioners through insurance company. There are certain treatments which are not covered under health insurance as per the Insurance Regulatory and Development .Authority of India (IRDA) details of such exclusions are available in the scheme uploaded on website of the health department of Punjab www.pbhealth.gov.in. The reimbursement of such exclusion will be made available to employee/pensioners as per existing policy and States service Rule 1940 as amended from time to time.
He said that any treatment taken abroad will not be covered under this scheme, any public servant/pensioners will have take overseas insurance covered before going abroad. Premium of such insurance cover will be borne by employee/pensioner. If any public servant is going on Government tour, premium of such overseas insurance will be borne by the employee pensioner.
Giving more information he said that the State Government selected Oriental Insurance Company through tendering .The insurance company will make buffer of Rs. 25 crore for meeting out expenses over and above Rs. 3 lac and cashless insurance to any employee/pensioner will be available beyond Rs. 3 lac subject to the availability of the buffer.
Spokesman said that enrolment under the scheme will start from immediate and will be completed by 31 December 2015 and the benefit under this scheme will start from 1 January 2016 to 31 December 2016 initially. Every employee/pensioner will ensure his/her enrolment along with dependents before 15 December 2015 and the insurance company to give enrolled insurance card up to 31 December 2015.
He said that the employees/pensioner will be entitled for fixed medical allowance as per the existing pattern to cover the routine OPD expenditure. Any employee/pensioner can take any kind of information related to as Punjab Government employees and Pensioner Health Insurance Scheme ( PGEPHIS) and also registered its complaint at medical help-line number 104.A similar scheme can be adopted boards, corporations and public sectors under taking of Punjab Government for its employee and pensioner in consultation with the State Government in Finance Department.
Date:
Wednesday, October 21, 2015
