PGEPHIS Punjab Government Employee & Pensioners Health Insurance Scheme

Organization : MDIndia Healthcare Services
Service Name : Punjab Government Employee and Pensioners Health Insurance Scheme( PGEPHIS)
Applicable State: Punjab

Website : http://pgephis.co.in/pes/PESDefault.aspx

PGEPHIS

The Governor of Punjab is pleased to introduce a Cashless Health Insurance Scheme hereinafter referred as Punjab Government Employee and Pensioners Health Insurance Scheme( PGEPHIS) to cover indoor medical diseases as sepecified or to be sepcified by State Government. The Scheme will be applicable to all the Government Serving Employees and Pensioners on compulsory basis.

Related : MD India BGSSS Bhai Ghanhya Sehat Sewa Scheme Punjab : www.statusin.in/18421.html

All personnel of the Punjab Government including All India Service officers, Serving, Newly Recruited, Retired who are covered under the existing Punjab Medical Attendant Rules [CS(MA) Rules, 1940] shall be offered Health Insurance Scheme on compulsory or on optional basis.

In-patient benefits :
The Insurance Scheme shall pay all expenses incurred in the course of medical treatment availed by the beneficiaries in the empanelled hospitals/ nursing homes (24 hours admission clause) within the country, arising out of any illness/disease/injury and or sickness.

Coverage of Pre-existing diseases:
All diseases under the Scheme shall be covered from day one. A person suffering from any disease prior to the inception of the policy shall also be covered.

Pre & Post hospitalization Benefit:
Benefits up to 7 days Pre Hospitalization & up to 30 days Post Hospitalization respectively which would cover all expenses related to treatment of the sickness for which hospitalization was done. The beneficiary shall avail this benefit on cashless basis in empanelled hospitals. The pre and post hospitalization investigations shall be covered at CGHS Rates.

FAQ:
What is the definition of a family?:
Family means a Government Employee’s wife (including judicially separated wife) or husband in case of a female Government employee, who is residing with & wholly dependent on him/her, legitimate children (including step & adopted children) up to two and father and mother residing with and wholly dependent on the Government employee.

(Punjab Govt. Letter No. 12/9/93-5H5/9495 dated 17.03.1994) The definition given above will be applicable on those employees also who children exceed two after the birth of any child/children within a year after the issue of the above instructions. (Punjab Govt. Letter No. 12/97/93-5H5/8093 dated 14.03.1995)

How Can I Verify, Whether I Am Enrolled Under The Policy?:
You Can Check That On Our Website By Clicking On The “Instant E-Card” And Type 0 Followed By Your 10 Digit Mobile Number.

Where Can I Get The Cashless Hospitalization Benefit?:
You Can Get The Cashless Hospitalization Benefit In Network/ Empaneled Hospitals Of Punjab & Ncr. You Can Get The List Of Hospitals By Clicking On ‘Hospital Search’ Tab On The Homepage Of Our Website.

If Hospital Asks, For Money Even After Approval, Whom Should I Contact?:
The Beneficiary / Patient Can Get Cashless Benefit In Any Network Hospital. Incase The Hospital Denies To Give Cashless Benefit, Please Report The Same On Our Tollfree Number Or Draft An E-Mail Or Write A Letter To Us. If The Patient Has Got The Approval For Partial Amount For Treatment, The Differential Amount Shall Be Paid By The Patient (Patient Written Consent Is Must In This Case).

Contact Us:
General EnquiryToll Free No. : 104
Cashless Toll Free No. : 1 800 233 5557
Email : authorisation_pgephis@mdindia.com
Email : customercare_pgephis@mdindia.com