Published On: Wed, Oct 21st, 2015

Cashless health insurance for Punjab govt employees, pensioners

Chandigarh: Punjab government today said it has notified cashless health insurance scheme – Punjab Government Employees and Pensioner Health Insurance Scheme (PGEPHIS) to cover expenses of patient’s indoor medical treatment, specified day care procedure and chronic disease.

Punjab Health Minister Surjit Kumar Jayani

Punjab Health Minister Surjit Kumar Jayani

According to official spokesman, this scheme will be applicable for 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 state 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 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 Rs 3 lakh per family per year on floater basis.

Medicines for chronic disease are also available on cashless basis from designated stores and hospitals in every district and block. All pre existing disease will be also covered, he said.

He further said the treatment can be availed by 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 Panchkula 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 Rs 3 lakh as per the package rate defined under the scheme.

He said 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.

He said any treatment taken abroad will not be covered under this scheme and any public servant/pensioners will have to 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.

The State Government roped in Oriental Insurance Company which will create buffer of Rs 25 crore for meeting expenses over and above Rs 3 lakh and cashless insurance to any employee/pensioner will be available beyond Rs 3 lakh subject to the availability of the buffer.


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