Punjab government has declared that the cashless health insurance scheme will now be known as Punjab government employees and pensioner health insurance scheme (PGEPHIS), which will cover all indoor medical treatment expenses, specified day care procedure and treatment of chronic diseases as specified by the government, this scheme will be applicable to all government employees (whether covered under old or new pension scheme) and pensioners on compulsory basis.
The state government 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 as defined, day care procedure requiring less than 24 hours hospitalisation and OPD medical expenses relating to chronic disease up to a sum of Rs. 3 lakh per family per year on floater basis. Medicines for chronic diseases are also available on cashless basis from designated stores and hospitals in every district and block. All pre existing disease will be also covered.
Punjab government said that the treatment can be availed by any enrolled beneficiary in government or empanelled hospitals of Punjab, Chandigarh, Gurgaon, Noida and Delhi. The state government said that no reimbursement will be available to employee/pensioner in the Punjab, Chandigarh and Panchkula region where cashless treatment is available. However, employee/pensioner can claim reimbursement 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 lakh as per the package rate defined under the scheme.
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. The state government also said that any treatment taken abroad will not be covered under this scheme; any public servant/pensioner before going abroad may take overseas insurance cover, 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 has 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 lakh and cashless insurance to any employee/pensioner will be available beyond Rs. 3 lakh, subject to the availability of the buffer.
Punjab government stated that the enrollment under this scheme will start from immediate effect and will be completed by 31 December 2015. 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 can also register their complaint at medical helpline number 104.