Punjab Government Employees & Pensioners Health Insurance Scheme – PGEPHIS
THE SALIENT FEATURES OF PUNJAB GOVERNMENT EMPLOYEES AND PENSIONERS HEALTH INSURANCE SCHEME
All personnel of the Punjab Government including All India Service officers, Serving, Newly Recruited, Retired and Retiring 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 as indicated below:
a. PGEPHIS shall be compulsory to all serving Punjab Government Employees and Pensioners (herein after referred to as “Serving Employees and pensioners”) who are presently covered under the existing Punjab Medical Attendant Rules [CS (MA) Rules, 1940].
Serving Employees and Pensioners shall have to mandatorily submit their Enrollment Form within the duration of Enrollment Period. In an event of their failure to get enrolled under the Scheme during the Enrollment Period, they shall be able to get enrolled in the subsequent renewal/ policy plan period of PGEPHIS. No fresh enrollment of the Serving Employees and Pensioners shall be allowed after the date of expiry of Enrollment Period except for any exceptional circumstances, under which coverage as well as payment of premium of such employees/pensioners shall be allowed on pro-rata basis (herein after referred to as employee/pensioner under exceptional circumstances).
b. PGEPHIS shall also be compulsory to new Punjab Government Employees who would be joining after the date of expiry of Enrollment Period of the scheme (hereinafter referred to as “New Employees”). The enrollment of new employees, who join after the date of after the date of expiry of Enrollment Period, shall continue throughout the policy plan period. The coverage as well as payment of premium of new employees shall be on pro rata basis, for the remaining period of policy plan period from the date of their joining in the service. In an event a new employee avails hospitalization during the intervening period between his/her date of joining in the service and his/her enrollment, the new employee shall be entitled to receive treatment at the provider network on the reimbursement basis as per the package rates defined under the Scheme, subject to submission of bills/ claim within prescribed time period.
c. PGEPHIS would be available on voluntary/ optional basis for the following categories:
- All IAS & IPS officers serving in the State- serving and retired who are covered under the existing Punjab Medical Attendant Rules [CS(MA) Rules,1940].
- Serving & Ex-MLAs,
- Serving and Ex-Judicial officers including judges of Punjab & Haryana High Court,
In order to enroll under PGEPHIS, the beneficiaries falling under the category for which the scheme is available on optional basis, if covered under the existing Medical Attendant Rules, will have to opt out of the current reimbursement system, if applicable. Those who wish to opt for PGEPHIS shall exercise their option/ choice at the time of filling the Enrollment Form within the stipulated Enrollment Period. Those who do not opt for PGEPHIS during the duration of Enrollment Period, shall be able to exercise their option in the subsequent renewal/ policy plan period of PGEPHIS. No fresh enrollment of the beneficiaries falling under categories, for which the scheme is available on optional basis, shall be allowed after the date of expiry of Enrollment Period.