Q.1 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)
Q.2 What is the definition of Dependents?
Any family member who is not Income Tax payee can be treated as Dependent and eligible for medical reimbursement. (Punjab Govt. Letter No. 12/2/11-5H5/721 dated 30.03.2012)" Family members of employees who are also earning members are not entitled to reimbursement of medical charges unless they are also the State Govt. Employees. A Govt. Employee can, thus claim reimbursement of medical charges in respect of those members of family who are wholly dependent upon him. (Punjab Govt. Letter No. 149-1HB1/69 dated 29.12.1969) A wife/husband of a Govt. Employee who is in private service is not entitled to any medical reimbursement (Punjab Govt. Letter No. 782-1HB1-72/18006 dated 26.06.1972) Accordingly employees working in private schools or their family members even with no benefit of free medical treatment/reimbursement are not entitled to reimbursement of medical charges. (DHS Pb’s Letter No. PM (2) 71-3633 dated 26.03.1971) Any family members claiming medical reimbursement from other sources is not dependent Father not income tax payee. Mother, if widow, and herself not income tax payee,treated as dependent. Unmarried Son, if not income tax payee treated as dependent. Married son is not dependent. Unmarried daughter, if not income tax payee treated as dependent Family of wife cannot be treated as dependents. Wife of a Government employee shall be deemed to be wholly dependent on him as long as she is not legally separated from him. The son or daughter of a Government employee is suffering from any disorder or disability of mind or is physically crippled or disabled for life as certified by the Competent Authority i.e. a medical officer not below the rank of a Civil Surgeon.
Q.3 Who is Income Tax Payee? A person having annual income of more than Rs. 2.50 lacs.
Q.4 What are the conditions when both husband and wife are in service of Punjab Govt. and when employed in different States? When both husband and wife are State Govt. Employees, they may be allowed to avail the medical concessions depending upon their own and their dependent children’s status. For the same purpose they will have to furnish a joint declaration to their respective administrative authorities as to who will claim for reimbursement of medical expenses incurred on the medical attendance and treatment in respect of wife/husband and their children. The declaration state above should be submitted in duplicate and a copy of each shall be recorded into their personal file of each of their respective offices. The declaration shall remain in force till revised on the express request in writing by both husband and wife in the event of promotion, transfer, resignation etc. off either of the two. If such a declaration is not doe, the medical concessions shall be availed by the wife and the children, according to the status of the husband. Although the entitlement of medical expenses is to be regulated according to the individual status of each of them i.e. husband and wife in service, their respective department separately debar husband/wife from claiming reimbursement. In such case only one of the spouses will prefer claims for reimbursement of medical expenses against a joint declaration and furnishing the Certificate given as per Punjab Govt.’s letters No. 2653-HBIV-60-59236 dated 16.12.1960, 12378-5HB1-72/8144 dated 27.03.1973 and 14972-1HB1-69/554-618 dated 21.01.1970. Punjab Govt. employee is not entitled to claim reimbursement of medical charges in respect of any member of his family who is an employee of other State/Central Govt. or is working in any other Govt. institution. In such cases also it will be necessary for the husband/wife to submit a joint declaration as to who will prefer the claim in respect of their dependent family members. (PG letter No. 12510-5HB1-73/31255 dated 17.12.1973)
Q.5 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.
Q.6 Who Will Be My Dependents? Spouse, Unmarried Son Upto The Age Of 28, Unmarried Daughter Till She Is Independent, Mother & Father.
Q.7 Can I Cover My Son Above 28 Years? No, As Per The Policy, Son Can Be Covered Only Upto The Age Of 28 Unless He Is/Has Cronic Ailment/Mentally Retarded/Physicaly Disablled Or Completely Dependent On You, After Producing A Valid Certificate For The Same.
Q.8 If There Is Any Mistake In My MDID Card, Whom Should I Contact? For Corrections ,Click On The 'Enroll Corrections' Tab Available On Our Website. You Will Require To Insert Your Mobile Number & Confirm The Corrections Required. We Will Resolve The Problem Within 48 Hours.
Q.9 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.
Q.10 Which Ailment Is Covered Under This Policy? Every Ailment/ Disease/Sickness Amd Procedures Are Covered Under This Policy Except Dental, Cosmetic & Lasik Surgery Unless Arising Due To Accident Or Trauma You Can .
Q.11 What Is Payable Under This Policy? Expenses Arising From Room Rent, Consultation, Medicines, Investigation, Surgery, Etc. Are Paybale Under This Policy.
Q.12 What Is Not Payable Under The Policy? All Non Medical Expenses Such As Diet Charges, Admission Fee, Extra Facilities Taken By The Patient Excess Of Eligibilty, Artifical Limbs, Hearing Aids, Spectacles, Etc. Are Not Payable Under This Policy.
Q.13 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).
Q.14 Will I Get Reimbursement If I Go To A Non Network Hospital? Yes, For Punjab & Ncr Region You Will Get Reimbursment Only In Govt Hospitals. For Other States Reimbursment Is Available Only On Cghs/Pgephis Rates.
Q.15 What Is The Period For The Pre & Post Hospitalization? Pre-Hospitalization Is 7Days Before The Date Of Admission And Post-Hospitalization Is 30 Days After The Date Of Discharge.
Q.16 Within How Many Days, Should I Submit The Documents? You Should Submit All The Relevant Documents Within 45 Days From Date Of Discharge.
Q.17 Which Documents Should I Submit For Pre- Hospitalization & Post-Hospitalization Claim? Claim Form,Ecs Details, Photocopy Of Discharge Summary/ Card, Medicine Bills With Prescription, Investigation Reports With Prescription & Bills, Consultation Paper With Supporting Consultation Bills, Govt Authorized Id Proof
Q.18 What Are The Documents Required To Submit For Opd Claims? Claim Form, Essential Certificate Duly Stamped & Signed By Govt Hospital, Critical Illness Certificate, Medicine Bills Along With Prescription, Ecs Details & Govt Authorized Id Proof
Q.19 From Where I Can Get My Chronic Certificate? You Can Collect The Chronic Certificate From Any One Of The Below 6 Hospitals.
1)Pgimer, Chd,
2)Gmch-32, Chd,
3)Aiims, New Delhi,
4) Rajindera Hospital, Ptl
5) Govt Medical College, Asr
6) Ggsmch, Fkt
Q.20 Within How Many Days, Will I Get My Reimbursement Amount? The Amount Will Be Reimbursed Within 30 Days From Date Of Submission Of Claim Documents