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Policy Information


Eligibility for Coverage In Scheme
  • Any cooperative society registered under the Punjab Cooperative Societies Act,1961
  • Members and employees of Eligible Cooperative Societies/ Institutions, employees or retired employees of the Department of Cooperation/ office of the Registrar Cooperative Societies, the Punjab Employee Trust, and their families across the State of Punjab and Chandigarh, shall be covered under the Scheme for a period of one year from the date of commencement of the Punjab Employee Group Mediclaim Policy.
Main Member
  • Is a person who is a member or an employee of any Eligible Cooperative Society/ Institution, employee or retired employee of the Department of Cooperation/ office of Registrar Cooperative Societies Punjab Employee Trust
  • Is not more than 75 years of age on the date of commencement of the Policy Plan Period.
  • Fills up the Member Enrollment Form declaring his status as the Main Member and pays the insurance premium on behalf of his or her Family.
Beneficiary or Insured
  • Main Member+Dependants of the Main Member = Beneficiaries/insured
  • Beneficiary/Insured means a member or employee of the Eligible Cooperative Societies/ Institutions, employee or retired employee of the Department of Cooperation/ office of the Registrar Cooperative Societies, Punjab Employee Trust and their families across the State of Punjab and Chandigarh, who have been named as dependants in the Member Enrollment Form for being covered under the Scheme, provided none of such persons is more than 75 years of age on the date of commencement of the Policy Plan Period.
Family

Family means the persons named in the Member Enrollment Form including the Main Member and any of his or her following relatives irrespective of whether or not they are residing with the Main Member

  • Spouse of the Main Member;
  • Parents of the Main Member;
  • Unmarried children of the Main Member;
  • Widow and divorcee daughters of the Main Member.
  • Minor children of widow and divorcee daughters of the Main Members
  • Parents or Parents-inlaw in case of a lady Main-Member
  • Age limit - upto 75 Years
Exclusions Under the Scheme

No payment under the scheme will be made in respect of any expenses whatsoever incurred by the members in connection with or in respect of the following circumstances: -

  • Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not).
  • Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be necessitated due to an accident.
  • Vaccination or inoculation or change of sex or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
  • Cost of spectacles, contact lenses and hearing aids.
  • Dental Treatment or surgery of any kind.
  • Convalescence, general debility, run down condition or rest cure, Congenital external disease or defect of anomalies, sterility, venereal disease, HIV positive diseases and diseases directly attributable to alcoholic intake.
  • Self inflicted injuries, HIV or any complications/diseases attributing to HIV.
  • Charges incurred at Hospital or Nursing Home primarily for diagnostic, X-ray or laboratory examinations not leading to indoor treatment.
  • Expenses on vitamins and tonics unless forming part of treatment for injury or disease as certified by the attending physician.
  • Injury or disease directly or indirectly caused by or contributed to by nuclear weapons/materials.
  • Naturopathy Treatment, Ayurvedic and Homeopathic treatment.
  • Physiotherapy, psychiatric treatment, hospitalization only for giving traction, without any medical management/support. However, hospitalization exclusively for providing traction or for providing psychiatric treatment shall be covered only in Government hospitals.
Items not covered under the scheme and the member has to pay to hospital at the time of discharge
  • Ambulance charges
  • Extra Bed for Attendant , Attendant Pass , Food and Beverages for Attendant
  • Bed retaining charges
  • Expenses on Luxury items like Radio, T.V, A/c, Laundry, Telephone.
  • Expenses on vitamins, tonics, if not related to treatment
  • Sanitary items
  • Special duty nursing fee
  • Photocopy / Certifying charges
  • Vaccination / Nutrition and Dietetics
  • Expenses on spectacles / hearing aids