PNB Parivar Bhavisya Arogya Yojna- Lodgement of Claims and Issue of I-Cards

Transcription

1 PNB Parivar Bhavisya Arogya Yojna- Lodgement of Claims and Issue of I-Cards M/s MD India Healthcare Services (TPA) Pvt. Ltd, Third Party Administrator (TPA) for PNB Parivar Bhavishya Arogya Yojna has informed that the following procedure be adopted for hospitalization/lodgement of claim:- A. M/s MD India Healthcare Services Ltd. has empanelled sufficient number of Hospitals all over India and the same is available in their websitewww.mdindiaonline.com. The list is updated/revised from time to time by them. For cashless facility, the employees/their family members can approach these hospitals and the same should immediately be brought to the notice of the TPA desk attached with the hospital or to any of the nearby offices of M/s. MD India given at Annexure-A. Since the list of hospitals is being revised by the TPA from time to time, it is requested to refer to their website, i.e., ww.mdindiaonline.com for the updated list of such hospitals or contact at their Customer Care Phone No B. In case hospitalization is done in any of the hospitals other than the hospital empanelled by MD India, the intimation of the same be sent to any of the nearby offices of MD India within 24 hours of hospitalization. C. For submission of hospitalization claim, certain formalities are to be completed/complied with, which are given at Annexure-B. Specimen claim form of M/s. MD India Healthcare Services TPA) Pvt. Ltd. is also enclosed as Annexure-C. The same should be submitted within a period of 15 days from the date of discharge, to any of the nearby offices of MD India, complete in all respect. While making claim, concerned employees are advised to mention their correspondence address, phone no. including mobile, FAX No. and the address, if any. D. As regards issuance of I-cards to the family members of employees who have opted for the additional cover, the same is to be sent directly to M/s. MD India Healthcare Services (TPA) Pvt. Ltd., as per the proforma given at Annexure-D, along with a copy of policy, at the following address:- M/s MD India Healthcare Services (TPA) Pvt. Ltd. Regional Office: E-98, 2nd Floor, Lajpat Nagar-II, New Delhi Ph: , Fax: Employees and/or their family members may ensure timely payment of the annual insurance premium directly to the Insurance Company during the stipulated period at the address mentioned below. Lapses/delay in timely payment of premium may lead to cancellation of an individual s policy by the Insurance Company. The Oriental Insurance Company Ltd. Divisional Office No.1, Jeevan Vihar Building, 04th Floor (Rear Block), Sansad Marg, New Delhi Ph No.: , , , , Fax: (HRD Division Circular No. 531 dated )

2 Annexure-A LIST OF BRANCH ADDRESSES & CONTACT NUMBERS Sr. No. Name 1 Agra Office Address Contact Numbers Name, Designation, contact number & mail ID of the Contact Person Survey No / Plot no A, Sector 11, Awas Vikas Colony Sikandara, Agra (U. P.) ID: agra@mdindia.com STD Code 0562 Land Line Fax Contact 1 Contact Mr.Manoj Parashar M: agra@mdindia.com 2 Ahmedabad 3 Aligarh 4 Allahabad 5 Bangalore 6 Baroda 7 Bhopal 8 Chandigarh 9 Chennai 10 Coimbatore 11 Dehradun 806/807, Sukhasagar Complex, 8thFloor, Usmanpur, Near Fortune Landmark Hotel, Ashram Road, Ahmedabad (Gujarat) ID: ahmedabad@mdindia.com Shop No 6, Near Milk Bar, Marris Road, Corporate Plaza, Aligarh (U. P.) ID: aligarh@mdindia.com 25/5, LIC Colony, Tagore Town Allhabad (U. P.) ID: allahabad@mdindia.com 90/2, First and second floor, K H Road, Bangalore ID: bangalore@mdindia.com 216, Lalita Towers, Behind Railway Station, Near Hotel Rajpath, Dinesh Mills Road, Baroda (Gujarat) ID: baroda@mdindia.com Plot No 15, 2nd Floor, Chitransh Home, A 1, Chitragupt Nagar, Behind Chitransh College, E 7 Arena Colony, 11 No Bus Stop, Bhopal (M. P.) ID: bhopal@mdindia.com S.C.F. No. 58 Sector 8, Main Market, Opp Post Office, Panchkulla, Chandigarh ID: chandigarh@mdindia.com 1402, H Block, 15th Main Road, Anna Nagar, Chennai ID: chennai@mdindia.com Door No. 880, 2nd floor,mattupalayam Road, Flower Market Area, Coimbatore (Tamilnadu) ID: coimbatore@mdindia.com House no. 54, Lane 4, Ground floor Portion, Mohit Nagar, Dehradun (Uttarakhand) ID: dehradun@mdindia.com Applied for Applied for Dr. Nirman Pandya (Sr. Manager - Baroda) M: npandya@mdindia Mr. Pankaj Kumar sharma M: aligarh@mdindia.com Ms. Neelam Misra M : allahabad@mdindia.com Mr. Mallikarjuna Rao J. ( Manager) M : mrao@mdindia.com Mr. Hariom Pandya ( Manager) M: hpandya@mdindia.com Ms. Vaibhavi Shah (Sr. Executive - Operations) M: ahmedabad@mdindia Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : ppardeshi@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: npandya@mdindia Dr. Abhishek Shukla Mr. Prakash Terdale (Sr. Executive - Client Servicing) (Asst. Manager - M.P & Chattisgarh) M : bhopal@mdindia.com pterdale@mdindia.com Mr. Rahul Gupta (Sr. Executive - Client Servicing) M : chandigarh@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : ppardeshi@mdindia.com Ms. Karpagam R. ( In-charge) M : rkarpagam@mdindia.com Mr. Amit Kumar (Assistant Manager - Operations) M: dehradun@mdindia.com Mr. V Vivek Vardhan (Asst. General Manager - South) M: vvardhan@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : ppardeshi@mdindia.com

3 12 Delhi 13 Faizabad E-98, II Floor, Lajpat Nagar II, New Delhi (New Delhi) ID: Plot No 8/10/213, Opp Petrol Pump, Mujaffara Naka, Dhaulgir marg, Faizabad (U. P.) ID: Mr. Sanjeev Gupta ( Manager) M : sgupta@mdindia.com Mr. Amitkumar Sen M : faizabad@mdindia.com 14 Goa 115/9, 3 rd floor, NevrekarChambers Above ING Vysya Bank, M.G. Road, Panjim (Goa) ID: goa@mdindia.com Mr. Digpal Singh ( In-charge) M: goa@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : gbhosale@mdindia.com 15 Gorakhpur 232 / D Behind Sahara Complex Mohalla, P.O. Daudpur, Gorakhpur (U. P.) ID: gorakhpur@mdindia.com Mr. Ghansham Tripathi M : gorakhpur@mdindia.com 16 Gwalior 17 Hyderabad 18 Indore 19 Jabalpur 20 Jaipur 21 Kanpur 1st Floor, Aim Plaza, Jinci Nala No. 3 Near Janak Hospital, Lashkar, Gwalior (M. P.) ID: gwalior@mdindia.com /1, Above Gayatri Bhavan 1st floor Himayath Nagar Hyderabad ID: hyderabad@mdindia.com 501- A, 5 th Floor, Rajani Bhavan, 569, M.G. ROAD, Indore (M.P.) ID: indore@mdindia.com 1852 / 1,Om Vihar, Prem Nagar Near Gulati Petrol Pump, Madan Mahal, Jabalpur (Madhya Pradesh) ID: jabalpur@mdindia.com Plot / Survey No 357, Kamal Kunj, Ramnagar, Sodala, Jaipur (Rajasthan) ID: jaipur@mdindia.com 12/192 (35) Lajpat Nagar Opp. Mariampur School, Kanpur Nagar (U. P.) ID: kanpur@mdindia.com Mr. Saurabh Mandloi M: gwalior@mdindia.com Mr. Pratap Stumpum ( Manager) M: pstumpum@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com Mr. V Vivek Vardhan (Asst. General Manager - South) M: vvardhan@mdindia.com Mr. Prakash Terdale Mr. Sandeep Mishra Asst.Manager-M.P& Chattisgarh (Sr. Exe.-Operations & Client Servicing) pterdale@mdindia.com indore@mdindia.com Mr. Vishal Kaushal M : jabalpur@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com Mr. Virbhadra Agarwal (Sr. Executive - Client Servicing) M: jaipur@mdindia.com Mr. Neerajkumar Bhola M : kanpur@mdindia.com 22 Kochi 23 Kolkata Door No: XL/ A, First Floor, T D Road, North End, Ernakulam Kochi (Kerala) ID: kochi@mdindia.com 169, Sarat Bose Road, 3rd floor, Kolkata (West Bengal) ID: kolkata@mdindia.com Ms. Rashmi Dinesh ( In-charge) M : rdinesh@mdindia.com Mr. Debapriya Chowdhury (Sr. Manager - East) M: dchowdhury@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : ppardeshi@mdindia.com Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: kolkata@mdindia.com 24 Kolkatta Police Regional Office, Kolkatta Police Head Quarter, 18, Lalbazar Street, Kolkata (W.B.) ID: kp@mdindia.com Mr. Joydeep Roy (Asst. Manager - Operations) kp@mdindia.com Mr. Debapriya Chowdhury (Sr. Manager - East) M: dchowdhury@mdindia.com 25 Lucknow B 3/3, 1st Floor, Crossing No. - 8, Nirala Nagar, Lucknow (U. P.) ID: lucknow@mdindia.com

4 26 Meerut House No 335, Ashok Vatika, Prabhat Nagar, Behind Times of India, Meerut (U.P.) ID: meerut@mdindia.com Ms. Rekha Tyagi M: meerut@mdindia.com 27 Mumbai MDIndia Healthcare Services (TPA) Pvt. Ltd., 204, VTM Building No: 2, Mehra Compound, Next to Fair Price Shop, Vijay Print Bus Stop, Andheri- Kurla road, Andheri East, Mumbai. 022 Pallav Saxena PETER Mr.Nitin Thuse (Asst. General Manager) M : nthuse@mdindia.com Mr.Shirish Nadkarni (Asst. General Manager) M : snadkarni@mdindia.com Dr. Prashant Patil (Sr. Manager - Operations) M : ppatil@mdindia.com Mr. Prashant Shirke (Sr. Manager - Business Dev.) M : pshirke@mdindia.com 28 Nagpur 51/A, 2nd Floor, Dr. Bhiwapurkar Marg, Dhantoli, Nagpur ID: nagpur@mdindia.com Dr. Kiran Uttamchandani ( In-charge) M: kuttamchandani@mdindia.com Mr.Ramesh Chorghade (Sr. Executive - Client Servicing) M: nagpur@mdindia.com 29 Nashik Flat No. 14, First Floor, Bella Vista Co. Op. Hsg. Society, Opp. Mazada Hotel, Trimbak Naka Old Agra Road, Nashik - 2 ID: nashik@mdindia.com Dr. Dhiraj Sonawane ( In-charge) M : dsonawane@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : gbhosale@mdindia.com 30 Patna 881/ 485 A at Circle No. 9, Mohalla Exhibition Road Crossing, P.O., G.P.O., P. S. Gandhi Maidan, R K Bhattacharya Road, Patna ID: patna@mdindia.com Mr. Deepak Kumar patna@mdindia.com Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: kolkata@mdindia.com 31 Pune 32 Raipur Sr. No. 42A / 1B, Flat No. 2, Nilgiri Apartment, Erandwane, Karve Road, Pune ID: pune@mdindia.com Parthivi Nagar, House no 34, Nagorao Estate, Mahoba Bazar, Raipur (Chhattisgarh) ID: raipur@mdindia.com Mr. Dinesh Shindey ( In-charge) M : dshindey@mdindia.com Mr. Mohseen Khan M: raipur@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : gbhosale@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com 33 Rajkot 1st Floor, Above Prakash Photo Studio, Dhebar Road, One way, Near Bhabha Guest House Rajkot ID: rajkot@mdindia.com Dr. Pratik Solanki (Sr. Executive - Operations) rajkot@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: npandya@mdindia 34 Satna HIG - 7, Mandakini Vihar Colony, Civil Lines, Satna (M. P.) ID: satna@mdindia.com Mr. Sanjay Jain (Executive - Client Servicng) M: satna@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com 35 Shahdol MIG - Junior 17 M.P. Housing Board Colony, Near New Bus Stand, Shahdol (M P) ID: shahdol@mdindia.com Applied for Applied for Mr. Surya Prakash Mishra M: shahdol@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com 36 Surat 904, Meridian Towers, 9th Floor, Near Rajkumar Cinema, Udhana Darwaja, Ring Road, Surat ID: surat@mdindia.com Dr. K. Ritesh Mallik ( Manager) M : rmalik@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: npandya@mdindia 37 Varanasi D/58/12, 69 A,Gandhinagar, Sigra Varanasi (U. P.) ID: varanasi@mdindia.com Mr.K.P. Shrivastav M : varanasi@mdindia.com

5 Annexure-B CLAIM DOCUMENTS CHECK LIST S. No. Cashless Claim Reimbursement 1 Claim intimation to MD India Claim intimation to MD India 2 Card issued by MD India Card issued by MD India 3 Photo identity card Photo identity card 4 Previous Claim History - if Any Photocopy of policy issued by Ins. Co. 5 Claim form 6 Original attested discharge card 7 Original hospital bills 8 Original bill receipts 9 FIR/ MLC - if applicable 10 Claim lodged amount 11 All Investigation Reports - In Original Note: 1) Hospital should be registered with local authorities 2) If registration is not must in that state than hospital should have fully equipped operation theatre, round the clock qualified doctors & nursing staff 3) For list of emplaned hospitals refer 4) For any kind of further quarry refer

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10 Annexure-D DETAILS OF RETIRING EMPLOYEE OF PUNJAB NATIONAL BANK FOR AVAILING THE BENEFITS UNDER PNB PARIVAR BHAVISHYA AROGYA YOJNA Paste an attested recent passport size photograph here S. No. PARTICULARS OF RETIRING EMPLOYEE 1 Name 2 PF No. 3 Date of Birth 4 Date of Retirement 5 Office from where retired 6 Address for Communication (including Phone No., Mobile No., Fax No. and , if any) 7 Permanent Address 8 Policy Number (Photograph be attested by Bank Official with official stamp) (Please fill all details in BLOCK LETTERS) Place: Date: Signature, Name and Designation of Bank Official with official stamp