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.18002331166. 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 e-mail 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 110 024 Ph: 011 29811840, Fax: 011 29811838 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 110 001 Ph No.: 011 23341745, 23361521, 23745628, 23364865, Fax: 011 23742077 (HRD Division Circular No. 531 dated 20-03-2009)
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 1257 - A, Sector 11, Awas Vikas Colony Sikandara, Agra - 282 007 (U. P.) E-mail ID: agra@mdindia.com STD Code 0562 Land Line Fax Contact 1 Contact 2 2603004 3244324 2603329 Mr.Manoj Parashar M: 09319008556 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-380 013 (Gujarat) E-mail ID: ahmedabad@mdindia.com Shop No 6, Near Milk Bar, Marris Road, Corporate Plaza, Aligarh - 202 002 (U. P.) E-mail ID: aligarh@mdindia.com 25/5, LIC Colony, Tagore Town Allhabad - 211 006 (U. P.) E-mail ID: allahabad@mdindia.com 90/2, First and second floor, K H Road, Bangalore - 560 027 E-mail ID: bangalore@mdindia.com 216, Lalita Towers, Behind Railway Station, Near Hotel Rajpath, Dinesh Mills Road, Baroda- 390 005 (Gujarat) E-mail 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 - 462 042 (M. P.) E-mail ID: bhopal@mdindia.com S.C.F. No. 58 Sector 8, Main Market, Opp Post Office, Panchkulla, Chandigarh 134 109 E-mail ID: chandigarh@mdindia.com 1402, H Block, 15th Main Road, Anna Nagar, Chennai- 600 040 E-mail ID: chennai@mdindia.com Door No. 880, 2nd floor,mattupalayam Road, Flower Market Area, Coimbatore - 641 001 (Tamilnadu) E-mail ID: coimbatore@mdindia.com House no. 54, Lane 4, Ground floor Portion, Mohit Nagar, Dehradun - 248 006 (Uttarakhand) E-mail ID: dehradun@mdindia.com 079 0571 0532 080 0265 0755 27560006 32955357 2408066 3200102 2466973 3201300 22111050 32422117 2320602 3258347 2430511 3200070 27560057 2401581 2466972 22111070 2323244 2430533 0172 2584758 2585458 044 0422 26162386 32978497 2477151 3240076 26164000 2477153 Applied for Applied for Dr. Nirman Pandya (Sr. Manager - Baroda) M: 09377302254 npandya@mdindia Mr. Pankaj Kumar sharma M: 09319006333 aligarh@mdindia.com Ms. Neelam Misra M : 09305907022 allahabad@mdindia.com Mr. Mallikarjuna Rao J. ( Manager) M : 09341402251 mrao@mdindia.com Mr. Hariom Pandya ( Manager) M: 09327429266 hpandya@mdindia.com Ms. Vaibhavi Shah (Sr. Executive - Operations) M: 09377472337 ahmedabad@mdindia Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 ppardeshi@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: 09377302254 npandya@mdindia Dr. Abhishek Shukla Mr. Prakash Terdale (Sr. Executive - Client Servicing) (Asst. Manager - M.P & Chattisgarh) M : 09300101780 bhopal@mdindia.com pterdale@mdindia.com Mr. Rahul Gupta (Sr. Executive - Client Servicing) M : 09316001286 chandigarh@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 ppardeshi@mdindia.com Ms. Karpagam R. ( In-charge) M : 09367602251 rkarpagam@mdindia.com Mr. Amit Kumar (Assistant Manager - Operations) M: 09319391665 dehradun@mdindia.com Mr. V Vivek Vardhan (Asst. General Manager - South) M: 09347924476 vvardhan@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 ppardeshi@mdindia.com
12 Delhi 13 Faizabad E-98, II Floor, Lajpat Nagar II, New Delhi 110 024 (New Delhi) E-mail ID: delhi@mdindia.com Plot No 8/10/213, Opp Petrol Pump, Mujaffara Naka, Dhaulgir marg, Faizabad 224 001 (U. P.) E-mail ID: faizabad@mdindia.com 011 05278 29811840 32590562 248296 320107 29811838 248295 Mr. Sanjeev Gupta ( Manager) M : 09312090609 sgupta@mdindia.com Mr. Amitkumar Sen M : 09300101797 faizabad@mdindia.com 14 Goa 115/9, 3 rd floor, NevrekarChambers Above ING Vysya Bank, M.G. Road, Panjim 403 001 (Goa) E-mail ID: goa@mdindia.com 0832 2421982 3218840 2425466 Mr. Digpal Singh ( In-charge) M: 09325402255 goa@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 gbhosale@mdindia.com 15 Gorakhpur 232 / D Behind Sahara Complex Mohalla, P.O. Daudpur, Gorakhpur - 273 016 (U. P.) E-mail ID: gorakhpur@mdindia.com 0551 2204309 3200670 2204309 Mr. Ghansham Tripathi M : 09305906944 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 474 009 (M. P.) E-mail ID: gwalior@mdindia.com 3-6-562/1, Above Gayatri Bhavan 1st floor Himayath Nagar Hyderabad E-mail ID: hyderabad@mdindia.com 501- A, 5 th Floor, Rajani Bhavan, 569, M.G. ROAD, Indore 452001 (M.P.) E-mail ID: indore@mdindia.com 1852 / 1,Om Vihar, Prem Nagar Near Gulati Petrol Pump, Madan Mahal, Jabalpur - 482 001 (Madhya Pradesh) E-mail ID: jabalpur@mdindia.com Plot / Survey No 357, Kamal Kunj, Ramnagar, Sodala, Jaipur - 302 019 (Rajasthan) E-mail ID: jaipur@mdindia.com 12/192 (35) Lajpat Nagar Opp. Mariampur School, Kanpur Nagar - 208 012 (U. P.) E-mail ID: kanpur@mdindia.com 0751 040 0731 0761 2420336 3201217 23410031 23414122 23414125 23414121 2544980 3259911 2428698 3206644 2429738 23417905 2544981 2428698 0141 2291413 2291413 0512 2224056 3209767 2224056 Mr. Saurabh Mandloi M:09300101798 gwalior@mdindia.com Mr. Pratap Stumpum ( Manager) M: 09396402251 pstumpum@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com Mr. V Vivek Vardhan (Asst. General Manager - South) M: 09347924476 vvardhan@mdindia.com Mr. Prakash Terdale Mr. Sandeep Mishra Asst.Manager-M.P& Chattisgarh (Sr. Exe.-Operations & Client Servicing) 0731-3259911 pterdale@mdindia.com indore@mdindia.com Mr. Vishal Kaushal M : 09300101893 jabalpur@mdindia.com Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) pterdale@mdindia.com Mr. Virbhadra Agarwal (Sr. Executive - Client Servicing) M:09314103751 jaipur@mdindia.com Mr. Neerajkumar Bhola M : 09305906929 kanpur@mdindia.com 22 Kochi 23 Kolkata Door No: XL/6503 - A, First Floor, T D Road, North End, Ernakulam Kochi - 682 035 (Kerala) E-mail ID: kochi@mdindia.com 169, Sarat Bose Road, 3rd floor, Kolkata - 700 026 (West Bengal) E-mail ID: kolkata@mdindia.com 0484 033 2381388 3271022 24632726 32504952 2381399 24656633 Ms. Rashmi Dinesh ( In-charge) M : 09387302251 rdinesh@mdindia.com Mr. Debapriya Chowdhury (Sr. Manager - East) M: 09331002253 dchowdhury@mdindia.com Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 ppardeshi@mdindia.com Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: 09333441389 kolkata@mdindia.com 24 Kolkatta Police Regional Office, Kolkatta Police Head Quarter, 18, Lalbazar Street, Kolkata - 700 001 (W.B.) E-mail ID: kp@mdindia.com 033 22141584 22141584 Mr. Joydeep Roy (Asst. Manager - Operations) 033 - kp@mdindia.com Mr. Debapriya Chowdhury (Sr. Manager - East) M: 09331002253 dchowdhury@mdindia.com 25 Lucknow B 3/3, 1st Floor, Crossing No. - 8, Nirala Nagar, Lucknow (U. P.) E-mail ID: lucknow@mdindia.com 0522 2789045 3202952 2789045
26 Meerut House No 335, Ashok Vatika, Prabhat Nagar, Behind Times of India, Meerut - 250 001 (U.P.) E-mail ID: meerut@mdindia.com 0121 2672227 3201331 2672227 Ms. Rekha Tyagi M: 09319009058 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 26451781 26451141 30604891 9322502251 9323253857 26451638 Mr.Nitin Thuse (Asst. General Manager) M : 09326702254 nthuse@mdindia.com Mr.Shirish Nadkarni (Asst. General Manager) M : 09323322251 snadkarni@mdindia.com Dr. Prashant Patil (Sr. Manager - Operations) M :09323931331 ppatil@mdindia.com Mr. Prashant Shirke (Sr. Manager - Business Dev.) M : 09320591947 pshirke@mdindia.com 28 Nagpur 51/A, 2nd Floor, Dr. Bhiwapurkar Marg, Dhantoli, Nagpur - 440 012 E-mail ID: nagpur@mdindia.com 0712 2420391 3254777 2420393 Dr. Kiran Uttamchandani ( In-charge) M: 09371656241 kuttamchandani@mdindia.com Mr.Ramesh Chorghade (Sr. Executive - Client Servicing) M: 09326702263 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 E-mail ID: nashik@mdindia.com 0253 2310050 3245220 2310051 Dr. Dhiraj Sonawane ( In-charge) M : 09372464524 dsonawane@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 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 E-mail ID: patna@mdindia.com 0612 2320329 2320329 Mr. Deepak Kumar 0612-2320329 patna@mdindia.com Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: 09333441389 kolkata@mdindia.com 31 Pune 32 Raipur Sr. No. 42A / 1B, Flat No. 2, Nilgiri Apartment, Erandwane, Karve Road, Pune 411038 E-mail ID: pune@mdindia.com Parthivi Nagar, House no 34, Nagorao Estate, Mahoba Bazar, Raipur - 492 001 (Chhattisgarh) E-mail ID: raipur@mdindia.com 020 0771 25435821 32517724 2322322 3200144 25135820 2322322 Mr. Dinesh Shindey ( In-charge) M : 09372157472 dshindey@mdindia.com 9371644536 Mr. Mohseen Khan M:09300101930 raipur@mdindia.com Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 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 - 360 001 E-mail ID: rajkot@mdindia.com 0281 2228742 2228743 Dr. Pratik Solanki (Sr. Executive - Operations) 0281-2228742 rajkot@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: 09377302254 npandya@mdindia 34 Satna HIG - 7, Mandakini Vihar Colony, Civil Lines, Satna 485 001 (M. P.) E-mail ID: satna@mdindia.com 07672 222995 320727 222956 Mr. Sanjay Jain (Executive - Client Servicng) M: 09302396071 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) E-mail ID: shahdol@mdindia.com 07652 Applied for 321686 Applied for Mr. Surya Prakash Mishra M:09300101937 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 E-mail ID: surat@mdindia.com 0261 2343009 3238040 2345335 Dr. K. Ritesh Mallik ( Manager) M : 09377302251 rmalik@mdindia.com Dr. Nirman Pandya (Sr. Manager - Baroda) M: 09377302254 npandya@mdindia 37 Varanasi D/58/12, 69 A,Gandhinagar, Sigra Varanasi - 221 002 (U. P.) E-mail ID: varanasi@mdindia.com 0542 2222574 3204420 2222703 Mr.K.P. Shrivastav M : 09305907244 varanasi@mdindia.com
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 www.mdindiaonline.com 4) For any kind of further quarry refer www.mdindiaonline.com
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 e-mail, 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