under the rules and terms and conditions of
PGEPHIS package rates has already been paid to the
complainant. There exist no privity of contract ... claim was processed as per the rates
of PGEPHIS and as per the terms and conditions of the policy.
Claim
family
members were covered under the Punjab Employers and
Pensioners Health Scheme (PGEPHIS). An insurance health card
under the scheme bearing ... entertain, try and decide the present complaint. As per the
PGEPHIS Scheme, the salient features of the scheme provides
that if the grievance between beneficiaries
Punjab Government Employees and
Pensioners Health Insurance Scheme' (for short PGEPHIS) guidelines
under Clause 11.6 and was held not justifiable, as they were ... same by falling back on part of clause 11.6 of PGEPHIS, which reads
as under:-
"The treatment availed by the beneficiary shall
Health
Insurance Scheme, namely, Punjab Government Employees and
Pensioners Health Insurance Scheme (PGEPHIS), which had been
launched by the Government of Punjab vide notification dated ... petitioner submitted that the Punjab Government
Employees and Pensioners Health Insurance Scheme (PGEPHIS)
annexed as Annexure P-1 had been framed so as to cover
vide notification dated 20.10.2015
introduced cashless health insurance scheme (in short 'PGEPHIS') on
compulsory basis for Punjab Govt. employees and pensioners. ID card ... under PGEPHIS was issued to the
complainant. The scheme remained in operation till 31.12.2016.
Husband of the complainant namely Bant Singh had to be admitted
introduced a Cashless Work Insurance Scheme, vide its
Notification dated 20.10.2015, Chandigarh, PGEPHIS and was
compulsory to all the service employees and pensioners ... jurisdiction, therefore, no cause of
action has arisen at Mansa. As in PGEPHIS rules, it is provided in
Para 21 of Dispute Resolution & Grievance
Services (TPA) Pvt. Ltd. (Punjab
Government Employees and Pensioners Health Insurance
Scheme (PGEPHIS), MD India Health Insurance TPA Pvt. Ltd.,
Maxpro Info Park ... Pensioners
Health Insurance Scheme" (hereinafter to be referred as
"PGEPHIS"). The policy was issued and premium as consideration
was paid
claim as agreed between the Government of Punjab and Ops
as per PGEPHIS Schedule rates. Item No. 1066 and 1066.1
PCNL(P), Unilateral ... package charges are Rs. 12,674/-.
We have PGEPHIS Schedule of rates and Para No. 2 of this
Annexure reads as under:-
"2) Package
being Govt. Pensioner, who was insured with OPs under
Health Insurance Scheme (PGEPHIS), vide ID Card No.MD15-
08146007818 and GPF/APO No.0251 ... Consumer Protection Act . The Punjab Govt. sponsored
PGEPHI Scheme for its employees and pensioners for which no any
insurance consideration has been deducted from
employees and pensioners under Punjab Government employees and Pensioners Health Insurance Scheme (PGEPHIS). In the said notification, list of the hospitals was also attached ... appellant that the patient has been rightly paid Rs.6000/- as per PGEPHIS schedule of rates (Ex.OP1/9). The charging
