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PNB Parivar Bhavishya Arogya Yojna-Lodgement of Claims & Issuance 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. Branch Name Office Address Branch Contact Numbers STD Code 1 Agra Branch Survey No / Plot no 1257 - A, Sector 11, Awas Vikas Colony Sikandara, Agra - 282 007 (U. P.) E-mail ID: [email protected] Land Line Fax Name, Designation, contact number & mail ID of the Contact Person Contact 1 Contact 2 Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Ms. Vaibhavi Shah (Sr. Executive - Operations) M: 09377472337 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 [email protected] Dr. Nirman Pandya (Sr. Branch Manager - Baroda) M: 09377302254 [email protected]

0562

2603004 3244324

Mr.Manoj Parashar (Executive - Client Servicing) 2603329 M: 09319008556 [email protected] Dr. Nirman Pandya (Sr. Branch Manager - Baroda) 27560057 M: 09377302254 [email protected] Mr. Pankaj Kumar sharma (Executive - Client Servicing) 2401581 M: 09319006333 [email protected] Ms. Neelam Misra (Executive - Client Servicing) 2466972 M : 09305907022 [email protected] 22111070 Mr. Mallikarjuna Rao J. (Branch Manager) M : 09341402251 [email protected]

2

3

806/807, Sukhasagar Complex, Ahmedabad 8thFloor, Usmanpur, Near Fortune Branch Landmark Hotel, Ashram Road, Ahmedabad-380 013 (Gujarat) E-mail ID: [email protected] Shop No 6, Near Milk Bar, Aligarh Marris Road, Corporate Plaza, Branch Aligarh - 202 002 (U. P.) E-mail ID: [email protected] Allahabad 25/5, LIC Colony, Tagore Town Branch Allhabad - 211 006 (U. P.) E-mail ID: [email protected] Bangalore 90/2, First and second floor, Branch K H Road, Bangalore - 560 027 E-mail ID: [email protected] Baroda Branch 216, Lalita Towers, Behind Railway Station, Near Hotel Rajpath, Dinesh Mills Road, Baroda- 390 005 (Gujarat) E-mail ID: [email protected] 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: [email protected]

079

27560006 32955357

0571

2408066 3200102

4

0532

2466973 3201300

5

080

22111050 32422117

6

0265

2320602 3258347

Mr. Hariom Pandya (Branch Manager) 2323244 M: 09327429266 [email protected]

7

Bhopal Branch

0755

2430511 3200070

Dr. Abhishek Shukla Mr. Prakash Terdale (Sr. Executive - Client Servicing) (Asst. Manager - M.P & Chattisgarh) 2430533 M : 09300101780 M : 09300102253 [email protected] [email protected] Mr. Rahul Gupta Mr. Ashesh Das (Sr. Executive - Client Servicing) (Regional Manager - Delhi) M: 09350853382 2585458 M : 09316001286 [email protected] [email protected] Mr. Pankaj Pardeshi (Sr. Manager - South Region) 26164000 M : 09382185488 [email protected] Ms. Karpagam R. (Branch In-charge) M : 09367602251 [email protected] Mr. V Vivek Vardhan (Asst. General Manager - South) M: 09347924476 [email protected] Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected]

8

Chandigarh S.C.F. No. 58 Sector 8, Main Market, Branch Opp Post Office, Panchkulla, Chandigarh 134 109 E-mail ID: [email protected] Chennai Branch 1402, H Block, 15th Main Road, Anna Nagar, Chennai- 600 040 E-mail ID: chennai[email protected]

0172

2584758

9

044

26162386 32978497

10

Door No. 880, Coimbatore 2nd floor,Mattupalayam Road, Branch Flower Market Area, Coimbatore 641 001 (Tamilnadu) E-mail ID: [email protected] Dehradun House no. 54, Lane 4, Branch Ground floor Portion, Mohit Nagar, Dehradun - 248 006 (Uttarakhand) E-mail ID: [email protected] Delhi Branch E-98, II Floor, Lajpat Nagar ­II, New Delhi ­ 110 024 (New Delhi) E-mail ID: [email protected]

0422

2477151 3240076

2477153

11

Mr. Amit Kumar (Assistant Manager Operations) Applied for Applied for M: 09319391665 [email protected] Mr. Sanjeev Gupta (Branch Manager) M : 09312090609 [email protected] Mr. Amitkumar Sen (Executive - Client Servicing) M : 09300101797 [email protected]

12

011

29811840 32590562

29811838

13

Faizabad Plot No ­ 8/10/213, Opp Petrol Branch Pump, Mujaffara Naka, Dhaulgir marg, Faizabad ­ 224 001 (U. P.) E-mail ID: [email protected]

05278

248296 320107

248295

14

Goa Branch

115/9, 3rd floor, NevrekarChambers Above ING Vysya Bank, M.G. Road, Panjim ­403 001 (Goa) E-mail ID: [email protected]

0832

2421982 3218840

Mr. Digpal Singh (Branch In-charge) 2425466 M: 09325402255 [email protected]

Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 [email protected]

15

232 / D Behind Sahara Complex Gorakhpur Mohalla, P.O. Daudpur, Gorakhpur Branch 273 016 (U. P.) E-mail ID: [email protected] Gwalior Branch 1st Floor, Aim Plaza, Jinci Nala No. 3 Near Janak Hospital, Lashkar, Gwalior ­ 474 009 (M. P.) E-mail ID: [email protected]

0551

2204309 3200670

Mr. Ghansham Tripathi (Executive - Client Servicing) 2204309 M : 09305906944 [email protected] Mr. Saurabh Mandloi (Executive - Client Servicing) 2429738 M:09300101798 [email protected] Mr. Pratap Stumpum (Branch Manager) 23417905 M: 09396402251 [email protected]

Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) M : 09300102253 [email protected] Mr. V Vivek Vardhan (Asst. General Manager - South) M: 09347924476 [email protected]

16

0751

2420336 3201217

17

18

3-6-562/1, Above Gayatri Bhavan Hyderabad 1st floor Himayath Nagar Branch Hyderabad E-mail ID: [email protected] 501- A, 5 th Floor, Rajani Bhavan, Indore 569, M.G. ROAD, Indore ­ 452001 Branch (M.P.) E-mail ID: [email protected] Jabalpur Branch 1852 / 1,Om Vihar, Prem Nagar Near Gulati Petrol Pump, Madan Mahal, Jabalpur - 482 001 (Madhya Pradesh) E-mail ID: [email protected] Plot / Survey No 357, Kamal Kunj, Ramnagar, Sodala, Jaipur - 302 019 (Rajasthan) E-mail ID: [email protected] 12/192 (35) Lajpat Nagar Opp. Mariampur School, Kanpur Nagar - 208 012 (U. P.) E-mail ID: [email protected] Door No: XL/6503 - A, First Floor, T D Road, North End, Ernakulam Kochi - 682 035 (Kerala) E-mail ID: [email protected] 169, Sarat Bose Road, 3rd floor, Kolkata - 700 026 (West Bengal) E-mail ID: [email protected] Regional Office, Kolkatta Police Head Quarter, 18, Lalbazar Street, Kolkata - 700 001 (W.B.) E-mail ID: [email protected]

040

23410031 23414122 23414125 23414121 2544980 3259911

0731

2544981

Mr. Prakash Terdale Mr. Sandeep Mishra Asst.Manager-M.P& Chattisgarh (Sr. Exe.-Operations & Client Servicing) M : 09300102253 0731 - 3259911 [email protected] [email protected] Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) M : 09300102253 [email protected]

19

0761

2428698 3206644

Mr. Vishal Kaushal (Executive - Client Servicing) 2428698 M : 09300101893 [email protected]

20

Jaipur Branch

0141

2291413

Mr. Ashesh Das Mr. Virbhadra Agarwal (Sr. Executive - Client Servicing) (Regional Manager - Delhi) 2291413 M:09314103751 M: 09350853382 [email protected] [email protected] Mr. Neerajkumar Bhola (Executive - Client Servicing) 2224056 M : 09305906929 [email protected] Ms. Rashmi Dinesh (Branch In-charge) 2381399 M : 09387302251 [email protected] Mr. Debapriya Chowdhury (Sr. Manager - East) 24656633 M: 09331002253 [email protected] Mr. Joydeep Roy (Asst. Manager - Operations) 22141584 033 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Mr. Pankaj Pardeshi (Sr. Manager - South Region) M : 09382185488 [email protected] Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: 09333441389 [email protected] Mr. Debapriya Chowdhury (Sr. Manager - East) M: 09331002253 [email protected]

21

Kanpur Branch

0512

2224056 3209767

22

Kochi Branch

0484

2381388 3271022

23

Kolkata Branch

033

24632726 32504952

24

Kolkatta Police Branch

033

22141584

25

Lucknow B 3/3, 1st Floor, Crossing No. - 8, Branch Nirala Nagar, Lucknow (U. P.) E-mail ID: [email protected] House No 335, Ashok Vatika, Prabhat Nagar, Behind Times of India, Meerut - 250 001 (U.P.) E-mail ID: [email protected] 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.

0522

2789045 3202952

Mr. Gaurav Pandey Mr. Ashesh Das (Sr. Executive - Client Servicing) (Regional Manager - Delhi) 2789045 M : 09307078309 M: 09350853382 [email protected] [email protected] Ms. Rekha Tyagi (Executive - Client Servicing) M: 09319009058 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected] Dr. Prashant Patil (Sr. Manager - Operations) M :09323931331 [email protected] Mr. Prashant Shirke (Sr. Manager - Business Dev.) M : 09320591947 [email protected]

26

Meerut Branch

0121

2672227 3201331

2672227

27

Mumbai Branch

Mr.Nitin Thuse (Asst. General Manager) M : 09326702254 [email protected] 26451638 Pallav Mr.Shirish Nadkarni 9322502251 Saxena (Asst. General Manager) M : 09323322251 9323253857 PETER [email protected] 26451781 26451141 30604891

022

28

Nagpur Branch

51/A, 2nd Floor, Dr. Bhiwapurkar Marg, Dhantoli, Nagpur - 440 012 E-mail ID: [email protected] Flat No. 14, First Floor, Bella Vista Co. Op. Hsg. Society, Opp. Mazada Hotel, Trimbak Naka Old Agra Road, Nashik - 2 E-mail ID: [email protected] 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: [email protected] Sr. No. 42A / 1B, Flat No. 2, Nilgiri Apartment, Erandwane, Karve Road, Pune ­411038 E-mail ID: [email protected] Parthivi Nagar, House no 34, Nagorao Estate, Mahoba Bazar, Raipur - 492 001 (Chhattisgarh) E-mail ID: [email protected] 1st Floor, Above Prakash Photo Studio, Dhebar Road, One way, Near Bhabha Guest House Rajkot - 360 001 E-mail ID: [email protected] HIG - 7 , Mandakini Vihar Colony, Civil Lines, Satna ­ 485 001 (M. P.) E-mail ID: [email protected] MIG - Junior 17 M.P. Housing Board Colony, Near New Bus Stand, Shahdol (M P) E-mail ID: [email protected] 904, Meridian Towers, 9th Floor, Near Rajkumar Cinema, Udhana Darwaja, Ring Road, Surat E-mail ID: [email protected] D/58/12, 69 ­ A ,Gandhinagar, Sigra Varanasi - 221 002 (U. P.) E-mail ID: [email protected].com

0712

2420391 3254777

2420393

Dr. Kiran Uttamchandani (Branch In-charge) M: 09371656241 [email protected]

Mr.Ramesh Chorghade (Sr. Executive - Client Servicing) M: 09326702263 [email protected] Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 [email protected] Mr. Amit Chaklader (Asst. Manager - Client Servicing) M: 09333441389 [email protected]

29

Nashik Branch

0253

2310050 3245220

Dr. Dhiraj Sonawane (Branch In-charge) 2310051 M : 09372464524 [email protected] Mr. Deepak Kumar (Executive - Client Servicing) 0612 - 2320329 2320329 [email protected]

30

Patna Branch

0612

2320329

31

Pune Branch

020

25435821 32517724

32

Raipur Branch

0771

2322322 3200144

Mr. Dinesh Shindey (Branch In-charge) 25135820 M : 09372157472 [email protected] 9371644536 Mr. Mohseen Khan (Executive - Client Servicing) 2322322 M:09300101930 [email protected] Dr. Pratik Solanki (Sr. Executive - Operations) 2228743 0281 - 2228742 [email protected] Mr. Sanjay Jain (Executive - Client Servicng) M: 09302396071 [email protected]

Dr. Girish Bhosale (Sr. Manager - Mah & Goa) M : 09326702262 [email protected] Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) M : 09300102253 [email protected] Dr. Nirman Pandya (Sr. Branch Manager - Baroda) M: 09377302254 [email protected] Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) M : 09300102253 [email protected] Mr. Prakash Terdale (Asst. Manager - M.P & Chattisgarh) M : 09300102253 [email protected] Dr. Nirman Pandya (Sr. Branch Manager - Baroda) M: 09377302254 [email protected] Mr. Ashesh Das (Regional Manager - Delhi) M: 09350853382 [email protected]

33

Rajkot Branch

0281

2228742

34

Satna Branch

07672

222995 320727

222956

35

Shahdol Branch

07652

Mr. Surya Prakash Mishra Applied for (Executive - Client Servicing) Applied for M:09300101937 321686 [email protected] 2343009 3238040 Dr. K. Ritesh Mallik (Branch Manager) 2345335 M : 09377302251 [email protected] Mr.K.P. Shrivastav (Executive - Client Servicing) 2222703 M : 09305907244 [email protected]

36

Surat Branch

0261

37

Varanasi Branch

0542

2222574 3204420

Annexure-B

CLAIM DOCUMENTS CHECK LIST

S. No.

1 2 3 4 5 6 7 8 9 10

11

Cashless Claim

Claim intimation to MD India Card issued by MD India Photo identity card

Reimbursement

Claim intimation to MD India Card issued by MD India Photo identity card Claim form Original attested discharge card Original hospital bills Original bill receipts FIR/ MLC - if applicable Claim lodged amount All Investigation Reports - In Original

Previous Claim History - if Any Photocopy of policy issued by Ins. Co.

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 FAMILY MEMBERS OF PUNJAB NATIONAL BANK FOR AVAILING THE BENEFITS UNDER PNB PARIVAR BHAVISHYA AROGYA YOJNA

Paste unattested recent passport sized photograph here

Sr. No.

PARTICULARS

Name of Insured Person

1

2 3

Name of employee PF No. of employee

4

Date of Birth of Insured Person

5

Address for Communication (including Ph. No. , FAX No., e-mail, if any)

6

Permanent Address

7

Policy Number

Place: __________ Date: __________

(Please fill all details in BLOCK LETTERS)

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