Organization : Department of Health & Welfare
Facility : Punjab Government Employees & Pensioners Health Insurance Scheme (PGEPHIS)Member Enrollment Form

Home Page : http://pbnrhm.org/pgephis.aspx
Details Here : http://www.indianjobtalks.com/uploads/76004-PGEPHIS.pdf

PGEPHIS Member Enrollment Form Procedure :
The Enrolment Form consists of two forms, i.e., Main Member Enrolment Form and Dependant Form. The details of the dependants who are eligible to be covered in accordance with the family definition applicable as per Punjab Medical Attendant Rules [CS (MA) Rules, 1940] are to be filled in the Dependents Form.

In one Dependant Form, details of four dependants can be filled. In case, if there are more dependents, please attach additional sheets of Dependant Form.

a. Offline Mode :
1. Visit web site : pbhealth.gov.in.
2. Click on Enrolment Form and Dependant Form to download both the forms
3. Take Print out of downloaded forms

4. Fill the Enrolment Form and Dependant Form and paste your and your dependants photographs on the forms
5. Staple the enrolment form and sheets of dependant forms. Ensure that staple is not loose, so that forms are not misplaced/ lost during transit

6. Submit the filled forms to your DDO, for verification and onward transmission to the Insurer Company. In case of pensioners, the form is to be submitted to the DDO of the Office, from where last pay was drawn.

7. Collect your ID Cards from your DDO.
8. Continue to visit the above website for any further notices/ information.

b. Online Mode :
9. Visit web url : pbhealth.gov.in. and go to online submission link for online submission of enrolment form.
10. Select your Department, District, Block, Office, DDO from the dropdown given on the web page.
11. After selecting your DDO, an enrolment form web page will be displayed.

12. Type the information in all the fields given in the Main Member Form Enrolment Form.
13. Select the photograph, already saved in your computer, against the field of photograph. In case, if you don’t have soft copy of photograph, you can leave it blank.
14. After filling all the fields, save the form by clicking on save button on the bottom of the form.

15. The form will be saved and pdf page of filled form will be displayed. Save the pdf file and take its print out.
16. Put your signature and date on the filled printed form. Paste the photograph, if you had not made online selection of the photograph earlier.

17. Similarly enter details of dependant forms, save it and take its print out. Put your signature and date on the filled printed dependent form.
18. Staple the enrolment form and sheets of dependant forms. Ensure that staple is not loose, so that forms are not misplaced/ lost during transit

19. Submit the filled forms to your DDO, for verification and onward transmission to the Insurer Company.
20. Collect your ID Cards from your DDO.
21. Continue to visit the above website for any further notices/ information. .

c. General Instructions :
Please follow the instructions given below while filling the form.
** Do NOT fold or smudge the Enrolment Form.
** Do NOT write “NA” or “N/A” or “NOT APPLICABLE” in any boxes in the form to convey that the column is not relevant for your case.