Scheme Coverage

OBJECTIVE:

Working and retired journalists Health Scheme is formulated to provide cashless treatment to the journalists of the Telangana Government and their dependent family members. 

IMPORTANT STAKEHOLDERS IN THE SCHEME

The scheme is intended to benefit Serving working and retired Journalists of the State.

Beneficiaries:

  1. Aarogyasri Health Care Trust will implement the scheme under the supervision of Government of Telangana.
  2. Repudiation: The Trust may repudiate a claim for reason of not being covered by the policy under intimation to Scheme Technical Committee.
  3. An appeal lies to the Appellate Committee either against repudiation (rejection) as defined in Term 12.4 (ii) or reduction of claim as defined in Term 12.4 (i) under Term 12.5 within 3 months from date of repudiation advice or settlement of claim.

Network Hospitals - Service Providers:

A health care provider shall be a hospital of nursing home in Telangana established for indoor medical care and treatment of disease and injuries and should be registered under Telangana Private Allopathic Medical Establishments (Registrations & Regulation) Act and Pre-Conception and Pre- Natal Diagnostic Techniques Act (wherever Applicable).

Software Company - Technology Solutions:

A dedicated real-time online workflow system was designed by the Trust in order to bring dynamism and decentralization of work like online processing of the cases starting from registration of case at network hospital, pre-authorization, treatment and other services at the hospital, discharge and post treatment follow-up, claim settlement, payment gateway, accounting system, TDS deductions, e-office solutions etc. The maintenance of the workflow is done round the clock.

A) Empanelment

The existing network hospitals (NWHs) already empanelled with the Aarogyasri Health Care Trust (AHCT) under Employees Health Scheme will serve the 'Working and retired Journalists Health Scheme'.

B) Hospital Payments

Payments under the Scheme will be based on package prices already approved by Government under Employees Health Scheme. The period from the date of reporting to hospital to 10 days after the date of discharge from the hospital will be treated as part of the package.

C) Penal Actions

Empanelled hospitals resorting to irregularities or misuse will be blacklisted and the entire amount recovered besides launching criminal action.

POPULATION COVERAGE:

Eligible Beneficiaries:

1.Serving Journalists:

1.1. All accredited working and retired Journalists. A State Government Journalists will have the meaning as defined under Fundamental Rules.

2.Family:

2.1.Dependent Parents (either adoptive or biological, but not both). 
2.2.One legally wedded wife in case of a male journalist.
2.3.Husband in case of a female journalist.
2.4.Wholly dependent legitimate children (including step children and adopted children);

3.Dependency:

3.1. In case of parents, those who are dependent on the journalist for their livelihood.
3.2. In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted. 
3.3. In case of unemployed sons, those who are below the age of 25 years 
3.4. Disabled children with a disability which renders them unfit for employment.

4.Authentication:

The eligible beneficiaries will be provided with health cards (also called eligibility cards).
The procedure of verification of eligibility of beneficiary under the scheme shall be by online authentication of the health card details. The beneficiary shall provide either the eligibility card or the card number in case the card is unavailable. The staff at the kiosk in the Network Hospital shall verify the details online by accessing the database. Once the system accept card authentication is complete.

5.Penal Actions:

Any irregularities or misuse committed by the beneficiaries coming to the notice of Government or AHCT will entail disciplinary action as per A.P. C.S. (CCA) Rules, 1991 and may attract penal action as per law.

BENEFIT COVERAGE

In-Patient Treatment:

1. The scheme will provide inpatient treatment for the listed therapies for identified diseases under all specialties in the empanelled hospitals. List of IP therapies 
2.End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a listed therapy (ies) 
3.Free OP evaluation of patients for listed therapies who may not undergo IP treatment including consultation and investigations

Follow-up Services:

Follow-up services are provided for a period of one year through fixed packages to the patients whoever requires long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up package includes consultation, investigations, drugs etc., for one year for listed therapies. List of IP therapies

FINANCIAL COVERAGE

1.The total cost on implementation of Journalists Health Scheme shall be borne by the Government and no contribution will be collected from them.
2. There shall be no upper limit on the financial coverage and the total cost of treatment of the patient for the enlisted therapies will be covered under the Scheme.
3. Treatment for all the enlisted procedures will be provided in all the network hospitals (both private and Government) empanelled with Aarogyasri Health Care Trust. However position will be reviewed after six months so as to ensure a minimum of 60% participation by Government Hospitals in terms of amount. To achieve that, if required certain procedures may be reserved for Government hospitals which have required infrastructure for such procedures.
4. Out patient for chronic diseases will be provided in the notified Government Hospitals only and the guidelines for chronic OP treatment shall be issued separately.

NETWORK HOSPITALS

Empanelment:

Guidelines for empanelment of hospitals within the State and outside, preauthorization and other modalities while implementing the scheme will be in conformity with the existing standard procedures being followed by AHCT. The list of empanelled hospitals will be made available in the official website www.jhs.telangana.gov.in.

Hospital Payments:

Payments under the Scheme will be based on package prices already approved by Government under Employees Health Scheme. The period from the date of reporting to hospital to 10 days after the date of discharge from the hospital will be treated as part of the package.

Penal Actions:

Empanelled hospitals resorting to irregularities or misuse shall be blacklisted and entire amount recovered besides launching criminal action.