Health Insurance 285 views April 14, 2021

Understanding the healthcare needs of individuals, Telangana State Government offers Employees and Journalists Health scheme that provides cashless treatment to all the State government employees including the pensioners (state government) along with their dependent family members at network hospitals of Aarogyasri Health Care trust. Telangana State Government Employees and Journalists Health Scheme replaces the medical reimbursement system that was in place before this scheme.

With this health scheme from the Telangana State Government, policyholders can also enjoy the benefits of post-operative care and treatment of chronic diseases that do not require hospitalization and treatment in empanelled hospitals. On this page, we will discuss important aspects related to Telangana State Government Employees and Journalists Health Scheme so that you can understand better. Keep reading!

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What is Covered Under Telangana State Government Employees and Journalists Health Scheme?

One of the crucial aspects to know about the Telangana State Government Employees and Journalists Health Scheme is its coverage benefits to the policyholders. We are discussing the same below. Please check!

In-patient Treatment

With this scheme, policyholders will receive coverage for in-patient treatment for the listed therapies for the identified diseases as specified in empanelled hospitals. The following services will include under this benefit.

  1. End-to-end cashless service offered through a network hospital from the time of reporting of a patient until 10 days after discharge medication (including complications up to 30 days after discharge
  2. Free outpatient evaluation of patients for listed therapies who may not undergo In-patient treatment (including consultation and investigation tests)

Follow-up Services

Policyholders who need long-term follow-up therapy to get maximum benefits from the medical procedure and avoid complications will also receive follow-up services for a period of 1 year through fixed packages. These services include consultation, investigations, drugs, etc for one-year listed therapies.

Outpatient Treatment for Identified Chronic Diseases

In the notified hospitals, policyholders will also get coverage for outpatient treatment for pre-defined long-term or chronic diseases. Orders regarding modalities and provision of the required budget will be issued separately.

Hospital Stay

Telangana State Government Employees and Journalists Health Scheme will also provide coverage against the hospital stay during the treatment according to the pay grade slab of employees.

Slab A employees (Pay Grades from I to IV) and Slab B employees (Pay Grades from V to XVII) will get coverage for the Semi-private ward, while Slab C employees ( Pay Grades from XVIII to XXXII) will get coverage for Private Ward.

Financial Coverage

Policyholders will not need to contribute as the total cost will be borne by the state government. Also, there is no upper limit on the financial coverage, and the overall treatment cost incurred on the enlisted therapies will be covered under the scheme.

Who is Eligible Under the Telangana State Government Employees and Journalists Health Scheme?

The following people are covered under the Telangana State Government Employees and Journalists Health Scheme. Do check the below table.

Serving Employees

  1. All regular State Government Employees (A State Government Employee will have the meaning as defined under Fundamental Rules)

  2. Provincialized Employees of local bodies

Retired Employees

  1. All service pensioners

  2. Family pensioners without dependents

  3. Re-employed Service Pensioners

Family

  1. Dependent Parents (either adoptive or biological, but not both)

  2. One legally wedded wife in case of a male employee/ service pensioner

  3. Husband in case of a female employee/ service pensioner.

  4. Wholly dependent legitimate children (including step-children and adopted children); and

  5. Dependents of family pensioners shall also be eligible as in the case of Service Pensioners.

Dependent Family Members

  1. Parents who are dependent on the employee for their livelihood

  2. Unemployed daughters who are unmarried or widowed or divorced or deserted

  3. Unemployed sons who are below the age of 25 years

  4. Disabled children with a disability that renders them unfit for employment

Individuals Not Covered Under Telangana State Government Employees and Journalists Health Scheme

Following individuals will not receive any coverage under the Telangana State Government Employees and Journalists Health Scheme. 

  1. Individuals who are covered under other insurance schemes such as Central Government Health Scheme (CGHS) 
  2. Casual and Daily paid workers
  3. ESIS, Railways, RTC, Aarogya Bhadratha of Police Department, and Arogya Sahayatha of Prohibition & Excise Department
  4. Law officers (Advocate General, State Prosecutors, State Counsels, Government Pleaders and Public Prosecutors)
  5. Biological parents if adopted parents exist
  6. All independent children
  7. AIS officers and AIS pensioners.

Steps to Get Health Insurance Under Telangana State Government Employees and Journalists Health Scheme

It is important to understand the steps to get health insurance under this Telangana government scheme. We are mentioning them below. Please check!

Step 1: The beneficiary (patient) will need to visit any of the nearest or convenient network hospitals under the scheme.

Step 2: The patient will be registered at the network hospital by AarogyaMithra application.

Step 3: In case the patient has a permanent health card, the biometric verification process will be initiated. Now, the patient will be sent for the preliminary diagnosis at the hospital, irrespective of whether he/she has a health card or not.

Step 4: Based on the diagnosis of the patient, the nature of treatment (in-patient or out-patient) will be decided.

Step 5: In case hospitalization is needed, in-patient registration will be initiated. After which, the E-pre-authorization request will be sent to the concerned medical team.

Step 6: At the network hospital, required surgery or treatment will be initiated.

Step 7: After the required treatment, the patient will be discharged and follow-up will be advised (if required).

Step 8: The network hospital will initiate the cashless claim process for the hospitalization of the patient.

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