Government of Andhra Pradesh issued orders for implementation of Group Medi-claim policy, as health insurance scheme, for the working journalists. After review and examination of the scheme, the Government has decided to provide comprehensive health coverage to the working journalists in Andhra Pradesh similar to the Employees Health Scheme introduced in the G.Os.
Government after careful examination, hereby approve the ‘Working Journalists Health Scheme’, which will ipso facto replace the existing Group Medi-claim policy launched in the G.O. 1st read above.
Government also hereby issue the following guidelines for implementation of ‘Working Journalists Health Scheme’.
The coverage under the scheme is as follows:-
1 BENEFICIARIES COVERED:
The coverage will, at present, be applicable to the accredited Print and Electronic Media Journalists, and accredited freelance journalists. The Commissioner, Information & Public Relations Department will review and compile the details of eligible journalists for coverage under the scheme. A separate memo may be issued to I&PR, Commissioner.
Option will be given to the journalists, who are having white ration cards to choose either the Working Journalists Health Scheme or Dr NTR Vaidya Seva, but are not allowed to avail both the Schemes.
In respect of journalists working in Hyderabad, the Commissioner, I&PR., shall compile the details of the journalists working for the Andhra Pradesh State in Hyderabad. The Journalists working in Hyderabad for residuary Andhra Pradesh State shall give an undertaking stating that they have not applied for such scheme in the State of Telangana.
2 FAMILY MEMBERS: The following family members are entitled to avail of the Working Journalists Health Scheme.
- Dependent Parents (either adoptive or biological, but not both).
- One legally wedded wife in case of a male journalist.
- Husband in case of a female journalist.
- Wholly dependent legitimate children (including step children and adopted children)
2.1 DEPENDENCY WILL HAVE THE FOLLOWING MEANING:
- In case of parents, those who are dependent on the Journalist for their livelihood.
- In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted.
- In case of unemployed sons, those who are below the age of 25 years.
- Disabled children with a disability which renders them unfit for employment.
- BENEFITS COVERED:
- In-Patient Treatment:
- The scheme will provide inpatient treatment for the medical and surgical procedures, similar those being provided to the Government employees, in the empanelled hospitals.
- Inpatient treatment Package includes the following services:
- End-to-end cashless inpatient services from the time of
reporting of the patient, including professional services, investigations, medicines, implants, consumables, diet and ten (10) days post-discharge medication, including treatment of complications, if any, up to thirty (30) days post-discharge for those patients who undergo “listed therapy(ies) offered through Network Hospitals.
? Free Pre-evaluation of patients, including consultation and investigations for listed therapies, even if it may not end up with IP treatment .
2 Follow-Up Services
Follow-up services will be provided for a period of one year through fixed packages to those patients who require long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up packages include consultation and medication.
3 Ward Entitlement
During inpatient treatment, the beneficiary is entitled to stay in semiprivate ward.
- The financial coverage for the working journalists and their dependent family members under this Scheme will be Rs.2.00 lakhs (Rupees two lakhs only) per episode of illness, with no limit on the number of episodes. However in the cases where the cost of treatment exceeds Rs.2.00 lakhs cashless treatment will continue and no network hospital shall deny treatment in such cases.
- The limit of Rs.2.00 lakhs will not apply in cases where the predetermined package rates are above Rs.2.00 lakhs.
- Chief Executive Officer, Aarogyasri Health Care Trust will settle the claims that exceed Rs.2.00 lakhs, following the standard claims settlement process after obtaining approval of the Standing Committee already constituted by the Government for Employees Health Scheme.
The existing network hospitals (NWHs) already empanelled with the Aarogyasri Health Care Trust (AHCT) under Employees Health Scheme will serve the ‘Working Journalists Health Scheme’.
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.
A) IMPLEMENTING AGENCY
Aarogyasri Health Care Trust will be the implementing agency for “Working Journalists’ Health Scheme (WJHS)”, leveraging on the experience it has gained in running Aarogyasri Scheme as well as the newly introduced Employees Health Scheme.
B) NODAL AGENCY:
The Commissioner, Information & Public Relations, Andhra Pradesh will be the nodal agency. The details of Journalists covered under the Scheme will be collected by the Information & Public Relations Department and forwarded to the Aarogyasri Health Care Trust, which in turn, will feed the data and generate the health cards.
In respect of coverage to the journalists working in Hyderabad, the Commissioner, I&PR., shall address the Media Managements for details of the journalists working for the Andhra Pradesh State in Hyderabad.
Any irregularities or misuse committed by the beneficiaries coming to the notice of Government or AHCT will entail forfeiture of benefits under the Scheme in the future, besides penal action as per law.
- Pre-authorization will be issued within 12hours for any IP treatment. The claims will be paid to the hospitals within 7 days.
- AHCT through its IT platform will process all pre-authorisations and claims and the entire data will reside in State Data Centre of Government of AP and be available for real-time audit
- There will be a grievance redressal mechanism and call centre cell 24×7 for addressing grievances of beneficiaries and hospitals.
- BUDGET, CONTRIBUTION AND FINANCIAL MANAGEMENT:
The probable premium per annum per journalist works out to Rs.2,500/- or Rs.208/- per month. Payment of premium is on equal basis i.e., 50:50 between Government and journalists.
The basis for payment of the premium shall be for the financial year and the membership will cease, if the journalist fails to pay the premium amount for two consecutive years.
The scheme is applicable for the financial year 2015-16. Presently, the Scheme shall start from 21-03-2015. For the period from 21-03-2015 to 31.03.2015, proportionate premium amount shall also be borne by the Journalists, in addition to the regular premium for the financial year 2015-16.
The fund comprising of contribution from Journalists will be collected by the Commissioner, I&PR., in quarterly installments and remiited to government journalists health care fund to be established by the Government. The Finance Department will issue separate orders in this regard.
- HEALTH CARDS:
The details of Journalists covered under the Scheme will be collected by the Information & Public Relations Department and forwarded to the Aarogyasri Health Care Trust, which in turn, will feed the data and generate the health cards. The journalists shall download the cards from the Aarogyasri Health Care Trust website.
The aadhaar number / aadhaar enrolment number shall be the identity number for the Health Coverage.
The scheme will be reviewed, in all aspects, including revision of premium, after six months by the Committee to be constituted by the Government.
The Commissioner, I&PR shall take necessary action for constitution of the Committee.
- Detailed operational guidelines required from time to time will be issued by Government in Health, Medical and Family Welfare Department, and made available in the Aarogyasri Health Care Trust website.
- Chief Executive Officer, Aarogyasri Health Care Trust and the Commissioner, Information & Public Relations Department shall take further necessary action in the matter.
- These orders shall come into effect from 21-03-2015.
- This order issues with the concurrence of Finance (EBS.I) Department vide their U.O.No.255/28/A1/EBS-I/15, Dated:10.02.2015.
G.O.MS.No. 12 Dated:11-02-2015.
1. G.O.Ms.No.203 GA (I&PR.I) Dept dated 27-07-2004.
2. G.O.Ms.No.174 HM&FW (M2) Dept dt.01-11-2013. 3.G.O.Ms.No.134HM&FW (I.1) Dept dated 29-10-2014.
2. From the CEO., AHCT., Hyderabad letter No.AHCT/4979/F.18/ Journalists/2014-2 Dated 13-08-2014.
3.From the Commissioner, I&PR., AP., Hyderabad Lr.No.019803/ MR/C1/2014, Dated 03-11-2014.