G.O.MS.No. 64 Dated: 22-7-2015 Government of Telangana 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 and retired journalists in Telangana similar to the Employees Health Scheme introduced in the G.Os2 and 3rd read
2 Government after careful examination, hereby approve the “Working and retired Journalists Health Scheme”, which will ipso facto replace the existing Group Medi-claim policy launched in the G.O.1st read above.
3 Government also hereby issue the following guidelines for implementation of ‘Working and retired Journalists Health Scheme.
The coverage under the scheme is as follows:-
I.1 BENEFICIARIES COVERED:
The Scheme will be applicable to the Working and Retired Journalists. The Commissioner, Information & Public Relations Department will compile the details of eligible journalists for coverage under the scheme.
Option will be given to the journalists, who are having white ration cards to choose either this Health Scheme or Aarogyasri Health Scheme, but they are not allowed to avail both the Schemes.
I.2 FAMILY MEMBERS: The following family members are entitled to avail the Health Scheme.
(a) Dependent Parents (either adoptive or biological, but not both).
(b) One legally wedded wife in case of a male journalist. Husband in case of a female journalist.
(c) Wholly dependent legitimate children (including step children and
(d) Adopted children)
I.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.
II. BENEFITS COVERED:
2.1 In-Patient Treatment:
a) The scheme will provide inpatient treatment for the medical and surgical procedures, similar to those being provided to the Government employees, in the empanelled hospitals.
b) Inpatient treatment Package includes the following services:
C) 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 postdischarge for those patients who undergo listed therapies offered through Network Hospitals.
II.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. Followup packages include consultation and medication.
II.3 Ward Entitlement
During inpatient treatment, the beneficiary is entitled to stay in Semi private ward.
III. 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.
IV. NETWORK HOSPITALS:
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.
V. IMPLEMENTATION MECHANISM:
A) IMPLEMENTING AGENCY
Aarogyasri Health Care Trust will be the implementing agency for Working and retired Journalists’ Health Scheme “, 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, Telangana 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 andgenerate the health cards.
C) PENAL ACTIONS
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.
a) Pre-authorization will be issued within 12 hours for any IP treatment.
The claims will be paid to the hospitals within 7 days.
b) 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 Telangana and be available for real-time audit
c) There will be a grievance redressal mechanism and call centre cell 24×7 for addressing grievances of beneficiaries and hospitals.
V. 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 idenity number for the Health Coverage.
The scheme will be reviewed, in all aspects, 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.
4. 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.
5. Chief Executive Officer, Aarogyasri Health Trust and the
Commissioner, Information & Public Relations Department shall take further necessary action in the matter.
GOVERNMENT OF TELANGANA ABSTRACT Telangana State – Health, Medical and Family Welfare Department –
Comprehensive health coverage to the working and retired journalists in Telangana – Notification of “Working and retired Journalists Health Scheme” – Orders – Issued. HEALTH, MEDICAL & FAMILY WELFRE (A2) DEPARTMENT G.O.MS.No. 64 Dated: 22-7-2015 Read the following:-
1. G.O.Ms.No.203.GA (I&PR.I) Department, dated: 27-7-2004
2. G.O.Ms.No.174, HM&FW (M2), Department, dated: 1-11-2013
3. G.O.Ms.No.32, HM&FW (A2I) Department, dated: 03-11-2014
4. From the Commissioner, I&PR Department, Hyderabad Lr. No.001042/MR/2014, dated 26-08-2014.