Providing Cashless medical treatment to the State Government Employees, Pensioners and their dependent family members
GOVERNMENT OF TELANGANA
Health, Medical
& Family Welfare Department – Employees Health Scheme – Providing Cashless
medical treatment to the State Government Employees, Pensioners and their
dependent family members – Further Orders – Issued.
HEALTH,
MEDICAL & FAMILY WELFARE (A2) DEPARTMENT
G.O.MS.No. 32 Dated:03-11-2014
Read
the following:-
1.G.O.Ms.No.174, HM & FW (M2)
Department, dt.01-11-2013
2.G.O.Ms.No.175, HM & FW (M2)
Department, dt.01-11-2013
3. G.O.Ms.No.176, HM & FW (M2)
Department, dt.01-11-2013
***
ORDER:-
In the G.O. 1st read above, the erstwhile
Government of Andhra Pradesh have formulated Employees Health Scheme to provide
cashless treatment for the listed therapies in the empanelled hospitals, to all
the Government employees, pensioners and their dependent family members in
replacement of the medical reimbursement system under APIMA Rules, 1972. In the
G.O.2nd read above operational guidelines for issue of health cards
were issued and in the G.O.3rd read above, the package prices for
the listed therapies were notified.
2. Consequent on reorganization of Andhra Pradesh into the States
of Telangana and Andhra Pradesh, the Chief Minister of Telangana reviewed the
implementation of the Employees Health Scheme in the meeting held on 21-10-2014 in the light of
the representations made by the representatives of Employees / Pensioners Associations and decided that the
Scheme be implemented with the following modifications:
1.
The total cost on implementation of Employees
Health Scheme shall be borne by the Government and no contribution will be
collected from the employees/ pensioners.
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.
5. There
is no need for ‘steering committee’ for the Scheme.
6.
Inclusion of other categories of employees will be
examined after implementation of the Scheme for six months.
3. Accordingly Government hereby direct that the “Employees
Health Scheme” shall be implemented with effect from 01-11-2014 with the
modifications mentioned in para-2 above.
4. Accordingly all fresh cases of treatments with effect from
01-11-2014 shall be governed by above scheme and all such cases shall not be
eligible for any reimbursement. However all cases of treatment commenced prior
to 01-11-2014 shall be eligible for reimbursement as per Rules for
reimbursement.
5. This order issues with the concurrence of Finance Department
vide their No.388/PFS/14, dt.24-10-2014.
(BY
ORDER AND IN THE NAME OF THE GOVERNOR OF TELANGANA)
SURESH CHANDA
PRINCIPAL SECRETARY TO GOVERNMENT
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