Notification of “Working and retired Journalists Health Scheme”

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.

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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.

                                   %%%%%

            In the G.O.1st read above, the then 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 and retired journalists in Telangana similar

to the Employees Health Scheme introduced in the G.Os2 and 3rd read

above.

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.

I. COVERAGE:

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 and

generate 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.

D) OPERATIONS

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

24x7 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 identity

number for the Health Coverage.

VI. REVIEW:

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.

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF TELANGANA)

                                                                                      SURESH CHANDA

                                                             PRINCIPAL SECRETARY TO GOVERNMENT

To

The Chief Executive Officer, Aarogyasri Health Care Trust, Telangana,

Hyderabad.

The Director o Medical Education, Telangana, Hyderabad.

All the District Collectors in the State.

All Network Hospitals through CEO, Aarogyasri Health Care Trust.

The Commissioner, I&PR Department.

All Heads of the Department of HM&FW Department.