Telangana Government- Employees and Journalists Health Scheme

Over the past few years, state governments are taking a lot of steps to ensure that they cater to the needs of their employees. As a result, there are quite a few schemes available for employees of the state governments. Amidst growing inflation and ever-increasing prices of all commodities, such schemes are most welcome. Telangana state government employees and journalists health scheme is one such important introduction. Here is everything that you need to know about the scheme.

Telangana state government employees and journalists health scheme is a newly introduced health insurance plan that is curated for pensioners, its employees, journalists, and their dependent family members. Simply put, the plan allows all the beneficiaries to avail of cashless benefits for their medical needs at any of the network hospitals.

One of the biggest perks of this employee health scheme is that it replaces the age-old reimbursement model. And it packs in additional benefits in the form of coverage for chronic disease, coverage for post-hospitalisation expenses, etc.

Though the policy is curated for the employees of the state government, they must meet certain eligibility criteria to be able to avail of this policy.

Employees Currently Serving

• The policy applies to all the provisional employees of local bodies as defined by the government.
• The policy applies to all the employees of the state government as defined by the fundamental rules.

Dependent Family Members

• The policy is available to dependent parents of employees, either biologically or adopted.
• The policy is applicable to the family members of service pensioners
• The policy is applicable to legally wedded spouses
• The policy is applicable to legitimate children, that can either be adopted or even stepchildren.

Retired Employees or Journalists

• The policy is applicable for service pensioners
• The policy is applicable for family pensioners without any dependents
• The policy is applicable for service pensioners who are re-employed

For further clarity, here is what a family means in this context.

• Dependent parents of the employees, either biological or adopted but not both
• A legally wedded spouse, either for service pensioners or employees
• Dependent members of family pensioners
• Entirely dependent children, who can either be biological or adopted

And here is what a dependent means, in the context of the policy.

• Parents of the employee who depend on them for their livelihood
• Unemployed children below the age of 25 years
• Disabled offspring, who might find it difficult to find work due to their disability

The employee health scheme is a well-packaged policy that offers quite a few features and benefits. The following are some of the leading features of the plan.

• The policy offers cashless service for medications up to 10 days post-discharge for a medical condition
• The policy does not have an upper limit when it comes to claims for the policy under this scheme
• The scheme does not require the employees or pensioners to bear any cost at their end
• The scheme offers complete financial coverage for certain therapies
• The benefits of the policy are extended to the family members and dependents of the employees under the scheme

As is the case with any other insurance policy, the employee and journalist health scheme offers quite a few benefits as well. Being aware of these benefits will help you make the most of the scheme or use it appropriately when needed. Here are some of the benefits of the scheme.

In-Patient

• If the beneficiaries are admitted as inpatients to a hospital, the following are benefits that they can avail of.
• In-patient treatment of certain therapies without any charges
• Cashless service of medicines up to 10 days post-discharge of hospitalisation
• Medical cover for up to 30 days post-discharge for people, if they have undergone any of the listed illnesses

Outpatient Treatment

• The scheme offers coverage for some chronic long-term diseases, at some of the listed hospitals. The scheme also covers outpatient - - treatment for certain listed therapies without any charges.

Follow up Visits

• The Telangana state government employees and journalists' health schemes offer follow-up services for the beneficiaries. These cover drugs, consultation, investigations of complex conditions, etc. for a duration of up to 1 year. There are different packages that the - beneficiaries can avail of.

No Upper Limit

• One of the biggest perks of the scheme is that there are no upper limits when it comes to the sum insured by the policy. Also, the employees or pensioners do not need to make any kind of contributions for the same.

Admission to Hospital

• The scheme allows patients to get admitted to different types of wards, depending on their pay scale. The following are the different slabs that are taken into consideration.

Slab A: Beneficiaries under this slab can avail of semi-private wards and their pay grades must be between I to IV. Slab B: Beneficiaries under this slab can avail of semi-private wards and their pay grades must be between V to XVII. Slab C: This slab is applicable to employees who are in the pay grade between XVIII and XXXII.

All the insurance policies have exclusions. These are scenarios or conditions that that policy does not offer coverage for. Should you file a claim for any of these scenarios, the chances are very high that the same might get rejected. Here are some of the exclusions for the employee health scheme Telangana government has come up with. The list primarily lists the beneficiaries who cannot avail of the scheme.

• The policy and its benefits are not applicable to AIS pensioners and officers
• Children who are independent are not covered by the scheme
• Employees or pensioners who are already covered as a part of any other Central Government Health Schemes (CGHS)
• Daily wage workers and casual workers are not covered as a part of the scheme
• Employees who work in ESIS, Aarogya Bhadratha of the Police Department, Aarogya Sahayatha of Prohibition and Excise Department, and employees of railways and RTC are not covered under this scheme
• The scheme is not available for biological parents if the adopted parents are present or vice versa
• The scheme is not available for law officers that include advocate general, state counsels, government leaders, state prosecutors or public prosecutors

• The Telangana government has some pre-requisites that must be met, for a hospital to be deemed as a network hospital. Telangana state government employees and journalists' health schemes mention health care providers in their documents.
• A health care provider is a nursing home or hospital that is present in Telangana and is capable of providing indoor medical care, and treatment of injuries and diseases. And the entity must be registered under Telangana Private Allopathic Medical Establishments Act and Pre-Conception and Pre-Natal Diagnostic Techniques Act.
• If any health care provider meets these criteria, will become eligible for empanelment with a trust. And once that is complete, it will be referred to as a network hospital. There usually is a single agreement between the trust and network hospitals for all the payments under the scheme. There are various packages for the listed therapies and the network hospitals must adhere to these.
• The official website has a list of all the network hospitals for your reference. You can browse through the list to identify a network hospital that is close to your location.
• The state intends to have a distributed list of network hospitals. Hospitals or nursing homes within the state must be empanelled with trust and the ones that are outside the state must be NABH accredited.
• For example, if a 50 bedded hospital wishes to be empanelled, they must have one or more specialities from the list such as OBG, General Medicine, General Surgery, Orthopaedics, Ophthalmology and ENT.
• Similarly, a multi-speciality hospital is expected to have more than one super speciality from the list that includes Cardiology, CT surgery, Paediatric surgery, Neurology, Urology, Plastic surgery, Neurology and Neurosurgery, etc.

The first step involves registering the beneficiary at a network hospital either with a referral or a complaint about registration. Once the registration is complete, the patient then moves to OP consultation. Where further investigation is carried out and depending on the medical condition, they are moved to inpatient. If the patient is found to be suffering from any of the listed therapies, a pre-authorization is submitted to the trust. It is then followed by the treatment of the patient. After the completion of treatment and discharge, the network hospital usually waits for 10 days before filing a claim.

The employee health scheme by the Telangana government is a positive step and it is in the right direction. Such schemes will help the beneficiaries receive adequate medical attention without particularly having to worry about the expenses.