The government of Telangana has implemented a comprehensive health insurance scheme specifically designed to cater to the needs of its employees, pensioners, journalists, and their respective families. Managed by the Arogyasri Health Care Trust, the scheme provides coverage for outpatient and inpatient treatment, as well as follow-up services, and it is completely funded by the government, which means that it does not require any contribution from the beneficiaries. The scheme replaces the previous medical reimbursement facility and offers additional benefits such as cashless hospitalisation and coverage for chronic diseases.
EJHS: Coverage and Eligibility
The Telangana State Government has a health scheme for its employees and journalists. It provides coverage benefits for hospitalisation, therapies, medications, and follow-up services for up to a year. The scheme also covers outpatient treatment for chronic diseases in specific hospitals, with different coverage categories based on the employee's pay grade. There is no maximum limit for coverage, and no contributions are required from employees or pensioners.
The Telangana State Government Health Program is available for:
Current and retired government employees
Journalists, and their dependent family members
Dependent parents
Spouses
Children (adopted or step)
Family members of pensioners
The program also covers:
Government employees and their spouses
Pensioners
Certain immediate family members
Dependents who rely on the employee's income
Unemployed sons under 25, and disabled children
The scheme provides full financial coverage for certain therapies, at no cost to employees or pensioners. There is no limit on the amount that can be claimed under this scheme, and some family members and dependents can also be covered. Cashless services are also available for up to 10 days of post-discharge medication.
EJHS: Who is not covered by the scheme?
The Telangana State Government - Employees and Journalists Health Scheme provides cashless treatment for serving, retired employees, journalists, and their families. However, there are certain beneficiaries who are not covered under the scheme. The policy benefits do not apply to individuals who are already covered under any central Government Health Schemes (CGHS).
This includes:
Employees in various government departments
Casual and daily wage workers
Independent children
Law officers
Biological parents in certain adoption cases
AIS pensioners and officers
EJHS: Mandatory requirements for network hospitals
The Telangana government has certain requirements for hospitals to be considered network hospitals. These requirements include being registered under specific medical establishment acts and being capable of providing indoor medical care. Once a hospital meets these criteria, it can be empanelled with a trust and referred to as a network hospital. The trust and network hospitals have a single agreement for all payments under the scheme, and the hospitals must adhere to the listed therapies and packages.
The official website provides a list of all the network hospitals, which can be used to find a hospital near your location. Hospitals within the state must be empanelled with the trust, while hospitals outside the state must be NABH accredited. Different types of hospitals have different requirements for empanelment, such as having specific specialities or super specialities.
Here’s how the process works:
The process starts with the beneficiary registering at a network hospital, either with a referral or a registration complaint.
After registration, the patient undergoes an outpatient consultation and further investigations.
Depending on the medical condition, they may be admitted as an inpatient.
If the patient requires any therapies listed, a pre-authorisation is submitted to the trust.
Treatment is then provided to the patient.
After completion of treatment and discharge, the network hospital waits for 10 days before filing a claim.
The health scheme offered by the Telangana government for employees is a beneficial initiative that will provide necessary medical care without the burden of expenses.
EJHS: Implementation
The state of Telangana has implemented the scheme for Journalist’s Health Scheme, which is meant for journalists working for the state government and they need to submit the application to the District Public Relations Officer (DPRO). Once their application is approved, it has to be verified by the Information and Public Relations Officer (IPRO). Once IPRO completes the final approval, the Journalists Health Card will be generated and the card has to be downloaded properly and thereafter, it can be printed and used.
Now that we have understood how EJHS provides cashless treatment to its beneficiaries, it is essential to know that the EJHS scheme enables specific benefits for post-operative care as well as treatment of chronic diseases that do not require any hospitalisation. Since you already know about the scheme and its benefits, take note of the toll-free number to contact the Telangana State Government Employees and Journalist Health Scheme: 104, which is available 24/7.
