Telangana State Government – Employees and Journalists Health Scheme is a new health insurance scheme formulated by the Telangana government for its employees, pensioners, journalists, and their dependent family members. The beneficiaries can avail of cashless hospitalisation at the network hospitals under this scheme. The scheme replaces the medical reimbursement facility and comes with additional benefits such as post-hospitalisation expenses, chronic diseases, etc.

Telangana State Government – Employees and Journalists Health Scheme Eligibility

The eligibility criteria for Telangana State Government – Employees and Journalists Health Scheme is as follows:

1. Current Serving Employees

• All regular state government employees as defined by the fundamental rules
• Provisionalised employees of local bodies

2. Retired State Government Employees or Journalists

• Service pensioners
• Re-employed service pensioners
• Family pensioners without any dependents

3. Dependent Family Members

• Dependent parents (either adopted or biological)
• Legally wedded spouse
• Dependent legitimate children (adopted or stepchildren)
• Family members of service pensioners

Kindly note that ‘family’ here means the following:

• Dependent parents (whether adoptive or biological), not both
• One legally wedded spouse in case of employees or service pensioners
• Biological, wholly dependent step and adopted children
• Wholly dependent biological or step adoptive children
• Dependent of family pensioners

‘Dependents’ here means the following:

• Parents who depend on the livelihood of the employee
• Unemployed sons aged below 25 years
• Disabled offspring who may not be able to work due to the disability

Kindly note that the scheme offers benefits only to government employees, spouses, pensioners, dependents, and some immediate family members.

Features of Telangana State Government – Employees and Journalists Health Scheme

Some features of the Telangana State Government – Employees and Journalists Health Scheme include the following:

• Complete financial coverage for some specific therapies
• Employees or pensioners are not required to bear any cost
• There is no upper limit to make a claim under this scheme
• Some family members and dependents can also seek cover under this scheme
• Cashless services for up to 10 days post-discharge medicines

Exclusions Under Telangana State Government – Employees and Journalists Health Scheme

Telangana State Government – Employees and Journalists Health Scheme allows all serving, retired employees and journalists as well as their family members to avail themselves cashless treatment. The beneficiaries can avail of cashless hospitalisation for some specific therapies or listed diseases. However, the scheme will not cover certain beneficiaries. Some exclusions under the policy are mentioned below:

• People who are covered under any central Government Health Schemes (CGHS) are excluded from policy benefits
• Employees working in railways, Aarogya Sahayatha of Prohibition and Excise Department, ESIS, Aarogya Bhadratha of Police Department, RTC.
• Casual and daily wage workers are not covered
• Independent children are not covered
• Law officers including public prosecutors, advocate general, state prosecutors, state counsels, as well as government leaders.
• Biological parents in case adopted parents are there or vice versa
• AIS pensioners as well as officers.

Benefits of Telangana State Government – Employees and Journalists Health Scheme

Following are the coverage benefits offered under Telangana State Government – Employees and Journalists Health Scheme:

1. In-patient Treatment: The beneficiaries can avail of the following in case of in-patient hospitalisation:

• Free in-patient treatment expenses for some specific therapies
• Outpatient treatment for an identical list of some specific therapies
• Cashless service for up to 10 days for medicines required after discharge
• Cover for up to 30 days after discharge for people undergoing any listed illness.

2. Follow-up Services: The scheme provides follow-up services in the form of drugs, investigation for a complete curative experience, consultation, for up to 1 year. The beneficiaries can avail of fixed packages for the same.

3. Outpatient Treatment for Chronic Diseases: Telangana State Government – Employees and Journalists Health Scheme provides cover for chronic long-term diseases in some listed hospitals.

4. Stay at Hospital (ward): The scheme covers employees for different types of wards that are allowed for employees in different pay scales, as given below:

• Slab A: This is for employees with pay grades from I to IV and is applicable for semi-private wards

• Slab B: This is for employees with pay grades from V to XVII and is applicable for semi-private wards

• Slab C: This is for employees with pay grades from XVIII to XXXII

5. Financial Coverage: There is no upper limit of the sum insured. There is no contribution to be made by an employee or pensioner.