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EHS & Medical Reimbursement Rules

EHS & Medical Reimbursement Rules

EHS ANDMEDICAL REIMBURSEMENT RULES


  • The State Government of Telangana has formulated a new health scheme for its employees, journalists, pensioners and their dependent family
  • They can make use of the cashless hospitalisation at the Network Hospitals (NWH)
  • The new scheme replaces the current medical reimbursement facility and comes with added benefits such as post- hospitalisation cover and treatment of chronic diseases.
  • Through the Employee and Journalist Health Scheme, State Government employees and State Government pensioners along with their dependant family members can avail cashless treatment at various empanelled hospitals. Under the supervision of the government, the Aarogyasri Health Care Trust will implement the scheme

Features and Benefits

Treatment for pre-defined therapies of identified diseases.

Free out-patient evaluation for pre-defined therapies.

Cashless service for the post-discharge medication of upto 10 days and upto 30 days coverage of complications post-discharge.

 Follow-Up
Services
Services up to 1-year. Package includes consultations, investigations, drugs, etc. for 1-year for the listed therapies.
Out-Patient Treatment Treatment of listed chronic (long-term) diseases at select hospitals.
Hospital

Stay (Ward)

Slab A & B (Employee Pay Grade – I to XVII): Semi- Private 

Slab C (Employee Pay Grade – XVIII to XXXII): Private

Coverage (Financial)   Eligible Sum: No upper limit. No Contribution by Employee/Pensioner.

What is Not Covered (Exclusions)

  • treatments for non-identified diseases as per the EHS will not be covered.
  • Those covered under any of the Central Government Health Schemes (CGHS).
  • Employees working in Aarogya Bhadratha of Police Department, Railways, ESIS, RTC and Aarogya Sahayatha of Prohibition and Excise
  • Casual and daily wage
  • Independent children
  • Law officers such as Public Prosecutors, State Prosecutors, Advocate General, State Counsels and Government Pleaders.
  • Biological parents if adopted parents exist or vice
  • AIS pensioners and officers.

WHO ARE COVRED

  • Regular State Government Employees
  • Provisionalised Employees of Local Bodies.
  • Retired State Government Employees / Journalists (Service Pensioners / Family Pensioners without Dependents / Re-Employed Service Pensioners.
  • Dependent Fmaily Members (Dependent Parents (Either Adopted / Biological). / One Legally Wedded Spouse / Dependent Legitimate Children (Adopted / Step Children) / Family Members of Service Pensioners
  • The EHS further classifies ‘Dependent Family Members’ as:
    • Parents: Dependent on the employee/journalist for their
    • Unemployed Sons: Below 25
    • Unemployed
    • Daughters: Unmarried/Divorced/Widowed/Deserted.
    • Children with Disabilities: Those are deemed unfit for

How to Enrol

  • Employee Enrollment
  • there is no separate enrollment process for serving
  • The Drawing and Disbursing Officer (DDO) will furnish the employees’ data (including Aadhaar) to the finance department through the Comprehensive Financial Management System (CFMS).
  • This data is then shared with the Aarogyasri Health Care Trust by the finance department to generate health cards and made available on the EHS website. This health card can be downloaded, printed and used by employees and their dependent family

LOGIN INSTRUCTIONS

  • Employees can upload the photograph of theirs or their dependent family members or even update dependent family members through the EJHS web Below is the login instructions:
  • Step 1: Visit the official web portal of the Employees Health Scheme.
  • Step 2: On the top right, click on ‘Sign-in’ and select ‘Employees’.
  • Step 3: Your Employee ID is the Username and the same Username as the first-time You may be asked to enter a new password for future logins.

Patient Process Flow

  • Below is the patient process flow for serving employees under the EJHS:
  • Step 1: Employee visits any of the networks of empanelled hospitals.
  • Step 2: The patient will be registered at the NWH (Network Hospital) by
  • Step 3: If the patient has a permanent health card, then a biometric verification will be enabled and sent for preliminary diagnosis at the
  • Step 4: If the patient does not have a permanent health card, they will be also sent for preliminary diagnosis.
  • Step 5: Based on the diagnosis, the patient will either be treated as out-patient or in-patient.
  • Step 6: If advised to be hospitalised, then in-patient registration will be
  • Step 7: E-pre authorisation will be sent to the concerned
  • Step 8: Required surgery or treatment will be initiated at the
  • Step 9: Patient will be discharged as required and if needed, follow-up will be advised.
  • Step 10: The hospital will initiate the claim process for the hospitalisation of the patient.

HOW TO ADD BENEFIECIARY

  • Below is a step-by-step guide to adding beneficiaries to the EJHS:
  • Step 1: Visit the official web portal of the Employee Health Scheme of the Government of Telangana.
  • Step 2: Click on ‘Sign-in’ found on the top-right corner of the page.
  • Step 3: Enter your Username and
  • Step 4: In the new page, click on ‘Registration’ found on the top-left of the page and click on ‘Initiate New/Rejected Beneficiaries’.
  • Step 5: You will be directed to a new page ‘Beneficiaries Worklist’. Click on ‘Add New Beneficiary’.
  • Step 6: Enter details of the beneficiary and attach Date of Birth (DOB) certificate and photo if the DOB is below 5-years. If the DOB is above 5-years old, then you will have to attach their Aadhaar card and
  • Step 7: Click on ‘Save’. You also have the option to
  • Step 8: A pop-up window will confirm the beneficiary is savedsuccessfully. Click on ‘Ok’.
  • Step 9: Once you click on Ok, you will be directed to the ‘Beneficiary List’ page, you can either remove or edit the details of the newly added.
  • Step 10: Click on ‘Submit’ after checking all information provided is correct.
  • Step 11: A pop-up window will confirm that the addition of a beneficiary is completed successfully.

LIST OF HOSPITALS

  • EHS Telangana List of Hospitals:
  • Registered hospitals or nursing homes in Telangana established for the treatment of diseases and injuries and health care are known as Health Care Providers. The State Government has authorised several hospitals and nursing homes to offer cashless hospitalisation under the EJHS.
  • List of Empanelled Hospitals for EJHS:
  • There are more than 200 empanelled hospitals located across the state. For the complete list of empanelled hospitals for EJHS.

GRIEVANCES

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