Working Journalists Health Scheme is formulated to provide cashless treatment to the journalists of the State Government and their dependent family members.
IMPORTANT STAKEHOLDERS IN THE SCHEME
The scheme is intended to benefit Serving Journalists of the State.
- Dr.YSR Aarogyasri Health Care Trust will implement the scheme under the supervision of Government of Andhra Pradesh.
- Repudiation: The Trust may repudiate a claim for reason of not being covered by the policy under intimation to Scheme Technical Committee.
- An appeal lies to the Appellate Committee either against repudiation (rejection) as defined in Term 12.4 (ii) or reduction of claim as defined in Term 12.4 (i) under Term 12.5 within 3 months from date of repudiation advice or settlement of claim.
Network Hospitals - Service Providers:
A health care provider shall be a hospital or nursing home in Andhra Pradesh established for indoor medical care and treatment of disease and injuries and should be registered under Andhra Pradesh Private Allopathic Medical Establishments (Registration & Regulation) Act and Pre-Conception and Pre-Natal Diagnostic Techniques Act (Wherever Applicable).
Software Company - Technology Solutions:
A dedicated real-time online workflow system was designed by the Trust in order to bring dynamism and decentralization of work like Online processing of the cases starting from registration of case at network hospital, pre-authorization, treatment and other services at the hospital, discharge and post treatment follow-up, claim settlement, payment gateway, accounting system, TDS deductions, e-office solutions etc. The maintenance of the workflow is done round the clock.
- Serving Journalists:
- All regular State Government Journalists.A State Government Journalists will have the meaning as defined under Fundamental Rules.
- Dependent Parents (either adoptive or biological, but not both).
- One legally wedded wife in case of a male journalist.
- Husband in case of a female journalist.
- Wholly dependent legitimate children (including step children and adopted children)
- 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.
The eligible beneficiaries will be provided with health cards also called eligibility cards.
The procedure of verification of eligibility of beneficiary under the scheme shall be by online authentication of the health card details. The beneficiary shall provide either the eligibility card or the card number in case the card is unavailable. The staff at the kiosk in the Network Hospital shall verify the details online by accessing the database. Once the authentication is complete, the eligibility verification ends.
- Penal Actions:
Any irregularities or misuse committed by the beneficiaries coming to the notice of Government or Dr.YSR Aarogyasri Health Care Trust will entail disciplinary action as per A.P. C.S. (CCA) Rules, 1991 and may attract penal action as per law.
- The scheme will provide Inpatient treatment for the listed therapies for identified diseases under all specialties in the empanelled hospitals. List of IP therapies
- Package includes the following services:
- End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a listed therapy(ies)
- Free OP evaluation of patients for listed therapies who may not undergo IP treatment including consultation and investigations
Follow-up services are provided for a period of one year through fixed packages to the patients whoever requires long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up package includes consultation, investigations, drugs etc., for one year for listed therapies. List of IP therapies
- 50% of total amount will be borne by Government and 50% by the Journalists contribution.
- The expenditure in running the scheme and scheme experience will be reviewed at the end of six months and revision of contribution effected accordingly.
- Guidelines for empanelment of hospitals within the State and outside, preauthorization and other modalities while implementing the scheme will be in conformity with the existing standard procedures being followed by Dr.YSR AHCT. The list of empanelled hospitals will be made available in the official website www.wjhs.ap.gov.in
Payments under the scheme will be based on approved package prices.
- Empanelled hospitals resorting to irregularities or misuse shall be blacklisted and entire amount recovered besides launching criminal action.