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NEHS / EHS Telangana New Guidelines 2026: What Employees Need to Know

NEHS / EHS Telangana New Guidelines 2026
Last Updated: September 10, 2026 | By Zishu
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⚡ Quick Summary: What You Must Know

  • Effective Date: July 17, 2026 (Guidelines apply retrospectively from the scheme's start date).
  • Official Release Date: August 22, 2026 (Proceeding No. 01/EHCT/NEHS/1505/2026).
  • Approved By: Sri Sanjay Jaju, IAS, Chief Secretary to Government & Chairman, EHCT.
  • Who is Covered: Serving State Government employees, provincialized local body employees, Aarogya Bhadratha (Police) and Aarogya Sahayatha (Prohibition & Excise) beneficiaries, all Service Pensioners, Family Pensioners, re-employed service pensioners, and eligible dependants.
  • Financial Cap: ₹3 lakh per illness episode, with no limit on the number of episodes — and no denial of treatment even beyond ₹3 lakh.

Telangana Employees Health Scheme (EHS / NEHS): Official New Guidelines 2026

Table of Contents

1. Preamble

Under the Employees Health Care Trust (EHCT), Chief Secretary Sri Sanjay Jaju, IAS approved the comprehensive Guidelines for Implementation of the New Employees Health Scheme (NEHS) vide Proceeding No. 01/EHCT/NEHS/1505/2026, dated 22.08.2026, in pursuance of G.O.Ms.No.40 (dt. 17.06.2026), G.O.Ms.No.50 (dt. 16.07.2026), and the Minutes of Meeting No. 03/EHCT/NEHS/2026 (dt. 31.07.2026). The scheme provides cashless and comprehensive healthcare to serving employees, service pensioners, family pensioners and their eligible dependants.

2. Who is Covered Under NEHS?

The Guidelines set out coverage in two broad categories:

  • Serving employees: All regular State Government employees (as defined under the Fundamental Rules); provincialized employees of local bodies; and beneficiaries under the Aarogya Bhadratha Scheme (Police Department) and Aarogya Sahayatha Scheme (Prohibition & Excise Department).
  • Retired employees: All Service Pensioners; Family Pensioners; and Re-employed Service Pensioners.

The categories of beneficiaries, constitution of family, dependency criteria and exclusions continue to be governed by existing Government Orders, unless EHCT specifically orders otherwise. Inclusion of Aarogya Bhadratha and Aarogya Sahayatha beneficiaries into NEHS is subject to implementation modalities approved by EHCT and the Finance Department.

3. Enrolment, Health Cards & Data Correction

Digital Enrolment

  • EHCT maintains an online beneficiary management module as part of the EHS software platform and mobile app.
  • Beneficiary and dependant particulars are enrolled and validated through IFMIS, integrated with EHCT.
  • Where contribution has not been deducted (e.g., Fully Self-Drawing Officers or other administrative reasons), the DDO/Head of Office must regularise the pending deduction before Health Card benefits are activated or continued.

Health Cards

  • New EHS Health Cards are generated digitally via the NEHS app/portal once the beneficiary database is validated through IFMIS.
  • The digital Health Card / QR code is accepted at all empanelled hospitals and Wellness Centres for identification.
  • Important: Until the new Health Card is issued, treatment continues on the basis of the existing Employee/Pensioner ID. No eligible beneficiary can be denied admission or treatment solely because the new card hasn't been issued yet.

Data Correction & Family Mapping

The Finance Department prescribes a time-bound online procedure for correcting demographic particulars, adding/deleting dependants, and resolving dual-spouse declarations or mismatches — with a verifiable audit trail integrated with the NEHS portal via API.

4. Purpose and Objective of These New Rules

The Scheme aims to provide cashless outpatient treatment, basic investigations and medicines through Wellness Centres, and cashless inpatient treatment through empanelled Government and private network hospitals — simplifying both OPD and IPD processes.

Related Reads:

5. Out-Patient Treatment (Wellness Centres)

Out-patient treatment is ordinarily provided through Wellness Centres, covering:

  • Consultations: Common ailments, ophthalmic, dental, ENT, paediatric conditions, physiotherapy, and long-term/chronic diseases (diabetes, hypertension, coronary artery disease, cerebrovascular disease, cancer, renal failure, TB, leprosy, rheumatological disorders, arthritis, lupus, autoimmune diseases, urological and orthopaedic conditions, and more).
  • Investigations: Haematology & pathology (blood grouping, haemoglobin, WBC/RBC counts, ESR, urine/stool exam, Pap smear); biochemistry (glucose tolerance, creatinine, urea, uric acid, lipid profile, LFTs, PSA, serum calcium); microbiology/serology (HIV, HBsAg, HCV); radiology (X-ray, ultrasonography, ECG, mammography, PFT, gynaecological investigations); and eye examinations.
  • Pharmacy: Prescribed medicines, surgical consumables and life-saving drugs for common ailments and long-term treatment (ophthalmic, dental, ENT, diabetic, cardiac, renal, transplant, psychiatric, oncological and other conditions) via approved formulary.
  • Referrals: Investigations unavailable at a Wellness Centre are referred to Government diagnostic facilities (cashless); inpatient cases are referred to an empanelled network hospital with clinical records.
  • Emergency Direct Admission: In an emergency, a beneficiary can go straight to the nearest empanelled hospital without a prior referral — intimation to EHCT must follow within 48 hours.

6. In-Patient Treatment & CGHS Packages

  • End-to-end cashless inpatient treatment through empanelled Government and private hospitals for approved medical, surgical and day-care procedures.
  • CGHS 1,816 packages (October 2025 rates) do not extend to outpatient services or standalone investigations — only to inpatient/day-care packages, where included investigations can't be billed separately.
  • An approved package covers all services, medicines, consumables, investigations, implants/devices and follow-up care — hospitals cannot demand extra payment for anything within the package.
  • Hospital categorisation for empanelment/package rates: Non-NABH Hospitals, NABH Hospitals, NABH Super-Specialty Hospitals.
  • Utilisation management: Treatment-progress checkpoints at package-value thresholds of ₹3 lakh, ₹10 lakh, and higher for bigger packages.
  • Medical management cases: Telephonic intimation to EHCT within 24 hours, with pre-authorisation particulars uploaded subsequently.
  • Treatment outside the State: Prior EHCT approval ordinarily needed if treatment isn't available in-state; in an emergency outside the State, intimation within 24–48 hours with emergency/essentiality certificates, discharge summary and invoices.
  • Beneficiary liability: No payment needed for anything in the approved package; OPD consultation/investigation charges at CGHS rates are paid by the beneficiary; a higher room category chosen voluntarily is paid by the beneficiary.
  • Misuse: Any irregularity, false declaration or misuse makes the beneficiary liable for recovery, disciplinary action and penal action under law.

7. Important Points for Government Employees & Pensioners

Topic AreaKey DetailMain Benefit
Who Manages It?Employees Health Care Trust, under the supervision and control of the Board of Trustees (Chairman: Sri Sanjay Jaju, IAS)Fair management under official Government Orders (G.O.Ms.No. 40 & 50)
Start Date17 July 2026Protects and covers medical costs incurred since the scheme launched
Who Gets It?Working employees, service/family pensioners, and eligible dependantsFull medical security for the whole family
Package RatesCGHS October 2025 packages (1,816 packages) adopted for inpatient careStandardised, transparent pricing across all network hospitals

8. Key Changes and How They Work

  • Backdated Benefit: Though released on 22 August 2026, the Guidelines officially apply from 17 July 2026.
  • Proper Oversight: CEO Hanumanth and his team are managing the daily operations and expanding wellness centers to all districts.
  • Regular Audits: Hospitals undergo routine medical and financial audits to ensure quality care without unfair billing.
  • CGHS Package Adoption: Inpatient treatment follows CGHS October 2025 package rates — this does not apply to outpatient services or standalone investigations, which are billed separately at empanelled hospitals.

9. Financial Coverage: How Much Does NEHS Pay?

  • ₹3 lakh per illness episode — no limit on the number of episodes.
  • If treatment costs exceed ₹3 lakh, cashless treatment continues; no network hospital can deny treatment on this ground.
  • The ₹3 lakh limit doesn't apply where the predetermined CGHS package rate itself is higher.

Approval Levels for Claims

Claim AmountWho Approves It
Up to ₹3 lakhTechnical Committee
₹3 lakh – ₹10 lakhSub-Committee (Technical Committee + 3–4 Board of Trustees members)
Above ₹10 lakhEmergency Board/Trust meeting (physical or digital)
Important: Beneficiaries pay out of pocket only if they voluntarily choose a room category above their entitlement, or a service/item not admissible under the approved package.

10. Hospital Room Entitlement

Room entitlement is based on Pay Grade, in three Slabs:

Pay GradeSlabAccommodation Eligibility
I to IVSlab-AEligible for Semi-Private Ward
V to XVIISlab-B
XVIII to XXXIISlab-CEligible for Private Ward

For service/family pensioners, the applicable Slab is based on the Pay Grade of the post the employee retired from. Dependants get the same room entitlement as the principal employee/pensioner. Choosing a higher room category voluntarily means paying the difference in room rent and related charges.

11. Implementation Mechanism

  • NEHS is implemented, administered, managed and operated by EHCT under the supervision and control of the Board of Trustees.
  • The Board exercises all powers under the Trust Deed, Rules and Government Orders; the Chief Executive Officer, EHCT has executive control over implementation, with powers delegated by the Board and Government.
  • For the Head Office, EHCT may engage staff on deputation/contract/outsourcing, utilise Rajiv Aarogyasri Health Care Trust field staff, engage specialist doctors for claims review, and appoint nodal officers for grievance redressal.
  • EHCT constitutes an Expert Committee (to review implementation issues and recommend improvements) and an Executive Committee (for routine operational matters and coordination with Hospital Associations, placing policy matters before the Board).

12. Wellness Centres: Where and How Many?

  • The 12 existing Employees/Journalists Health Scheme Wellness Centres (under G.O.Ms.No.204, dated 06.11.2025) continue functioning.
  • 25 new Wellness Centres are being added, taking the total to 37 across the state.
  • Spread across all 33 districts, with locations finalised based on beneficiary concentration, accessibility, existing Government infrastructure, patient load and administrative feasibility — subject to Board of Trustees approval.
  • New centres will preferably come up in Government General Hospitals, Teaching Hospitals, District Hospitals or Area Hospitals, functionally placed under the Director of Medical Education or Director, NIMS.
  • Medical Officers, specialists, nursing and paramedical staff are deployed by DME/NIMS; administrative/non-medical staff (data entry operators, housekeeping, security) are arranged by EHCT.
  • Laboratory equipment and medicines are procured via TGMSIDC/NIMS rate contracts, GeM, or other approved procurement methods.

13. Hospital Empanelment & Payments

  • Empanelment (within/outside the State) follows standard Aarogyasri Scheme procedures, with modifications approved for NEHS, based on infrastructure, specialists, equipment, accreditation, geographical necessity and patient safety.
  • Hospitals already empanelled under EHS or under DME (for Medical Reimbursement) are deemed empanelled under NEHS until their current validity expires.
  • An empanelled hospital found guilty of irregularity or misuse faces recovery of amount, penalty, suspension, de-empanelment, blacklisting, and criminal/legal action.
  • The list of empanelled hospitals is published on EHCT's official website, mobile app and other channels.
  • Payments: Based on CGHS October 2025 package rates; processed on a first-in-first-out (FIFO) basis, subject to medical/financial scrutiny and fund availability. Package rates may be revised when CGHS rates change.
  • Claims must be supported by beneficiary authentication, case sheet, discharge summary, investigation reports, procedure notes, implant details and invoices.

14. Medical Audit, Financial Audit & IT Infrastructure

  • Medical Audit examines medical necessity, appropriateness of admission/treatment, length of stay, clinical documentation, implant use, readmissions, mortality and package-protocol adherence.
  • Internal Financial Audit examines package-rate compliance, duplicate/irregular claims, contribution receipts, matching Government contribution, and Trust Fund reconciliation.
  • Annual accounts of the Trust Fund are audited by the Comptroller and Auditor General of India (or an authorised agency) and placed before the Board of Trustees.
  • IT infrastructure may use the existing service provider of Rajiv Aarogyasri Health Care Trust (RAHCT); the software/app is integrated with IFMIS, Treasuries and Pension Payment Offices wherever required.

15. Financing and Budget

  • NEHS is financed via monthly beneficiary contributions, an equal matching contribution from the State Government, and additional budgetary support as needed.
  • Every serving employee contributes 1.5% of Basic Pay; every service/family pensioner contributes 1.5% of Basic Pension — deducted at source by DDOs/PPOs/STOs/Treasuries before disbursement.
  • Where both spouses are serving employees/pensioners, contribution from one spouse alone is sufficient (subject to a prescribed declaration).
  • The State Government provides an equal matching contribution every month, transferred directly to the EHCT Trust Fund Account (maintained in a Scheduled Bank).
  • The Trust Fund is used exclusively for settling admissible claims and for the Scheme's operational/administrative expenditure — no diversion to unconnected purposes.
  • A separate administrative budget is provided for Wellness Centre operations and expansion.

16. Grievance Redressal

  • Multi-level grievance mechanism at the State, district, Wellness Centre, and network hospital levels.
  • Complaints about Health Cards, eligibility, denial of treatment, illegal payment demands, room entitlement, medicines, investigations, pre-authorisation, hospital coordination and quality of care must be registered and resolved within prescribed timelines.
  • Cases involving denial of emergency treatment, unauthorised collection of money, or patient safety concerns are handled on priority.

17. Board of Trustees: Powers & Fund Utilization Rules

As per G.O.Ms.No.50 (dated 16.07.2026), the Board of Trustees of EHCT has been entrusted with full authority for:

  • Full Implementation Powers: All powers and responsibilities for effective implementation, administration, management and operation of NEHS.
  • 1.5% Contribution: Confirmed contribution from Basic Pay/Basic Pension of employees and pensioners, matched equally by the State Government every month.
  • Strict Fund Utilization: Funds must be used strictly per the Trust Deed, Rules and Guidelines, solely for member employees, pensioners and eligible dependants — with full transparency and accountability.
  • The EHCT may also constitute Committees to develop SOPs, package manuals, medical protocols and other operational documents, with Board approval.

18. Frequently Asked Questions

Was there a change in Chief Secretary during this period?

Yes. K. Ramakrishna Rao retired as Chief Secretary on 30 June 2026, and Sanjay Jaju, IAS took charge from July 2026 onwards. The EHS Trust reconstitution order (G.O.Ms.No.40) was issued on 17 June 2026 under K. Ramakrishna Rao, while later orders — including G.O.Ms.No.50 confirming the Board of Trustees' powers, and the final Guidelines themselves — were signed under Chief Secretary Sanjay Jaju.

What powers does the Board of Trustees have now?

The Board of Trustees holds full authority to implement, administer, manage and operate the NEHS scheme, and must ensure funds are used strictly as per the Trust Deed and rules, solely for the benefit of employees, pensioners and their eligible dependants.

What happens if my treatment cost goes above ₹3 lakh?

Cashless treatment continues without interruption. No network hospital can deny treatment just because the ₹3 lakh threshold has been crossed; higher-value claims simply move to a different approval level (Sub-Committee or Emergency Board meeting, depending on the amount).

Do I have to pay anything at all under NEHS?

Not for anything included in the approved package. You only pay if you voluntarily choose accommodation above your entitled room category, or opt for a service/item not covered under the package. OPD consultation and investigation charges are payable at CGHS rates.

How many Wellness Centres will Telangana have under NEHS?

37 in total — the 12 existing centres plus 25 new ones, spread across all 33 districts.

Helpful Tip: Always check official government portals to stay updated on your medical benefits and claim statuses.

19. Official Helpdesk & Useful Links

If you need to check your health card status or want official help, click below:

Zishu
About the Author: Zishu is a public policy researcher, who specializes in writing about NEHS (New Employees' Health Scheme) and employee welfare schemes in Telangana.
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