Cash less Medical Treatment By Health Cards to Employees under Employee Health Scheme through GO.174
Cash less Medical Treatment By Health Cards to Employees under Employee Health Scheme through GO.174: Providing Cashless medical treatment to the State Government Employees, Pensioners and their dependent family members of Andhra Pradesh. Notification of the 'Employees Health Scheme (EHS). The Employees Health Scheme is formulated to provide cashless treatment to the employees and pensioners of the State Government and their dependent family members which will ipso facto replace the existing medical reimbursement system under APIMA Rules, 1972, with additional benefits such as post-operative care and treatment of chronic diseases which do not require hospitalization and treatment in empanelled hospitals.
1 G.O.Ms.No.74, HM&FW (K1) Dept dated:15-03-2005.
2. G.O.Ms.No.180 HM&FW (K1) Dept dated 11-05-2006.
3. G.O.Ms.No.105 HM&FW(K1)Dept dated:09-04-2007.
4. G.O.Ms.No.397 HM&FW(K1)Dept, dated: 14-11-2008.
5. G.O.Ms.No.68 HM&FW (K1) Dept dated 28-03-2011.
6. G.O.Rt.No.5832 GA (Cabinet) Dept Dated:04-12-2010.
7. G.O. Rt No. 3401 GA (GPM&AR) Dept Dated:23-07-2012
8. G.O.Ms.No.184 HM&FW(M2) Dept, dated:14-08-2012.
9. G.O.Ms.No.186 HM&FW(M2) Dept, dated: 14-08-2012.
Government after careful
examination and in supersession of the orders issued in
the G.O.Ms.No.184 HM&FW(M2) Dept, dated:14-08-2012 hereby
issue the following orders notifying the 'Employees Health Scheme (EHS) and
its implementation with immediate effect.
The Employees Health Scheme is formulated to provide cashless treatment to
the employees and pensioners of the State Government and their dependent
family members which will ipso facto replace the existing medical
reimbursement system under APIMA Rules, 1972, with additional benefits
such as post-operative care and treatment of chronic diseases which do not
require hospitalization and treatment in empanelled hospitals.
COVERAGE
OF THE EMPLOYEE HEALTH SCHEME:
The coverage under the
scheme is as follows:-
Beneficiaries Covered : In the first Phase the following categories of
beneficiaries will be covered.
a) Serving employees:
1. All regular State Government employees. A State Government employee
will have the meaning as defined under Fundamental Rules.
2. Provincialised employees of local bodies.
b) Retired employees:
1. All Service Pensioners
2. Family pensioners
3. Re-employed service pensioners
The following categories will not be covered under the scheme.
a) Those who are covered under other insurance schemes such as CGHS, ESIS,
Railways, RTC., Aarogya Bhadratha of Police Department and Aarogya
Sahayatha of Prohibition & Excise Department;
b) Law officers (Advocate General, State Prosecutors, State Counsels,
Government Pleaders and Public Prosecutors);
c) Casual and Daily paid workers;
d) Biological parents if adopted parents exist;
e) All independent children; and
f) AIS officers and AIS pensioners.
The following family members are entitled to avail of the Employees Health
Scheme.
a) Dependent Parents (either adoptive or biological; but not both);
b) One legally wedded wife in case of a male employee / service pensioner;
c) Husband in case of a female employee / service pensioner;); and
d) Dependents of family pensioners shall also be eligible as in the case
of service pensioners.
Dependency in the Employee Health Scheme means
a) In case of parents,
those who are dependent on the employee for their livelihood;
b) In case of unemployed daughters, those who are unmarried or widowed or
divorced or deserted; and
c) In case of unemployed sons, those who are below the age of 25 years.
d) Disabled Children with a disability which renders them unfit
for employment.
BENEFITS COVERED IN EMPLOYEE HEALTH SCHEME
In-Patient Treatment:
a) The scheme will
provide inpatient treatment for the listed therapies under all specialties in
the empanelled hospitals.
b) Necessary follow-up
treatments of surgical or medical ailments.
c) EHS patient requiring
IP treatment in an empanelled hospital will receive cashless services.
d) Aarogyamithra
belonging to AHCT in the empanelled hospital will guide and facilitate the
movement of EHS patient from the time of registration till the time of
discharge.
e) The network hospital
will earmark one of their staff as EHS liaison assistant to liaise with EHS
patients.
Outpatient Treatment for
identified chronic diseases:-
OP treatment for
pre-defined long-term (chronic) diseases will be provided in notified
hospitals. Orders on the modalities and provision of budget to the
notified hospitals will be issued
separately.
HOSPITALS
COVERED UNDER EHS
The empanelment and
hospital payments is as follows.
Hospital Empanelment
a. 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
AHCT.
The list of empanelled
hospitals will be made available in the official website www.ehf.gov.in
Hospital Payments
a. Payments under the scheme will be based on approved package prices.
b. The period from the date of reporting to hospital to 10 days after
the date of discharge from the hospital will be treated as part of
the package.
c. The package will include the entire range of investigations,
medicines, implants, consumables, diet, post-operations / post-treatment
complications and follow up care arising from the therapeutic
intervention.
Implementation Mechanism
of Health Cards:
The implementation
Mechanism for the scheme is as follows.
Aarogyasri Health Care
Trust will implement the Scheme under the supervision of Government of
Andhra Pradesh.
A Steering Committee
under the chairmanship of Chief Secretary to Government will review the
implementation of the Scheme from time to time. The Steering Committee
will meet as frequently as required, discuss, monitor and review the
Scheme, benefit packages, grievances, quality of medical care including
the modalities of an Employees Health Trust. The General
Administration (Services & HRM) Department will issue orders forming
the Steering Committee with 40% members from employees and
pensioners associations, and 60% members from Government.
Chief Executive Officer, Aarogyasri Health Care Trust will incur expenditure for implementation of Employees Health Scheme (EHS) from existing funds of Aarogyasri Scheme and recoup as and when EHS budget is received.
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