ehs.ap.gov.in Employee Health Scheme : Andhra Pradesh

Organisation : ​Government of Andhra Pradesh
Facility : Employee Health Scheme
Applicable For : Andhra Pradesh
Website : https://www.ehs.ap.gov.in/EHSAP/loginAction.do#

EHS :

Objective :
Employees Health Scheme is formulated to provide cashless treatment to the employees, pensioners of the State Government and their dependent family members,

Related : EHS Andhra Pradesh Search Employee Enrollment Status : www.statusin.in/24315.html

which will ipso facto replace the existing medical reimbursement system under the ‘Andhra Pradesh Integrated medical Attendance Rules, 1972 (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.

Important Stakeholders In The Scheme :
Beneficiaries :
The Scheme is intended to benefit Serving employees and Retired employees of the state.

Dr.NTR Vaidyaseva Trust :
** Dr.NTR Vaidyaseva Trust will implement the Scheme under the supervision of Government of Andhra Pradesh.
** 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.

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.

Population Coverage :
Eligible beneficiaries :
1. Serving Employees :
** All regular State Government Employees. A State Government Employee will have the meaning as defined under Fundamental Rules.
** Provincialized Employees of local bodies.

2. Retired Employees :
** All service pensioners
** Family pensioners without dependents
** Re-employed Service Pensioners

Beneficiaries not covered :
** 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;

** Law officers (Advocate General, State Prosecutors, State Counsels, Government Pleaders and Public Prosecutors);

** Casual and Daily paid workers;
** Biological parents if adopted parents exist;
** All independent children; and
** AIS officers and AIS pensioners.

Family :
The following will constitute the family :
** Dependent Parents (either adoptive or biological, but not both).
** One legally wedded wife in case of a male employee/ service pensioner.

** Husband in case of a female employee/ service pensioner.
** Wholly dependent legitimate children (including step children and adopted children); and
** Dependents of family pensioners shall also be eligible as in the case of Service Pensioners.

Dependency :
** In case of parents, those who are dependent on the employee 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.

Authentication :
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.