What is Employee Health Scheme? Are you concerned about your health? Ever heard of the phrase ‘health is wealth’? Well, in a very hostile and competitive world, health is the primary resource that one possesses. So, adequate emphasis needs to be laid on health and concerning policies.
Employees Health Scheme is aimed to offer cashless services to almost every government worker, pensioners, and corporate employees including their eligible family members. This is done by the Aarogyasri Healthcare Trust Scheme. The Scheme, initially launched on 5th December 2013, has been introduced in G.O. Ms with the alteration feature. HM & FW (I.1) Dept. No.134, Dt: 29.10.2014.
The beneficiaries may use cashless service in all of the Network Medical facilities for all the treatments specified for the impaneled specialties.
Aarogyasri Healthcare Trust has in place, a unique platform for the scheme, that enables workers and retired people to send their e-applications to register under the program for themselves as well as their dependent family members. The assurance eventually delivers robust healthcare services like health cards.
For the retired people and their families, 1,40 lakh provisional cards have been issued so far, whereas more than 32,000 cards have also been provided for the concerned government employees.
Who is Eligible?
All regular employees of the government as specified in FR, including;
● Provincialized employees charged with work.
● Workers of municipal bodies (Provincialized)
● All retirees of service
● Family pensioners
● Re-employed pensioners of service
Who are Not Eligible for Employee Health Scheme?
● Those who are covered by other insurance plans including CGHS, ESIS,
Railway, RTC., Arogya Bhadratha of Police force and Arogya Sahayatha of
Prohibition & Tax Board;
● Law Officers (Advocate General, State Attorneys, State Attorney, Govt.
Pleaders and Public Attorneys;
● Casual and Regular paying employees;
● Biological parents where there are adopted parents
● All independent children
● Officers of AIS and AIS pensioners, and
●Judiciary
Advantages Covered:
In-patient treatment:
● The scheme will also provide inpatient care at the impaneled facilities for
the treatments specified in all specialties.
● Additional surgical or medical follow-up treatments.
● EHS patients seeking IP care will provide cashless facilities in an impaneled hospital.
● Aarogyamithra in the hospital belonging to AHCT will direct and encourage the passage of EHS patients from the period of admission until the time of release.
● The hospital system must appoint one of its employees as an EHS support
assistant to contact with patients with EHS.
Out-patient:
OP care will be given in informed hospitals for predetermined long-term (chronic) illnesses. Instructions on the methods and budget allocation will be given individually for the notified hospitals.
Hospitals Covered under Employee Health Scheme:
The payments for empanelment and the hospital are as follows.
Empanelments:
● Recommendations for the empanelment of the hospital inside and outside
the State, pre-authorization, and other procedures should be in compliance
with the current standard procedures adopted by AHCT when implementing the system.
● Impanelled hospitals having to resort to fraud or abuse should be banned and recovered in full, in addition to criminal proceedings being launched.
● Any misconduct or abuse committed by the recipients who come to the
Government or AHCT notification may require disciplinary action as per
A.P. S.C. (CCA) Rules of 1991 and can bring criminal proceedings as
provided for in the law.
Payments:
● Payments under the scheme would be dependent on rates accepted for the kit.
● As part of the kit, the time from the date of going to the hospital to 10 days
after the day of hospital discharge will be treated.
● The kit would cover all kinds of inquiries, drugs, devices, drawbacks.
Thus, an employee health scheme is an indispensable need of the hour to address both medical and cost constraints. It is very obvious that the lack of access to such
provision amounts to the deprivation of distributive healthcare