- Details
- Benefits
- Eligibility
- Exclusions
- Application Process
- Documents Required
- Frequently Asked Questions
- Sources And References
- Feedback
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Employee Health Scheme
Andhra Pradesh
Details
Benefits
- In-Patient Treatment: The Employee Health Scheme (EHS) aims to provide cashless hospitalization to eligible beneficiaries such as employees, pensioners, and their dependents. The scheme covers listed therapies for identified diseases, providing end-to-end cashless services until 10 days post-discharge, including coverage of complications up to 30 days post-discharge. Additionally, free out-patient evaluation is available for listed therapies.
- Follow-Up Service: The EHS provides follow-up services up to 1-year, including consultation, investigation, drugs, etc., on listed therapies. The scheme offers packages that cover a range of services for eligible beneficiaries.
- Out-Patient Treatment for Chronic Diseases: The scheme covers treatment of pre-defined chronic diseases at notified hospitals. This is aimed at ensuring the well-being of beneficiaries suffering from chronic illnesses.
- Hospital Stay: Depending on their pay grade, eligible beneficiaries are provided with hospital stays in either semi-private or private wards. Slab A (Pay Grades – I to IV) is entitled to a semi-private ward, Slab B (Pay Grades – V to XVII) is entitled to a semi-private ward, and Slab C (Pay Grades – XVIII to XXXII) is entitled to a private ward.
- Financial Coverage: The EHS provides financial coverage of up to Rs. 2 lakhs per episode of illness, If packages exceed the ₹2 Lakhs limit, the above sum does not apply; Claims above ₹2 Lakhs are directed for settlement to the CEO of the Aarogyasri Trust
Eligibility
- All regular State Government employees. A State Government employee will have the meaning as defined under Fundamental Rules.
- Provincialised employees of local bodies.
- All Service Pensioners
- Family pensioners
- Re-employed service pensioners
Exclusions
- Those who are covered under other insurance schemes such as CGHS, ESIS, Railways, RTC, Aarogya Bhadratha of the Police Department and Aarogya Sahayatha of Prohibition & Excise Department;
- Law officers, including 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
- All India Services (AIS) Officers and AIS pensioners.
Application Process
Documents Required
- Aadhaar Card: Scan your Aadhaar Card and ensure the photo and the Aadhaar Number are clearly visible.
- Photograph: A scan of a 45mm x 35mm ICAO compliant passport size colour photograph of 200Kb size.
- Disability Certificates (if any)
- Spouse’s Pensioner ID/Employee ID: A scanned copy of the spouse In case working in the State Government or is a Service Pensioner.
- Date of Birth Certificate: A scan of the DOB Certificate of dependent family members less than 5 years of age.
Frequently Asked Questions
What is the financial coverage offered by the Andhra Pradesh government under EHS?
The financial coverage offered by EHS is up to Rs. 2 lakhs per episode of illness for state government employees, pensioners, and their dependent family members.
How do I check the status of my EHS application?
You can check the status of your EHS application online through the official website. Follow the step-by-step guide provided on the website to check the status.
How do I find my EHS ID?
You can find your EHS ID by contacting the 104-Seva Kendra by dialing 104, or by contacting the respective Sub Treasury Office (STO)/Assistant Program Officer (APO).
How do I check the medical reimbursement status for pensioners in Andhra Pradesh?
Pensioners can check the status of their medical reimbursement by following the same process as state government employees
What is the contribution ratio of the State Government versus the employee towards EHS?
The contribution ratio for EHS is 60:40, with the State Government contributing 60% and the employee contributing 40%.
How much is the monthly contribution for EHS for different pay grades?
The monthly contribution for Slab A (Pay Grade I to IV) and Slab B (Pay Grade V to XVII) is Rs. 90, while the monthly contribution for Slab C (Pay Grade XVIII to XXXII) is Rs. 120
Do I need to apply for EHS coverage after hospitalization?
No, you do not need to apply for EHS coverage after hospitalization. The network hospital takes care of the process within 10 days of discharge.
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Employee Health Scheme
Andhra Pradesh
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