TEACHERS INFO

More

STUDENTS INFO

More

AP: FREQUENTLY ASKED QUESTIONS ON HEALTH CARDS

GOVT. of ANDHRA PRADESH

Frequently Asked Questions:

Eligibility::

>>What is EHS?

Employees Health Scheme is intended to provide cashless treatment to all the State Government employees, pensioners and their dependent family members through a network of empanelled hospitals of Aarogyasri Health Care Trust, in lieu of the present medical reimbursement system under "The Andhra Pradesh Integrated Medical Attendance Rules, 1972. The Scheme, which was originally launched on 5th December,2013, is being implemented with the modification mode in G.O.Ms. No.134 HM & FW (I.1) Dept., Dt: 29.10.2014.The beneficiaries can avail cashless treatment for the empanelled specialties in all the Network Hospitals for all the listed therapies.For more information visit website, www.ehf.gov.in


>>Who is Eligible?

a) All regular State Government Employees, as defined under FR including provincialised work charged employees.

b) Provincialised Employees of local bodies

c) All service pensioners

d) Family pensioners

e) Re-employed service pensioners


>>Who is not eligible?

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, Govt. Pleaders and Public Prosecutors;

c) Casual and Daily paid workers;

d) Biological parents if adopted parents exist;

e) All independent children;

f) AIS officers and AIS pensioners andg) Judicial Officers;


>>Who are the family members?

a) Spouse.

b) Wholly Dependent Children (Including adopted children).

c) Wholly dependent parents (either adoptive or biological, but not both).

d) Dependents of family pensioners are also eligible as in the case of service pensioners.


>>Dependency means?

a) In case of parents, those who are wholly dependent on the employee for their livelihood.

b) In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted. (There is no age restriction).

c) In case of unemployed sons, those who are below the age of TWENTY FIVE years.

d) Disabled Children with a disabilitywhich renders them unfit for employment.


>>Are Judges, Govt. Pleaders, Standing counsels eligible?

No, Law Officer and Judicial Officers are not covered under the Scheme.If the parents of the employee have Aarogyasri Card,

>>are they eligible under the scheme?

Aarogyasri Card (White Card) will only be given to the BPL families. If parents are wholly dependent for their livelihood on the Govt servant, their white card stands cancelled and disciplinary action will be initiated against the employee for using a benefit meant for the poor. The parents, who are living independently and have an Aarogyasri Card are not eligible andshould not be included under the Employees Health Scheme by the employee.


>>What to do if parents of an employeeare added as beneficiaries (white card holder), employee wants to delete them from the application?

If parents of an employee having White Ration Card are added as beneficiaries such an employee shall apply online for deletion of the namein the EHF portal or may approach DDO concerned to delete them from the application.

>>Are the employee's/ Pensioner's in-laws eligible?

No. In-laws of an employee/pensioner (applicant) are not eligible.


>>Are Step Children allowed EHS facilities?

Yes. As per Para 4.1.3 (d) of G.O.Ms. No.174, HM & FW (M2) Dept., Dt:01.11.2013, Step Children are eligible for EHS benefits.


>>Are adopted children or adopted parents covered under the scheme?

Yes. Either adopted parents or biological parents are eligible but notboth. Similarly adopted children are also eligible.

>>If an unemployed son continues to bea dependant on the employee even after attaining the age of 25 years, is he eligible under the scheme?

No. Once the son attains the age of TWENTY FIVE years, he becomes ineligible underthe scheme. In case the dependent (son) of the employee/Pensioner is having disability that renders him ineligible for employment he will be eligible to avail the benefits under Scheme and in that case disability certificate which is mandatory, shallbe produced


>>If one of the spouses is in Government service and the other spouse is having a private or any other medical insurance is she/he eligible under the scheme?

Yes, as a family member he/she can be added as a beneficiary under the scheme. However, if that spouse is covered by CGHS, ESIS, Railway, RTC, Aarogya Bhadratha, Aarogya Sahayatha, he/she cannot avail benefit under EHS.


>>Are the Employees covered under Aarogya Bhadratha / Aarogya Sahayatha Scheme, eligible to enroll under EHS?

No, as an employee he/she is not covered by EHS. However, after retirement Service Pensioners, Family Pensioners will be covered under the Scheme.


>>Are the Scheme benefits available topensioners residing outside the State also?

Orders of Government are yet to be received in the matter.


Enrolment::


>>How to enroll in EHS as an employee?

No separate enrolment process is needed for an employee. Based on the employees data (including Aadhar Data) furnished by the DDOs to the Finance Department under CFMS, which is in term is madeavailable to the Aarogyasri Health Care Trust by the Finance Department to Aarogyasri Health Care Trust will generate cards in thelogin of the employee in EHF portal which can he downloaded, printed and used by the employees and their dependent family members.


>>How to enroll as a pensioner in EHS?

a) Login to the web portal www.ehf.gov.in.

b) Your username = p + STO ID + PPOID. Ex: If your STO ID is 230 and your PPO ID is 012, then your username = p230012. You can obtain your username and password from your STO/APPO or by calling 104-sevakendram by dialing ‘104'.


c) Sign-in with your username and password. Submit the application.You will receive a health card after approval by the Trust. The card enables the beneficiary to avail the scheme benefits from the list of Empanelled Hospitals, for the specialties empanelled under EHS.



>>Is Aadhaar card or Enrollment slip compulsory for enrolment under EHS?

Yes. Even if Aadhaar Card enrollment number is available, it is sufficient to enroll under EHS. Please read the instruction on how tofill Aadhaar enrolment number in the application form.


>>If a pensioner has not enrolled himself/herself under the scheme, does he/she have to contribute for the scheme?

Yes. The deduction of contribution tothe scheme will be done automatically by STO/APPO from the November pension payable on 01.12.2014 and onwards, as per G.O.Ms. No.134, HM & FW (I.1) Dept., Dt:29.10.2014, irrespective of whether he/she has enrolled in the scheme or not.A State Government Employee/Pensioner has enrolled under the Scheme and added his/her spouse, who is also a State Government Employee/Pensioner, asdependent family member. In that case whether contribution will be deducted from the salary/pension of the other spouse, who is added as dependent family member.As per para 6.3 of G.O.Ms. No.174, HM & FW (M2) Dept., Dt:01.11.2013, if both of the spouses are Government employees or Service Pensioners, contribution by any one of the spouses is sufficient. In such a case, the applicant shall give a declaration to the effect that the other spouse if Government Employee/Service pensioner, duly indicating the Employee Code/Pensioner Code of the other spouse.


>>Is a single card like ration card be given for the entire family under the scheme?

No. Individual cards will be issued to the employee, pensioner and their dependent family members.


>>What is the employees/pensioners subscription under the Scheme:

The monthly contribution will be Rs.90/- (for Slab A consisting of employees with Pay Grades from I toIV, and Slab B consisting of employees with Pay Grades from V to XVII)

and Rs.120/- (for Slab C consisting of employees with Pay Grades from XVIII to XXXII).

>>The contribution for service pensioners or family pensioners will be according to the present Pay Grade of the post from which the pensioner retired from service.From where the Health Card will be issued to the Pensioner?

Health Card will be generated by theTrust and placed in the Login of the Pensioner. The Pensioner can login tothe portal by using the "User ID" and "Password", download the Health Card, Print it and use it for availing treatment in the Network Hospitals under Employees Health Scheme.


>>If both the wife and husband are government employees / pensioners, who has to pay the contribution?

Contribution by any one of the employee / service pensioner is sufficient.

>>Is unemployed daughter if not married eligible under the scheme?

Yes. Unemployed daughters who are unmarried or widowed or divorced or deserted are eligible. Once she is married she becomes ineligible.


>>Who is competent to delete name of"son" who has crossed the age of 25 years?

The date of birth of "son" furnishedby the employee/pensioner is available in the System. As such, the system automatically renders the"Son" who crosses TWENTY FIVE years, ineligible under the Scheme and invalidates his Health Card.



>>Can the Employee edit the employee details on his health card?

No the employee cannot edit the details like name of the employee, date of birth, designation, department on his healthcard. As the details of all the employees details received from Finance department (CFMS) data and the same is authenticated by DDO Concerned.


>>I forgot my password. How to reset new Password?

After clicking on Sign-in button on home page, click on 'forgot password'. The system generated password will be sent to the applicant's mobile number and e-mail id.


>>Some details were incorrectly filled in and the application was submitted to the Trust. How to correct them?

In the case of pensioners, the individual cannot correct it, once it issubmitted. The application form has to be rejected by the TRUST/ STO/ APPO, enabling the applicant to correct the same and resubmit for approval or JEO (EHS) of the Trust can also make the corrections, based on the complaint.In the case of employees, the health cards will be issued using the HRMS data furnished to the Finance Dept by the DDOs and a provision has been made available to the employees if there are any corrections in the furnished data. Employee can edit only the details of Aadhaar details, other details cannot be edited.



>>My mobile number has been incorrectly entered at the time of changing password. What shall I do?

In such a case, the individual has to lodge a complaint in the portal, www.ehf.gov.in, by furnishing the details of user ID, Name, correct mobile number for taking suitable action.



>>When I wanted to log in with the given user ID and password, the alert message shows as 'Invalid User ID or Password'. What should I do?

There won't be a invalid user ID and password. Enter the correct 8 digits password which has been received through SMS on registered mobile aswell as through email. Password will be like "nAI0xQk7" (Case sensitive)Pensioner application has been rejected by the TRUST/STO/APPO with certain remarks.



>>What is the process for resubmission?

Comply the remarks and submit the same for verification and approval.


>>Employee/Pensioner name entered in the Aadhar card and service register/PPO copy is slightly differs, which name should I enter?

Enter the name, as recorded in the service register/PPO copy.



>>What is the last date for pensioners for enrolment?

There is no last date for enrolment for pensioners.


>>When will SMS be sent to the beneficiaries?

SMS will be sent to applicant's registered mobile number in respect of the following activity.

a. When the applicant changes password.

b. When the applicant uses "Forgot Password" Option.

c. When the Pensioners application is submitted.

d. When the TRUST/STO/APPO approves / rejects/put on hold the application.



>>Can enrollment be done in mee-Seva centers, if so what are the charges to be paid?

Yes. The Government / the Director, ESD (mee-Seva) issued instructions to mee-Seva centers for enrolment of pensioners for health cards at the following rates:

a. Rs.35/- for pensioner.

b. Rs.15/- for each dependent family memberc. Rs.2/- for printed application (perapplication).The services at mee-Seva centers may be availed at the above rates.STOs / APPOs are not attending to the job of clearing applications.




>>What is the status of health card when it shows as "Pending with DDO/STO"?

Government has directed the STOs /APPOs to clear the applications. The grievances have to be brought to thenotice of DTA for necessary action. There is no problem with the status showing "pending with DDO/STO". Without Approval of DDO/STO pensioner/Employee can download the health card and avail the treatment. Pending status can be cleared by the respective DDO/STO after clear instructions.



>>How to check the Health Card status?

Employee/Pensioner can check the status of health card on home page by using the health card status tab at the left bottom. Website: www.ehf.gov.in



>>In case of a widowed/divorced daughter and family pensioner whileenrolling under EHS, is it necessary to attach death certificate / court order?

No need to attach death certificate / court order.



>>Why no time-frame is given for resolution of problems?

Problems vary from one beneficiary to another. Utmost priority is, however, being given to resolve problems at the earliest possible time. At present, a reply is being given to the applicant, after the issue is resolved. However, instructions are issued to the concerned to acknowledge the receipt of mail and send another mail after resolving the issue.



Coverage::


>>What are the benefits covered underthe Scheme?

1) In patient treatment:· For the listed therapies under all specialties in all the empanelled hospitals.List can be seen on the website www.ehf.gov.in.· Follow-up treatment of Surgical or medical ailments.· Packages will include entire range of investigation, medicines, implants,consumable, diet, post operations/post treatment complications and follow-up care.· Packages will also include pre-evaluation by patients including consultation and investigations even in the cases which do not finally end up with admission for IP treatment.


2) Out Patient treatment for Chronic Diseases:· OP treatment for Chronic diseases will be provided in notified Government Hospitals and include consultation, investigations and drugs detailed Guidelines will be made available on the website.


3) Annual Health Checkup:· For employees who crossed 40 yearsof age.What is the financial coverage?The financial coverage under EHS is Rs.2.00 lakhs per episode of illness with no limit on the number of episodes, where the cost of treatment exceeds the above limit, cashless treatment will continue without denial of treatment by the network hospital.  This limit will not apply in cases where pre-determinedpackage rates are above Rs.2.00 lakhs Will I be reimbursed,

>>if treatment is taken out of the State of Andhra Pradesh?

Reimbursement is not allowed w.e.f.01.12.2014, even if, treatment is taken outside A.P. and Telangana States.;



>>What is the difference between Aarogyasri Scheme and Employees Health Scheme and in facilities, ceiling of amount etc?

The Aarogyasri Scheme introduced by the erstwhile Government of Andhra Pradesh has been renamed as "Dr. Nandamuri Taraka Rama RaoAarogya Seva". This Scheme is meant for BPL families and its coverage is Rs.2.50 lakhs per annum for the entire family on floater basis, covering 1038 procedures and the patient is entitled for in-patienttreatment in general ward only. 133 procedures are earmarked for treatment exclusively in GovtNetwork Hospitals.The Employees Health Scheme is meant to provide cashless treatmentto all regular State Govt. employees, pensioners and their dependent family members in all empanelled Network Hospitals (both Govt. & Private) and the financial coverage is Rs.2.00 lakhs per episode of illness with no limit on the number of episodes. Even, if the cost of treatment exceeds Rs.2.00 Lakhs, cashless treatment will continue without denial of treatment by the Network Hospital. The Procedures / Therapies covered are 1885 for the present and treatment will be provided in semi private and private wards as per eligibility. The Scheme also covers treatment for Chronic OP Diseases and annual health checkup for employees who crossed 40 (Forty) yrs of age in notified Government Hospitals.



>>Is Out-Patient treatment covered in Employees Health Scheme?

Outpatient treatment is available only for Chronic diseases in notified Government Hospitals between 2 PM - 4 PM on week days, in special clinics where a consultant Doctor willsee the patients. Pharmacist, Radiology and clinical laboratory services with sample collection will beavailable.



>>Medicines will be supplied to the patient at the Special Clinics as per the prescription given by the Consultant Doctor.Will I be reimbursed, if I were to pay the Hospital?

As per Para 2 (I) of G.O.Ms. No.134, HM & FW (I.1) Dept., Dt:29.10.2014, the deductions from the salary / pension of the employees / pensioners towards contribution under the Scheme, shall be effected from the salary/ pension pertaining to November, 2014 payable on 01-12-2014. Medical reimbursement under APIMA Rules, 1972 will not be allowed for the treatment undergone on and after 01-12-2014.



Hospitals


>>What are the empanelled hospitals?

The hospitals which are registered with Aarogyasri Trust, as service providers for providing cashless treatment to the beneficiaries under the scheme are called Empanelled hospitals. The list of empanelled hospitals is available in EHS website.


>>Are the wards same as Aarogyasri wards in private hospitals or are there any separate wards allotted for the employees/Pensioners?

No. Under EHS semi private and private wards are given as per eligibility.


>>Will the employees be treated on par with the common public who avail treatment on payment of cash?

Yes. They will be treated on par with the patients making cash payment



>>Is there a limit on the number of patients in each hospital?

No. There is no limit on the number of patients to be admitted in hospitals and it is subject to availability of beds in the hospital.



>>What precautions should be taken before approaching the hospital, to avail cashless treatment in EHS?

Ensure that the hospital and the required medical speciality is empanelled with the trust under the scheme to get the cashless treatment. For specific information may contact 104-Seva Kendram or visit website. After approaching the hospital the patient shall register with AAROGYA MITHRA available at the KIOSK of the hospital by providing the Health card



>>What are the Hospitals empanelled under the EHS?

The list of empanelled Network Hospitals is available in the EHF portal (www.ehf.gov.in)

* See the "Hospitals" tab

* Click on "List of Empanelled Hospitals for EHS "

* In the landing page, Select State, District and also Speciality.

* Click on "Search"You will find the list of District wise Network Hospitals.



>>Which are the Hospitals where I can be treated?

Treatment can be availed in the Government & Private Hospitals empanelled with AHCT under the Scheme. The List of Hospitals is available in the website (www.ehf.gov.in)




>>Whom should I approach for availing treatment at an empanelled Hospital?

In each empanelled hospital there will be a "Kiosk" pertaining to Aarogyasri Health Care Trust, wherean "Aarogyamithra" will be availableto take care of the EHS patient, whoapproaches the Hospital for availing treatment under the Scheme. He willregister the patient on production ofHealth Card and will take all the steps needed for the treatment of the patient.



>>What Should I do if the empanelled Hospital refuses to entertain or give a step motherly treatment?

Complaint

can be lodged in the portal as indicated below:

* Login on EHS portal (www.ehf.gov.in).

* Click on "Sign-in"

* Select "Employee/Pensioner"

* In the Landing Page, click on "Any issue/Complaint"

* Fill in the details of complaint and click "submit"(OR)

* Call 104-Seva Kendram and lodge complaint which will be forwarded to the Grievance Department of Aarogyasri Health Care Trust for redressal.