Team AckoSept 29, 2022
The State Government of Andhra Pradesh has formulated a health scheme for its serving/retired employees and their dependent family members to avail cashless treatment at several empanelled hospitals across the state. The scheme replaces the current medical reimbursement facility and boasts of new features such as treatment of chronic diseases and post-hospitalisation care. Read on to know about the Government of Andhra Pradesh’s Employee Health Scheme eligibility, coverage and benefits.
With the primary objective of providing health care for all and high-quality medical services to State Government Employees, the Dr YSR Aarogyasri Health Care Trust under supervision of the Government of Andhra Pradesh will implement the Employee Health Scheme (EHS). The scheme covers Andhra Pradesh government employees, pensioners and their dependent family members who can avail cashless treatment at empanelled hospitals or Network Hospitals (NWH).
It replaces the current medical reimbursement process and beneficiaries can avail new features such as post-hospitalisation medical care and treatment of chronic diseases. Beneficiaries include serving and retired employees of the state government of Andhra Pradesh.
With an aim to provide cashless hospitalisation to employees, pensioners and their dependents, the EHS offers several features and benefits. Below are the details:
|EHS Coverage||Features and Benefits|
|In-Patient Treatment||Treatment for Listed Therapies for identified diseases*End-to-End Cashless Service Till 10 Days Post-Discharge Medication and Coverage of Complications up to 30 Days Post-Discharge.Free Out-Patient Evaluation For Listed Therapies.|
|Follow-Up Service||Services Up to 1-yearPackages include consultation, investigation, drugs, etc. on listed therapies.|
|Out-Patient Treatment For Chronic Diseases||Treatment of pre-defined chronic diseases at notified hospitals.|
|Hospital Stay||Slab A (Pay Grades – I to IV): Semi-Private WardSlab B (Pay Grades – V to XVII): Semi-Private WardSlab C (Pay Grades – XVIII to XXXII): Private Ward|
|Financial Coverage||Eligible Sum: Rs.2 Lakhs per episode of illness with no limit on the number of episodes.The eligible sum is not applicable where predetermined packages are above Rs.2 Lakhs.Claims exceeding Rs.2 Lakhs will be settled by the CEO of Dr. YSR Aarogyasri Health Care Trust.|
The EHS covers state government employees and their dependents; however, it does not cover certain beneficiaries. Below is the list of beneficiaries not covered under the EHS:
Those covered under the Central Government Health Scheme (CGHS).
Railways, Road Transport Corporation, ESIS, Aarogya Sahayatha of Prohibition, Aarogya Bhadratha of Police Department and Excise Department.
Law officers such as public prosecutors, government pleaders, state counsels, state prosecutors and advocate generals.
Biological parents if adopted parents exist.
Casual and daily wage workers.
AIS officers and pensioners.
Under the EHS, serving and retired state government employees and their dependents are covered. They can avail cashless hospitalisation for identified diseases at empanelled hospitals. In a further classification, the Employee Health Scheme for Andhra Pradesh state government is divided as:
|Serving State Government Employees||All regular State Government Employees.Provisionalised Employees of Local Bodies.|
|Retired State Government Employees/Pensioners||All Service Pensioners.Re-Employed Service Pensioners.Family Pensioners Without Dependents.|
|Dependent Family Members||Dependent Parents (either biological or adopted, not both).One Legally Wedded Spouse (Serving and Retired Employee)Dependent Legitimate Children (Step-Children and Adopted Children).Dependents of Family Pensioners.|
The EHS further classifies the meaning of Dependent Family Members by:
Parents: Dependent on the employee for their livelihood.
Unemployed Daughters: Unmarried/Widowed/Divorced/Deserted.
Unemployed Sons: 25 Years and below.
Disabled Children: Those with a disability who are unable to find employment.
Also, read: Including Parents in Employer’s Insurance
The EHS services are offered to all state government employees of the State of Andhra Pradesh. To know the enrollment process of the Employee Health Scheme, follow the procedures mentioned below:
Below is the registration process for serving state government employees to avail EHS services:
Step 1: Visit the web portal of EHS.
Step 2: Enter your Employee ID in the ‘Username’ section and the password. Log in as ‘Employee’ and click on ‘Login’.
Step 2: You will be directed to a new page, where you need to enter the required details of all the mandatory fields, then click on ‘Save’.
Step 3: Once you have filled all the fields, click on ‘Print Application’ to keep a soft copy of the application as a reference or you could take a print out.
Step 4: Now, click on ‘Submit Application’.
The application will be sent to the employee’s respective Drawing and Disbursing Officer (DDO). Once the DDO verifies the application, the EHS Health Card will be generated. You need to login to the EHS web portal with your username and password to download the card.
The EHS offers out-patient treatment for chronic diseases to serving employees of the state government of Andhra Pradesh. Services are available during weekdays between 2 pm to 4 pm and they include:
Investigations (laboratory services and radiology services).
Yearly health checkup for employees who are aged above 40 years.
List of Chronic OP Procedures:
Type 1 and 2 DM
SLE and other Connective Tissue Disorders
Inflammatory Bowel Disease
Psychosis and Other Chronic Psychiatric Problems
Vascular Occlusive Disorder of Extremities
Chronic Kidney Disease
The State Government has directed all DDOs in Andhra Pradesh to collect the data of all state government employees online through web-based applications in order to implement the scheme and issue Health Cards. Sometimes there may be a situation wherein the employee needs to edit or correct or update information about them or their family members. In such instances, follow the procedure below:
Step 1: Visit EHS Web Portal and log in using Employee ID as User ID, and the same User ID as a first-time password.
Step 2: You will be able to upload photographs and update dependent family members.
Below is the process to know the status of the employee enrollment status online:
Step 1: Visit the EHS portal and under the Employee category, click on ‘Search Employee Enrollment Status’.
Step 2: On the new page, enter ‘Employee Name’, Date of Birth, Name of the Department and the respective DDO and click on ‘Search’.
Step 3: If the employee is already enrolled under the scheme, then the status would reflect as the application is approved.
Step 4: In case the employee is not enrolled under the EHS, then the status will reflect as ‘Not Enrolled’.
Step 5: On the same page, you need to click on ‘Enrol’. You may be asked to enter your email ID and contact number to send the Username and Password. Click on ‘Save Details’.
To know the medical reimbursement status of the EHS, serving state government employees need to follow the steps below:
Step 1: Visit the EHS service link and under the Employee menu, click on ‘Employee Medical Reimbursement Status’.
Step 2: You will be redirected to a new page. Here, you will have to select if the reimbursement was initiated online or offline.
Step 3: Enter the ‘Trust Number’.
Step 4: Enter the DME number and click on ‘Search’ and you will be able to view details such as Employee Name, Patient Name, DME no. along with the status.
Also, read: Arogya Sanjeevani Health Insurance
The State Government of Andhra Pradesh has replaced the existing Medical Reimbursement process with the Employee Health Scheme. Below is the registration process for pensioners or retired employees of the state government:
Retired employees or pensioners can register to the EHS service online by following instructions before you can log in to the EHS web portal.
Aadhaar Card: A scan of your Aadhaar Card and ensure your photo and the Aadhaar Number is clearly visible.
Photograph: A scan of a 45mm x 35mm ICAO compliant passport size colour photograph of 200Kb size.
Spouse’s Pensioner ID/Employee ID: A scanned copy of 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.
With all the required documents, you need to submit the application online. Also, you can approach the STO/APPO along with the documents or can contact the association representatives. Below is the guide to submit and register for the scheme for pensioners:
Step 1: Visit the EHS Web Portal and log in with your Username and Password. If you do not have the details, contact STO/APPO or by dialling EHS Toll-Free Number 104 to know your User ID.
Step 2: Sign in with your Username and Password and read the instructions provided on the website.
Step 3: Open the Enrollment Form and fill all the details including your head of department, STO/APPO and District.
Step 4: Attach all supporting documents.
Step 5: Ensure you verify all data before submitting the application.
Step 6: Click on ‘Submit’ and take a print out of the application form.
Step 7: Sign the print out of the application form and upload the signed document back online.
Step 8: Now, take a print out of the signed application form and submit with your respective STO/APPO.
An acknowledgement through SMS or email will be sent to your registered mobile number and email address, respectively. If it is rejected due to errors, then resubmit your application with correct details.
|Details||Data to Enter|
|PPO Number||Pension Payment Order (PPO) Number|
|Name||As per PPO|
|Aadhaar Card Number||As per Aadhaar|
|Aadhaar Enrollment Number||Aadhaar enrollment ID as it appears in the acknowledgement slip.|
|DOB||DOB as per PPO|
|Sex||Write your Gender (Male/Female)|
|Marital Status||Current Marital Status|
|Date of Retirement||Enter the date on which you retired|
|Community||Select the community such as SC, ST, BC, Minorities, Others|
|Disability Details||Type of Disability and Percentage of Disability|
|Nationality||Write your Nationality|
|Address||Residential Address and ensure you update the current Email ID and Mobile Number|
|Ration Card Number||If you hold a ration card, provide your ration card number.|
|Identification Marks||Two visible identification marks along with its exact location on your body.|
|HOD||Name of the last Head of Department you were working for.|
|District||Name of the last district you were working for.|
|Pay Grade||Enter the pay grade of the post from which pensioner (you) retired.|
|STO/APPO||Enter STO/APPO code and name of the office from where you are receiving the pension.|
|Photo||Soft copy of the passport size photograph (ICAO compliant) of the employee/pensioner and each of the dependent family members. (Size will be 35 mm wide x 45 mm height).|
|Aadhaar Card||Scan a copy of your Aadhaar Card/Enrollment Number with the number and photo clearly visible.|
|DOB Certificate||In the case of a dependent family member is a child who is less than 5-years old.|
|Disability Certificate||In case any of the members is disabled.|
|Family Member Details|
|Name, Relationship, Aadhaar Number|
|Employee ID/Pensioner ID of Spouse|
Once you follow the steps to register for the scheme, you have the option to get temporary health cards for you and your dependent family members. After the scrutiny of your application, temporary cards will be generated. You need to log in with your User ID and Password to take the print of the temporary card. This card can be laminated and used as your EHS Health Card.
Also, you can get a laminated temporary card at any of the Mee Seva Centres. The cost is capped at Rs.25 per temporary card.
To know the medical reimbursement status follow the steps below:
Step 1: Visit the EHS section of the Aarogyasri Health Scheme Web Portal.
Step 2: Under the ‘Pensioner’s menu’, click on ‘Pensioner Medical Reimbursement Status’.
Step 3: On the new page, select to confirm if the reimbursement was done online or offline.
Step 4: Enter the Trust Number and the DME Number and click on ‘Search’ to know the status.
The EHS offers out-patient treatment of chronic diseases to retired employees of the state government of Andhra Pradesh. Services are available only during the weekdays between 2 pm to 4 pm. Services include:
Investigations (radiology services and laboratory services).
Also, read: COVID-19 Health Insurance
The main objective of the scheme is to provide cashless treatment to serving and retired state government employees; hence, there is no need to follow the claim process by the employee/pensioner or their dependent family members. The concerned Network Hospital (NWH) will raise the claim after 10 days of discharge of the patient.
Once the claim is raised by the NWH, all claims related processes will be executed by the Trust Portal.
Once your application is approved and you have received the approval through an SMS or email, you can download the card online. Follow the steps below to know the AP EHS Health Card download process:
Step 1: Visit the EHS Portal and click on ‘Download Health Card’.
Step 2: In the new window, enter your ‘User ID’ and click on ‘Go’ to generate the EHS health card.
The State Government of Andhra Pradesh has empanelled several hospitals across the state to offer cashless treatment to serving and retired state government employees. For more details of the employee health scheme hospital list, click here for NABH hospitals and for NWHs. Follow the steps below:
Step 1: Visit the EHS Section of the Aarogyasri Health Scheme and click on ‘List of Empanelled Hospitals for EHS’ at the bottom of the page.
Step 2: On the new window, select the state, district and speciality. Now click on ‘Search’ to know the list of empanelled hospitals in the district.
Below are the contact details of the EHS scheme for Andhra Pradesh state government employees:
EHS Toll-Free Number: 104
For Health Card Issues and Grievances Under EHS:
Phone Number – 8333817469/14/06 Or: 0863-2259861 (Ext:326).
Email ID – [email protected]
For Medical Reimbursement Status and Issues:
Phone Number – 8333817363 Or: 0863-2259861 (Ext: 329)
Email ID – [email protected]
Contact CEO: 0863-2259861 (Ext: 302)
Dr. YSR Aarogyasri Health Care Trust Address
D.No. 25-16-116/B, Chuttugunta,
Behind Gautam’s Hero Showroom,
Guntur – 522004
Phone Number – 0863-2222802/2259861
Below are some of the common questions asked about the EHS:
The Government of Andhra Pradesh has made the process of checking the status of the EHS application easier online. Follow the above mentioned step-by-step guide to check the EHS applications status.
You can call the 104-Seva Kendra by dialling 104 to know the User ID to login to the EHS web portal or you can contact the respective Sub Treasury Office (STO)/Assistant Program Officer (APO).
If you are a retired state government employee of Andhra Pradesh then you can follow the above-mentioned process to check the status of the reimbursement.
The state government employees, pensioners and their dependent family members are eligible for financial coverage of Rs.2 lakhs per episode of illness. There is a limit to the number of episodes as per the APIMA Rules, 1972.
The state government will contribute 60% while the employee/pensioner will contribute the balance 40%. The monthly contribution will be:
>Slab A (Pay Grade I to IV): Rs.90>Slab B (Pay Grade V to XVII): Rs.90>Slab C (Pay Grade XVIII to XXXII): Rs.120.
|Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.|
|**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.|
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