AP Employees Health Care – Aarogyasri Scheme health cards to AP state employees and pensioners…
Who is Eligible to AP Employees Healthcare Fund Scheme health cards?
Employees Health Care Fund Scheme is intended to provide cashless treatment to all the AP State Government employees including pensioners, along with their dependent family members through a network of empanelled hospitals of Aarogyasri Health Care Trust, in lieu of the present medical reimbursement system. The scheme will provide treatment in Network Hospitals for all the listed therapies.
Eligible Categories AP Employees Healthcare Fund Scheme:
The categories of beneficiaries covered under EHF will cease to be covered under the APIMA rules upon commencement of EHF.
Following are the categories of beneficiaries:
Serving: 1. All regular State Government Employees.
2. Provincialised Employees of local bodies
Retired: 1. All service pensioners
2. All Family pensioners without dependents
3. Re-employed service pensioners
Family: The following will constitute the family. Parents, One legally wedded wife and her dependent parents, Husband and his dependent parents, Wholly dependent legitimate children.
Enrollment of AP Employees Healthcare Fund Scheme:
Family of the insured shall be the unit of enrollment There shall be no duplication of dependent family members at the time of enrollment in case both the spouses are eligible employees/services pensioners.
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 NWH shall verify the details online by accessing the database. Once the authentication is complete, the eligibility verification ends.
Benefits Coverage: Pre-existing diseases, Out-Patient cover and In-patient cover.
For each hospitalization, the transaction shall be cashless for “listed therapies”. A beneficiary shall go to the hospital and come out without making any payment to the hospital after treatment. The same shall hold true for diagnostic services if eventually, the beneficiary does not end up undergoing any listed therapy.
The sum insured under EHF scheme is Rs.3.00 lakhs per family per annum on a floater basis. The coverage limit on the beneficiary family will be on a floater basis. The beneficiary family will have the ability to avail of the total coverage limit either individually by one member or collectively by two or more members of the family.
The EHF will be jointly funded through monthly premium contribution by the State Government employees including the State Government pensioners to the extent of 40 per cent, and Government to the extent of 60 per cent. The beneficiaries will pay a monthly contribution to the Trust which is deducted automatically by the Drawing and Disbursing Officer concerned.
Enrolment and Contribution are Compulsory. In cases where both the spouses are eligible employees/service pensioners, then enrolment and contribution by both are compulsory, and there shall be no duplication of dependent family members at the time of enrolment. More details in http://ehf.gov.in.
AP Employees Health Care Fund Scheme – To enroll Employees Health Care Fund Scheme for health cards: Steps To Enroll For Health Card.