The Employees Health Scheme (EHS) for Andhra Pradesh formally came into effect on 5 December 2013, following a series of government orders that replaced the older medical-reimbursement system for state employees. The EHS is implemented through the state’s health trust, the Dr NTR Vaidya Seva Trust, which administers the scheme, maintains the empanelment of hospitals and issues the EHS health cards used for cashless treatment.
What is an Employee Health Scheme?
An Employee Health Scheme (EHS) is a government-backed healthcare programme that provides cashless medical treatment and health benefits to eligible employees, retirees, and their immediate family members through a network of empanelled hospitals. It aims to reduce financial burden by covering hospitalisation, follow-up care, and chronic illness treatments, replacing traditional reimbursement systems with more accessible care.
Key Benefits of an Employee Health Scheme
Here are some key benefits of EHS AP:
- Cashless treatment: You do not have to make any upfront payment for approved treatments at empanelled hospitals. This greatly reduces financial pressure during medical emergencies.
- Extensive hospital network: The scheme offers access to a wide network of government and private hospitals across the state, making quality healthcare easier to reach.
- Fixed package costs: Treatments are provided under standard package rates, which helps avoid unexpected bills and reduces disputes over hospital charges.
Coverage Offered Under Employee Health Schemes
The EHS AP offers the following coverage to eligible beneficiaries:
- Financial Cover: The scheme offers financial assistance of up to ₹2 lakh for each illness. However, if the treatment package cost goes beyond ₹2 lakh, this limit is not applicable. In such cases, claims exceeding ₹2 lakh are forwarded to the CEO of the Aarogyasri Trust for approval and settlement.
- Hospitalisation: The scheme offers inpatient care for surgeries, serious illnesses and emergencies. You can also get end-to-end cashless health services until 10 days after discharge.
- Chronic Disease Management: You can avail treatment for chronic diseases that do not require hospitalisation. The coverage extends to diabetes, hypertension, kidney disease, and cardiac ailments.
- Post-hospitalisation Care: After you are discharged from the hospital but still need follow-up consultations, diagnostic tests, and prescribed medicines, the scheme takes care of such expenses for up to 30 days after discharge.
- Specialised Treatments: The coverage extends to complex surgeries such as cardiac surgery, neurosurgery, oncology, nephrology, and organ transplants. It also covers dialysis and chemotherapy sessions.
Who is Eligible Under an Employee Health Scheme?
You are eligible for EHS group insurance if you satisfy the following conditions:
Serving State Government Employees
- All regular employees of the Andhra Pradesh State Government. This includes provisionalised employees of local bodies, such as municipalities and panchayats.
- Service pensioners who have retired from the AP government service.
- Pensioners re-employed by the state government are also eligible.
Retired Government Employees & Pensioners
- Service pensioners who have retired from the AP government service.
- Pensioners re-employed by the state government are also eligible.
- Family pensioners with dependents can avail the scheme.
Dependent Family Members
- One legally wedded spouse (husband or wife) of the employee/pensioner.
- Biological, adopted or step children who are dependent:
- Unemployed sons below 25 years.
- Daughters who are unmarried, widowed, divorced or deserted.
- Children with a disability (physically/mentally challenged and unable to support themselves).
- Either biological or adoptive parent who depends on the employee for livelihood (but not both at the same time).
Conclusion
If you are eligible under the AP EHS, ensure your EHS health card is active, and your dependent details are updated. Check the empanelled hospital list before planned treatment and understand package coverage in advance. While EHS is beneficial on its own, combining it with a group health insurance makes the overall coverage far more comprehensive.
FAQs
1. What post-hospitalisation benefits are available under EHS?
The scheme covers follow-up consultations, medicines, and diagnostic tests for up to 30 days after discharge.
2. Does an employee health scheme include dependents?
Yes. The EHS includes eligible dependents such as a legally wedded spouse, dependent children, and a dependent parent, subject to scheme guidelines.
3. How is an employee health scheme different from group health insurance?
EHS is a government-funded, cashless healthcare programme with fixed package rates at empanelled hospitals, while group health insurance is policy-based cover offered by insurers with premiums, sum insured limits and policy terms.
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