A Detailed Guide to the Employee Health Scheme (EHS AP)

The Government of Andhra Pradesh has launched the Employee Health Scheme (EHS AP) with Dr YSR Aarogyasri Health Care Trust to provide financial aid to current or retired state employees and their dependent family members. The financial aid is extended to fund the medical expenses of employees (current or retired) and their dependent family members. It offers a completely cashless facility.This guide will help current and retired state employees in Andhra Pradesh and their dependent family members navigate the comprehensive medical support provided under the Employee Health Scheme.

• The Employee Health Scheme of Andhra Pradesh offers cashless health insurance coverage to state government employees.
• Inpatient and outpatient treatments, follow-up charges, hospital stays, etc., are the primary coverage features.
• Current and retired government employees of Andhra Pradesh and their dependents can get coverage under the scheme.
• You can register for EHS AP online and get a health card. This card helps you avail of cashless treatments at empanelled hospitals.

The EHS AP is a health scheme which aims to provide financial assistance to state employees in funding their medical expenses.

Features of EHS AP

Some basic features of the scheme are as follows:

• The scheme has been launched by the government with the primary aim of providing better health care and treatment facilities to the current and ex-employees of the state.
• Dr YSR Aarogyasri Health Care Trust has been assigned by the government to ensure the smooth implementation and functioning of the EHS AP .
• It aims to introduce a completely cashless hospitalisation facilityto replace medical reimbursement in AP .
• The scheme also offers post-hospitalisation care and treatment of serious ailments.
• The main beneficiaries of the scheme are the current/retired employees and their dependent family members.
• The government has tie-ups with many hospitals, known as NWH or empanelled hospitals, to ensure the smooth functioning of EHS.
• You can avail of services at any listed NWHs to reap scheme benefits.
• The scheme has a set of listed therapies for chronic diseases.
• The trust has to claim funds directly from the government after the completion of the treatment procedure.
• Benefits from the scheme can be availed only through EHS Health Card AP , issued by the trust.
• You can download the AP Health Card from the official website of EHS AP .

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EHS is a comprehensive health scheme which takes care of the employees' medical expenses in a very defined manner.A medical treatment process consists of five parts, namely;

• In-Patient Treatment
• Follow-Up Services
• Out-Patient Treatment for Chronic Diseases
• Hospital Stay
• Financial Coverage

The biggest benefit of EHS is its specific directions for all the above-mentioned treatment processes. Here's why it stands out:

In-Patient Treatment

• EHS offers free of cost treatment to all in-patient and outpatient individuals for a pre-defined list of therapies as listed in the scheme.
• You can avail of the cashless service to purchase medicines under EHS up to 10 days after dischargefrom the hospital.
• In case you are suffering from a chronic disease and need treatment even after discharge, you can apply for coverage on the same even 30 days after discharge from the NWH.
• You can apply for cashless follow-up services from the NWH for up to a period of 1 year after discharge.
• The government has formulated a fixed package that includes services such as consultation, investigation, and cashless purchase of medicines for the listed therapies.

Out-Patient treatment

• The scheme also offers free treatment of serious diseases under the listed therapies at the empanelled hospitals.
• Annual check-ups of employees of ages 40 years and more.

Hospital Stay

This defines the type of ward that will be allocated in case of hospitalisation. The wards are allocated depending on pay scales.

• Employees with pay grades I-IV fall in slab A and are eligible for hospitalisation in a semi-private ward.
• Employees with pay grades V-XVII fall in slab B and are eligible for hospitalisation in a semi-private ward.
• Employees with pay grades XVIII-XXXII fall in slab C and are eligible for hospitalisation in a private ward.

Financial Coverage

The scheme provides financial coverage structured as follows:

• A sum of ₹2 lakhs for every single treatment episode at NWH. The number of such treatments is not fixed. You are eligible for this sum multiple times.
• In the case of predetermined packages worth more than ₹2 lakhs, the above-mentioned eligible sum limit is not applicable.
• Any claim amounting above ₹2 lakhs is settled by the CEO of Dr YSR Aarogyasri Health Care Trust.

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The following list of persons is covered under the scheme:

• All regular state government employees
• Provisionalised employees of local bodies

• All service pensioners
• Service pensioners who have been re-employed by the government
• Family pensioners who do not have any dependents

• Dependent parents, either adoptive or biological, but not both
• One legally married spouse for both the serving as well as retired employees
• Children, who are dependent but legitimate, own, adopted or step
• Family pensioner dependents

• Serving State Government Employees, which includes,
• Retired employees or pensioners of the state government, which includes,
• All the dependent family members, which include,

By dependent children, EHS AP means,

• Unemployed sons below the age of 25 years
• Daughters who are either unmarried, unemployed, divorced or deserted
• Physically or mentally challenged children who are unable to fend for themselves

Even though ESH is a scheme directly totally towards the welfare of the state employees and their family members, it has certain limitations. It does not provide coverage to certain beneficiaries, and to avail of the coverage benefits, they must have a valid health card in Andhra Pradesh . The following people are excluded from the beneficiary list:

• Individuals who are already covered under the Central Health Government Scheme (CHGS).
• Staff members of Railways, Road Transport Corporation, ESIS, Aarogya Sahitya of Prohibition, Aarogya Bhadratha of Police Department, and Excise Officers.
• Law enforcing officers like advocate generals, state counsels and prosecutors, government leaders, and public prosecutors.
• Parents either biological or adoptive, but not both.
• Casual and daily wage earners.
• Independent children.
• AIS officers and pensioners.

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The EHS AP Health scheme in Andhra Pradesh has pre-defined guidelines for who can benefit from the scheme and the application process. The main beneficiaries of the EHS AP are state-serving employees, pensioners, and dependent family members. Each beneficiary's enrolment process is different and is explained as follows:

Employees

You can enrol yourself for the EHS AP scheme by following the under-mentioned steps:

• Visit the official webpage of EHS AP .
• A page will appear on the screen asking for your username and password. Enter your employee ID in both fields.
• After this, log in as an “Employee” and click the ‘Login” button.
• A new page asking for your details will open up on the screen. Enter all the required information and click on the ‘Save’ button. The provided information must be correct.
• After giving all the details, you can take a printout of the application by clicking the “Print Application” button.
• Finally, click on the ‘Submit Application’ tab.
• The application will then be sent to the Drawings and Disbursement officer (DDO) for further verification.
• Once the verification process is over, your EHS Health Card in AP will be generated.
• You can download the Health Card in Andhra Pradesh from the registered website.

The EHS Health Card in AP can be used by you to check your Health Card medical reimbursement status.

The EHS Health scheme in Andhra Pradesh has laid out specific instructions to all the DDOs to collect all the state employee details online with the help of various web-based applications. This will ensure the smooth implementation of the EHS AP and the issuance of Health Cards in Andhra Pradesh. Employees can log in to their account to edit their or their dependent’s details, add/remove beneficiaries, or check their AP medical reimbursement status. The steps involved in the login process are as follows:

• Visit the official web page of the EHS AP .
• You need to log in to the page using your employee ID as your username and password.
• After logging in, you can edit the details as per your requirements.

To check your enrolment status, follow the below-mentioned steps:

• Visit the official EHS AP webpage and click on the ‘Employee Enrolment Status.’
• A new page asking for specific details such as ‘Employee Name’, ‘Date of Birth’, ‘Name of the Department’ and the respective Drawing and Disbursement Officer (DDO) will open. Click on the ‘Search’ button after entering all the details.
• Your enrolment status will be flashed as the application is approved if you are an existing scheme member. If not, your enrolment status will flash as ‘Not Enrolled.’
• Click the ‘Enroll’ button and enter your email ID and contact number to get your username and password. Then, click on the ‘Save Details’ tab.

You can check your AP medical reimbursement status by following these simple steps:

• Click on the EHS Service Link and select “Employee Medical Reimbursement Status” under the “Employee” menu.
• A new page will open asking for your mode of application for Medical reimbursement in AP, whether online or offline.
• After stating the mode of application, you need to enter the ‘Trust Number’ and the DME number.
• Click the ‘Search’ button to view details like your employee name, patient name, DME no, and Health Card medical reimbursement status .

Pensioners

Retired State Employees/Pensioners can enrol/register themselves for the EHS AP by following the given steps:

• Login to the registered webpage of the EHS-YSR AHCT using your employee ID as username and password.
• Then, upload scanned copies of the following documents in the specified format:
• Aadhar card: You must ensure that your photograph and Aadhar number on the card are clear and visible.
• Photograph: An ICAO-compliant passport-size colour photograph of size 200 kb with dimensions 45mm x 35mm.
• Disability certificates of dependent family members who are unable to earn for themselves.
• Employee ID or Pensioner ID of the spouse if the spouse is a retired pensioner or is working currently in the state government.
• Birth Certificate of a dependent family member of age 5 years and below.
• Once the documentation process is complete, you need to click on the ‘Submit Application’ button.
• Alternatively, you may also physically visit the STO/APPO or the association representatives and submit your documents to them.

Retired State Employees/Pensioners can follow these steps to log in to their EHS AP account:

• Login to the EHS portal using your username and password. If you do not remember your ID and password, contact your STO/APPO or call 104 (EHS toll-free number).
• Read the instructions carefully and fill out the enrolment form with appropriate details such as the name of your STO/APPO, head of the department, and district.
• Submit the documents and verify all the details before clicking on ‘Submit.’
• After submitting the form, you need to take a printout of the application form and sign the form.
• Scan the signed application form and upload it on the portal.
• Finally, print and submit the signed application form to the respective STO/APPO.
• You will receive an SMS on your mobile number confirming your registration. If your application gets rejected, follow the steps again and enter the correct details in the specified format.

You can check your health card medical reimbursement status by the following steps :

• Click on the EHS Service Link and select “Pensioners Medical Reimbursement Status” under the “Pensioner” menu.
• A new page will open up asking for your mode of application for the medical reimbursement in AP, whether online or offline.
• After stating the mode of application, you need to enter the ‘Trust Number’ and the DME number.
• Click the ‘Search’ button to view details like your employee name, patient name, DME no, and Health Card medical reimbursement status.

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You can get your Health Card Andhra Pradesh through any of these methods:

• You may visit the official webpage of the EHS AP and take a printout of your order EHS Health Card AP by logging in to the page with your username and password.
• You may visit any of the MEE Seva centres and get a laminated temporary health card at a minimal cost of ₹25 per card.

While the EHS AP scheme offers coverage only to the State government employees of the state, you can buy an independent health plan for financial protection. Customise the insurance plan to enjoy coverage for most medical expenses. You can also choose optional riders to enhance the scope of the policy.So, understand the state-sponsored scheme and check your eligibility. If you are eligible, you can enjoy affordable healthcare. If not, you can buy a health insurance plan and access quality medical treatment without the financial burden. Also Read: Health Insurance for Senior Citizens