Frequently Asked Questions:

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Eligibility

Enrolment

Coverage

  • What are the benefits covered under the Scheme?
    • 1) In patient treatment:
      · For the listed therapies under all specialties in all the empanelled hospitals.
      · 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 are available in the website.
      3) Annual Health Checkup:
      · For employees who crossed 40 years of age.
  • What is the financial coverage?
    • There is no financial coverage under EHS per either one episode of illness or on the number of episodes. 
  • 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 Rao Aarogya 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-patient treatment in general ward only. 133 procedures are earmarked for treatment exclusively in Government Network Hospitals.
      The Employees Health Scheme is meant to provide cashless treatment to 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 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 will see the patients. Pharmacist, Radiology and clinical laboratory services with sample collection will be available. 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