Frequently Asked Questions:

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Eligibility

1.What is EHS?

Employees Health Scheme is intended to provide cashless treatment to all the State Government employees including the State Government 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 under "The Andhra Pradesh Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)". The scheme will provide treatment in Network Hospitals for all the listed therapies.

2. Who are Eligible?

Employees Health Scheme is intended to provide cashless treatment to all the state Government employees including the State Government pensioners, along with their dependent family members. The categories of beneficiaries covered under EHS will cease to be covered under the APIMA rules upon commencement of EHS. Following are the categories of beneficiaries:

  1. SERVING
    1. All regular State Government Employees.
    2. Provincialised Employees of local bodies
  2. RETIRED
    1. All service pensioners
    2. All Family pensioners without dependents
    3. Re-employed service pensioners

The following will constitute the family.

  1. Parents (either adoptive or biological, but not both).
  2. One legally wedded wife and her dependent parents in case of a male employee/ service pensioner.
  3. Wholly dependent legitimate children (including step children and adopted children).

Dependency will have the following meaning.

  1. In case of parents, those who are dependent on the employee for their livelihood.
  2. In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted.
  3. Wholly dependent legitimate children (including step children and adopted children).

There shall be no duplication of dependent family members at the time of enrolment in case both the spouses are eligible employees/services pensioners. Those who are covered under other Government health insurance schemes such as CGHS etc. are not covered.

3. Are the work charged employees, nominal muster role workers and out sourcing employees eligible?

No. They are not eligible. Only regular employees and provincialised employees of local bodies, all service pensioners, and family pensioners without dependents are alone eligible under the scheme.

4. Are unemployed daughters if not married eligible under the scheme?

Yes. Unemployed daughters who are unmarried or widowed or divorced or deserted are eligible. Once she is married she is not eligible.

5. Are the institutions like Zilla Grandhalaya Samstha, or societies covered under the scheme?

As on 14-08-2012 only the regular government employees are eligible under the scheme. However separate instructions are awaited from Government regarding inclusion of the societies, corporations, universities, aided teachers etc.

6. Are Judges, Govt. Pleaders, Standing counsels eligible?

No, they are not covered. Judiciary is excluded. Tenure posts like government pleaders etc. are also excluded.

7. If the parents of the employee have Aarogyasri Card, are they eligible under the scheme?

Aarogyasri Card (White Card) will be given only to the BPL families. If parents are dependent on the Government servant, their white card will be cancelled and disciplinary action will be initiated against the employee for using a benefit meant for the poor. However in case the parents are living independently and have an Aarogyasri Card they are not eligible to be included under the Scheme by the employee.

8. An employee is working but retires at the time of enrolment. To what category does he belong under the scheme?

The status of the employee at the time of enrolment is the only criteria. If he is retired, he will be a pensioner irrespective of the fact whether his pension is settled or not.

9. In case of a male employee are his in-laws (parents of his wife) also eligible?

No, Parents of the employee are eligible.

10. Are adopted children or adopted parents covered under the scheme?

Yes. Either adopted parents or biological parents are eligible but not both. Similarly adopted children are eligible provided such adoption is legal.

11. If an unemployed son continues to be a dependant on the employee even after attaining the age of 25 years, is he eligible under the scheme?

No. Once he attains the age of 25 years he will become ineligible under the scheme. Though physical card is available with him it automatically ceases to function.

12. If either of the spouse is in Government service and one spouse is having ESI, or private medical insurance is she/he eligible under the scheme?

In case of private medical insurance spouse is allowed to join the scheme but in case of coverage under ESI it is not possible.

13. Under the Aarogya Bhadratha Scheme for the police department certain coverage is provided to the employee only. Whether he and/or his dependants are eligible under the scheme?

No. As on 14-08-2012 the employees covered under Aarogya Bhadratha Scheme are not eligible though their parents are not covered under the said scheme.

14. Is unemployed daughter if not married eligible under the scheme?

Yes. Unemployed daughters who are unmarried or widowed or divorced or deserted are eligible. Once she is married she becomes ineligible.

Enrolment

15. How to access EHS?

You need a health card to access the scheme. In order to obtain the health card, enrol for the scheme by submitting an e-form through www.ehf.gov.in following the instructions there. You will receive a health card thereafter. The card enables the beneficiary to avail the scheme benefits from the list of Empanelled Hospitals, spread across the State.

16. Aadhar number is compulsory for enrolment but a number of employees are not having Aadhar Cards. How can they be enrolled?

The Civil Supplies department and the Dist. Collectors are instructed by GoAP to locate the Aadhar Centers exclusively for the employees for issuing Aadhar Cards. If Aadhar Card enrollment number is available it is sufficient to enroll. Please read the instruction on how to fill Aadhar enrolment number in the application form.

17. If an employee is not enrolled under the scheme, does he have to contribute for the scheme?

The deduction of contribution to the scheme will be done by automativally by DDOs as per his scale of pay irrespective of whether he has applied for enrolment in the scheme or not. It is compulsory to enroll in the scheme, in his own interest, as his contributions will deducted regularly under the scheme.

18. Is a single card like ration card given for the entire family under the scheme?

No. Individual cards will be issued to the employee and his dependents. For this purpose, passport size photographs, which are ICAO compliant, are required to be uploaded. The photo studios can understand the ICAO complied passport size photographs. Such photos are not uncommon but usually given for getting passports. Any other photographs, or group photos are not accepted.

19. If both the spouses are govt. employees who has to pay the contribution?

Both employees or service pensioners shall pay the contribution to EHS. However they can share the number of dependants between them at the time of enrolment.

20. I forgot my password. How can I get my Password?

After clicking on Sign-in button on home page, click on 'forgot password'. The password created by the user will be sent as SMS to the mobile number mentioned.

21. Some details were incorrectly filled and the application was submitted to DDO/STO/APPO. It is pending with to DDO/STO/APPO. How to correct and my application ?

The DDO/ STO/ APPO can correct the details, based on the attachments made to the application form OR the application form has to be rejected by DDO/ STO/ APPO, enabling the applicant to correct the same and resubmit.

22. My mobile number has been incorrectly entered at the time of changing password. What shall I do?

The details of user ID, Name, mobile number entered in the portal and correct mobile number may be sent to ehf@aarogyasri.gov.in for suitable action.

23. My mobile number has been incorrectly fed into the application and the application has been submitted to DDO/STO/APPO. How to correct it?

Please get in touch with DDO/STO/APPO for necessary correction at his level, before approval by DDO / STO/ APPO.

24.When I wanted to 'log in' for submission of application for enrolment, I found that already some other person has opened it and filled the application and submitted it to unknown DDO/STO/APPO. How can I submit my application now?

The details of user ID, Name, date of birth and pensioner ID may be sent to ehf@aarogyasri.gov.in for suitable action.

25. When I wanted to log in with the given user id and password, the alert message reads as 'invalid user id or password'. When I clicked on 'forgot password', the alert message indicates 'your new password has been sent to your mobile no......................'. But the said mobile number does not belong to me. What should I do.

The details of user ID, Name, date of birth, pensioner ID and correct mobile number may be sent to ehf@aarogyasri.gov.in for suitable action.

26. My application has been rejected by the DDO/STO/APPO with certain remarks. What is the process for resubmission?

Please login with your user ID into the portal and save the application rejected by the DDO/ STO/APPO, then enter the correct details as per remarks of DDO/ STO/APPO, save, edit dependents details, if necessary submit application for approval.

27. My date of birth has been incorrectly fed into the application and the application has been submitted to DDO/STO/APPO how to rectify it?

The DDO/ STO/ APPO can correct the details, based on the attachments made to the application form OR the application form has to be rejected by DDO/ STO/ APPO, enabling the applicant to correct the same and resubmit

28. My name entered in the service records is slightly different from that in the aadhar card. Which name should I enter?

Enter the name, as it appears in the service record.

29. I have entered the aadhaar number / aadhaar enrolment number incorrectly and the application was submitted to STO / APPO. How can it be rectified / corrected.

Aadhaar number cannot be edited either by the beneficiary or DDO/STO/APPO. The details may be mailed to ehf@aarogyasri.gov.in

30. Why the User IDs of many employees / pensioners are not available in 104 Sevakendram ?

User IDs generated by DTA alone are available in 104 Sevakendram . If User IDs are not generated by DTA they will not be available with 104 Sevakendram.

31. How can the pensioners of Courts enrol ?

The pensioners who retired from the Courts of Principal District Judges, Chief Judges,   Metropolitan Sessions Judge, and  Special Judges, can enrol themselves for health cards.  They may obtain their user IDs and Passwords by contacting '104 Sevakendram ' or the concerned STO / APPO.  While enroling, they can select 'Registrar (Admin)'  as Head of the Department from the 'drop down list'.  If there is any problem in enrolment, the pensioners are free to send a mail to 'ehf@aarogyasri.gov.in' .

32. Why there are so many cases of invalid user IDs ?

It is observed that the applicants while enrolling their application, at any internet centre, are not collecting their changed password. In such cases, the message "Invalid user ID or Password" will appear.

In all such cases, the applicants should send their current user ID and mobile number to ehf@aarogyasri.gov.in for sending the new password through SMS.

33. Why the employees / pensioners are being asked to send mail on their queries, when they seek solutions / clarifications over phone?

This will enable the Staff deployed to look into the grievances / problems to study the issue carefully and give proper redressal / clarification.

34. What is the cut off date for enrolment?

There is no 'cut off' date for enrolment.

35. Why no time-frame is given for resolution of problems ?

Problems vary from one beneficiary to another. Utmost priority is, however, being given to resolve problems at the earliest possible time. At present, a reply is being given to the applicant, after the issue is resolved. However, instructions are issued to the concerned to acknowledge the receipt of mail and send another mail after resolving the issue.

36. Why SMS messages are not being sent to the beneficiaries ?

SMS messages will be sent after the following activity.
a) When the applicant changes password.
b) When the application is submitted On-line by the beneficiary.
c) When the DDO/STO/APPO approves / rejects the application.
d) When the card is ready for issue.

37. Internet centres are charging heavily for enrolment.

The Government / the Director, ESD (mee-Seva) issued instructions to mee-Seva centres for enrolment of employees / pensioners for health cards at the following rates:
1. Rs.35/- for employee / pensioner.
2. Rs.15/- for each dependent family member
3. Rs.2/- for physical printed application (per application).
The services at mee-Seva centres may be availed at the above rates.

38. STOs / APPOs are not attending to the job of clearing applications.

Government have directed the STOs / APPOs to clear the applications. The grievances have been brought to the notice of DTA for necessary action.

Coverage

39. What is the benefit cover?

Check the website for list of therapies covered. All diseases, including pre-existing diseases will be covered from day one. The period from date of reporting to hospital up to 10 days from the date of discharge from the hospital shall be treated as part of the package.

40. What is the financial cover?

The sum insured under EHS scheme is Rs.2.00 lakhs per family per annum on floater basis. 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 percent, and Government to the extent of 60 percent. Enrolment and Contribution are Compulsory. In cases where both the spouses are eligible employees/service pensioners, then enrolment and contribution by both is compulsory, and there shall be no duplication of dependent family members at the time of enrolment.

41. The financial coverage is Rs. 2.00 lakhs per family. Can it be increased if the treatment cost exceeds the said limit?

Yes. Additional amount as required will be available from a separate corpus to treat the needy cases. Treatment will not be denied merely due to the reason of amount exceeding the financial cover of Rs. 2 lakhs.

42. What is the difference between the present Aarogyasri Card holders and the Employees under the proposed the Employees Health Scheme (EHS) in treatment, facilities, ceiling of amount etc?

The sum insured under Aarogyasri Scheme per family per annum is only Rs.2.00 lakhs covering only 938 procedures where as in case of employees under EHS Scheme it is Rs.2.00 lakhs covers about 1,885 procedures with an additional amount which can be drawn in case of need.

43. Employees Health Scheme is intended to provide cashless treatment. Is OP care available?

No. OP is not available. However in certain chronic cases like diabetes, hypertension etc. are covered.

44. Will the coverage limit be enhanced automatically as under CGHS?

Coverage remains the same at Rs.2 lakhs. However if any beneficiary needs treatment beyond financial cover, treatment will not be denied.

45. How are the 'OP' patients for chronic diseases going to be given medicines regularly? At present the employees of secretariat are getting medicines in the Secretariat Dispensary every month.

OP treatment for chronic diseases like diabetes etc. will be given through a NWHs. The patient needs to take his drugs from a notified hospital.

46. At present under "Aarogyasri" guidelines, 133 procedures which are most commonly done, are under the reserved list, and limited to only Government and Aided Hospitals. Will the same procedure be adopted under the proposed Employees Health Scheme?

No. Aarogyasri Scheme has a different reserved list. The reserved list under EHS will be notified through this website after a decision by Government.

47. The procedures and treatments like hydrocele, Hernia Repair, Cataract Surgery, General fever, Respiratory Infections, Diarrhea etc. are not covered currently under the Rajiv Aarogyasri Scheme. Are the said treatments going to be covered under the E.H.F.?

Under Aarogyasri, only 933 procedures are covered where as under ECHF about 1,885 procedures are proposed to be covered. All of the above IP treatments will be included, and chronic OP treatments covered. For details of coverage see EHS website.

48. At present the Health Insurance Companies are increasing (loading) the premium in the succeeding year, if the amount claimed. In the EHCF, if the claims exceed the premium amount in a particular year, how the difference will be met. Whether, the contribution of the employees is going to be enhanced from the proposed amount? If they incur medical expenses?

The modalities of rate of contributions are not yet finalized. Over burdening the employee is not the intention of the government. Providing best medical care with least financial burden is the motto of the EHCF.

Hospitals

49. What are the empanelled hospitals?

The Employee Health Scheme is implemented through a network of empanelled hospitals. For list of empanelled hospitals check the EHS website.

50. Are the wards same as Aarogyasri wards in private hospitals or are any separate wards allotted for the employees ?

The Aarogyasri wards are exclusive wards for Aarogyasri scheme and not meant for employees and pensioners. The ward entitlement to employees and pensioners will be as per APIMA rules 1972.

51. Will the employees be treated on par with the common public who avail treatment on payment of cash?

Yes. They will be treated on par with the patients making cash payment. Cash will be transferred by AHCT based on pre-agreed prices with the hospitals electronically.

52. Is there a limit on the number of patients in each hospital?

No. There is no limit on the number of patients to be admitted in hospitals.

53. Are the rates under RAS going to be same for EHS too?

The rates under RAS are prepared base on prices for a general ward. The package prices for EHS will be different and will vary with type of ward to which the employee is entitled.

Furnishing Data

54. Can the table 1 provided in the website be edited?

Yes. Table 1 information is taken from the 9th PRC reports. If the number of posts have increased or been abolished by the department, such information must be provided duly editing the table 1.nIt must be ensured that the information given under table 5 should tally with the information in table 1, unless some of the posts in table 1 are located in DDOs belonging to a different Head of the Department.

55. At HOD level, should the posts available at Head Office only be given or the total posts from top to grass root level (districts/DDOs etc.) to be given?

As a Nodal Officer of particular department, you will total information from top to bottom including the posts of regional offices, district offices, mandal offices or village offices DDO wise in table 5 accurately. Data to be given on or before 29th August, 2012 positively.

56. Are the names of the posts with DDO code enough or are names of the incumbents also need to be filled up in table 5?

No. Only the name of the DDO office unit must be given with DDO code allotted by the DTA. Ex: For Director of Town and Country Planning, the DDO is statistical officer by designation whereas the DDO office unit name is Director of Town and Country Planning. The names of the employees working in those posts shall not be entered anywhere.

57. What is the difference between employee ID cards and Health Cards?

Employee ID cards are issued by Government to establish and authenticate a Government employee. The employee health card is issued by the implementing agency of any health scheme in order to access the health care service at an empanelled hospital. Employee ID card is issued only to an employee and is valid only as long as the employee is in service and is not issued after retirement. A health card is issued to each and every dependent family member of the employee and is valid even after retirement.