Government of pre organised Andhra Pradesh State launched “Employees Health Scheme” with effect from 05-12-2013, to provide cashless treatment to the employees, pensioners and their dependent family members in empanelled network hospitals for the listed therapies notified in G.O.Ms.No.176 HM&FW (M2) Dept dated 01-11-2013, duly replacing the reimbursement of expenditure incurred for inpatient care subject to the provisions of APIMA Rules, 1972
Consequent on reorganization of Andhra Pradesh, Government has reviewed the implementation of the Employees Health Scheme. After careful consideration of the matter, Government hereby issue the following orders in modification of the orders issued in the Government Orders first to fourth read above, with reference to the “Employees Health Scheme”
A. The Scheme, which was originally launched with effect from 05-12-2013, shall be implemented with all the following modifications, in a full-fledged manner, with immediate effect. Health cards to all the remaining beneficiaries shall be issued immediately.
B. In the first phase the following categories of beneficiaries will be covered.
a) Serving employees:
(i) All regular State Government Employees, as defined under the Fundamental Rules (FR), including Provincialised work charged employees; and
(ii) Provincialised employees of Local Bodies
b) Retired employees:
(i) All Service Pensioners;
(ii) Family pensioners and;
(iii) Re-employed service pensioners
C. The Employees / Pensioners health cards shall be seeded with Aadhar data, which shall be the basis for Biometric identification under Employees Health Scheme .
D. Steering Committee under the chairmanship of Chief Secretary, as envisaged in the G.O., first read above, shall be constituted immediately by including ten (10) members of the recognized associations of the NGO’s, Pensioner’s Gazetted Officers Association and proportionate member of officers to be nominated by the Government. The General Administration (Services) will issue specific orders defining the composition Steering Committee
E. The Steering Committee shall review the implementation of the scheme periodically and make appropriate recommendations for improving the effectiveness and efficiency of the scheme to the Government.
F. Out of one thousand eight hundred and eighty five (1885) procedures notified in G.O.Ms.No.176 HM&FW (M2) Dept dated 01-11-2013, three hundred and forty seven (347) procedures, which were earlier reserved exclusively for Government network hospitals, shall be permitted for treatment in all Network hospitals i.e., both Government and private hospitals. This, will, however, be reviewed after 6 months of implementation for taking a suitable decision on reservation of these procedures for Government hospitals.
G. The following rates are accepted for the Percutaneous Transluminal Coronary Angioplasty (PTCA) procedure with Stent:
(i) PTCA with bare metal Stent – Rs.55,000/-
(ii) PTCA with drug eluting Stent – Rs.65,000/-
H. The empanelled hospitals which have National Accreditation Board for Hospitals and Healthcare Providers (NABH) accreditation will be paid 25% over and above the package prices fixed for non NABH Hospital, for surgical and medical procedures, which shall include pre-admission OP evaluation.
I. 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. Finance Department will issue instructions to all the Drawing & Disbursing Officers, Pension Payment Officers / Sub-Treasury Officers accordingly.
J. The benefits enumerated above shall be implemented within the estimated annual budget of Rs.220 crores, which is derived from 40% contributions from employees / pensioners and 60% contribution by the Government.
K. The Finance Department will issue separate orders out lining the procedure and for advancing funds to the Aarogyasri Health Care Trust from the monthly contributions based on the utilisation and settlement of claims.
L. The Finance department will issue orders for reimbursement of expenditure incurred by Aarogyasri Trust towards claims payment and administrative expenditure under Employees Health Scheme between 1-11-2013 and 31-10-2014.
M. The expenditure incurred shall be reviewed by the Steering Committee headed by Chief Secretary after six months of implementation, and the Committee shall make recommendation on revision of contributions or any other changes if found necessary.
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