The Andhra Pradesh Government is set to roll out a comprehensive cashless Employees Healthcare Fund (EHF) scheme for all the government employees, pensioners and their dependent family members from November 1st. The scheme will be implemented through a network of empanelled hospitals of Aarogyasri Healthcare Trust and will replace the present medical reimbursement system. The operational guidelines for the scheme were approved through GO 186.
The EHF will be jointly funded through a monthly premium contribution. The employees including the pensioners will pitch in 40 percent by way of premium while the remaining 60 percent funding would be done by the state government. Sources said that the government had proposed the premium amount in three slabs of Rs 100, Rs 120 and Rs 150 keeping in mind the hierarchy but the final GO with regard to premium would be issued shortly. However, the sum insured is Rs 3 lakh per family per annum on floater basis.
Sources said that 7 lakh pensioners and 15 lakh government employees along with their dependent family members will benefit from the scheme. These figures include contract employees and those working with various corporations such as GHMC, APSRTC among others. All diseases, including pre-existing diseases, will be covered from day one. From the date of hospitalisation and up to 10 days from the date of discharge will be treated as part of the package, besides the follow-up treatment.
Further, the GO categorically states that diseases that can normally be treated in government hospitals would be reserved for government hospitals. The trust would be functioning on the same lines as the Aarogyasri scheme, as far as the treatment modalities are concerned. Enrollment and contribution are compulsory under the scheme, officials said. They added that the new scheme will rule out the large-scale malpractices that were taking place due to loopholes in the existing medical reimbursement system.
According to the GO, an office will be established in the AP Markfed building at Jambagh, M J Road to commence the operations. A nodal officer will also be appointed to coordinate and redress the grievances. A steering committee headed by the chief secretary will monitor the scheme.