EHS – Employee Health Scheme by Government of Andhra Pradesh
- Author :
- TATA AIG Team
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A medical insurance plan is no more a luxury but a necessity. The rising costs of healthcare facilities in India and increasing cases of lifestyle diseases have made health insurance a necessity for everyone. In the case of a medical emergency, it will cover a range of expenses, including hospitalisation charges, treatment expenses, doctor’s fees, diagnostic charges, and ambulance fees.
However, despite the best efforts by state and central Governments, health insurance penetration in India remains low. In 2021, the health insurance penetration in India stood at a meagre 3.2% of the 138 crore population. That is why various state Governments have launched health schemes and medical reimbursement AP facilities to improve the healthcare system in India.
One such scheme is the Employee Health Scheme (EHS) by the Government of AP. This scheme was launched for serving and retired state government employees. Under the EHS AP scheme, the beneficiaries and their immediate family members can avail of cashless treatment facilities at hospitals that have been empanelled across the state. Read ahead to know more about Andhra Pradesh Government’s EHS (Employee Health Scheme), EHS full form, EHS eligibility, EHS coverage, and EHS benefits.
What is Employee Health Scheme?
As mentioned, the main objective of the EHS AP scheme is to provide cashless treatment facilities to employees of the State Government at several network hospitals across Andhra Pradesh. The EHS full form is Employee Health Scheme under Dr YSR Aarogyasri Health Care Trust.
This scheme is supervised by the Government of AP and covers all state Government employees (serving and retired) and their immediate family members (spouse, parents, and children).
The EHS – YSRAHCT scheme replaces the ongoing medical reimbursement AP facility of the State Government for its employees. It provides some additional benefits to eligible beneficiaries, like post-hospitalisation care and medical treatment of chronic illnesses. To avail of the benefits under the EHS EHS – YSRAHCT scheme, a beneficiary has to get an EHS health card.
Features and Benefits of EHS
Intending to give cashless treatment to its pensioners, employees, and their family members, the Andhra Pradesh Government, offers several benefits under the EHS scheme. Below are some salient features and benefits offered under this scheme:
- In-patient treatment
This includes treatment for the therapies that have been listed and identified ailments under the EHS scheme. This benefit is provided as end-to-end cashless services at network hospitals for up to 10 days after discharge from the hospital. Coverage for post-discharge complications for up to a period of 30 days is also provided.
- Follow-up services
Follow-up services are also provided for up to one-year post-discharge in the EHS coverage. These services include doctor’s consultations, routine check-ups, investigations, drugs, diagnostics, and others.
- Out-patient treatments for chronic ailments
Cashless treatments of pre-defined chronic ailments are also provided to eligible beneficiaries under the EHS coverage scheme. Chronic ailments are those ailments that are life-threatening and usually take a long time for treatment. A few examples of chronic ailments include heart attack, cancer, diabetes, kidney failure, etc.
- Hospital’s room rent
The room rent incurred by beneficiaries during their stay at the hospital is also covered by the EHS coverage scheme. However, the category of room to be covered depends upon the pay grade of the employee. There are three categories in total:
- Semi-private ward for Slab A (Pay Grade I to IV)
- Semi-private ward for Slab B (Pay Grade V to XVII)
- Private ward for Slab C (Pay Grade XVIII to XXXII)
- Financial coverage
The beneficiaries are also provided with financial coverage of up to Rs. 2 lakhs for every illness. They can use this money to meet their living expenses while undergoing treatment at a hospital. However, this EHS health card limit of ₹2 lakh is applicable only if the package of the eligible employee does not exceed ₹2 lakhs. Any claim exceeding ₹2 lakhs is settled directly by the Chief Executive Officer of Dr YSR Aarogyasri Health Care Trust.
Eligibility Criteria for EHS – YSRAHCT
Unlike a regular health insurance policy, an EHS health card cannot be accessed by anyone. The benefits under the EHS – YSRAHCT scheme are available exclusively for Andhra Pradesh Government’s employees, pensioners, and their family members. Let’s look at the beneficiaries who are eligible to avail of the benefits stated under the EHS AP scheme:
- Currently serving employees
All regular employees of the State Government who are currently serving their duties are eligible to avail of the benefits under the EHS – YSRAHCT scheme. This also includes those who are on provisional duties of all the local bodies.
- Retired employees or pensioners
All retired employees and service pensions, who have once served the Andhra Pradesh Government (irrespective of their last post), can also avail of benefits under this scheme. This also includes those who have been re-employed by the Government.
- Dependent members of the family
All immediate and dependent family members of state government employees and retirees are also eligible to receive benefits under this scheme. These include legally wedded husbands or wives, dependent children, and parents.
Who All Are Not Covered Under The EHS Scheme?
Although the EHS scheme is designed to cover all state government employees, pensioners, and their dependent family members, it does not cover certain beneficiaries.
- Those who are also covered under the Central Government Health Scheme (CGHS)
- Legal officers, including state counsels, advocate generals, public prosecutors, etc.
- Employees of Railways, Road Transport Corporation, Excise Department, ESIS, Aarogya Bhadrata of Police Department, and Aarogya Sahayatha of Prohibition
- Daily wage workers and casual workers
- AIS Officers and pensioners
- Independent children and biological parents (if adopted parents also exist)
The EHS (Employee Health Scheme) by the Andhra Pradesh Government is a good initiative to provide free-of-cost healthcare services to serving and retired state employees and their dependent family members. To enrol themselves in this scheme, one needs to visit the official EHS website of the Government and enter the necessary details. In addition, one can also check their employee's medical reimbursement status AP by visiting the YSR Aarogyasri website.
To ensure extensive health coverage for yourself and your family members, you can also procure a health insurance policy from Tata AIG. In addition, you can compare health insurance offered by us to ensure that it’s the best for your requirements. With us, you get a network of over 7200 hospitals where you can file cashless claims, and the process is simple and hassle-free.