Aarogyasri Health Care Trust
Health Medical and Family Welfare – to provide Cashless treatment to the All India Service (AIS) Officers borne on the cadre of AP and working in connection with the affairs of the State & their dependents, the AIS pensioners of AP Cadre & their dependents, and the AIS family pensioners & their dependents - Constitution of Committee to review and make appropriate recommendation on the proposal of All India Services Health Scheme (AISHS) - Orders – Issued.
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HEALTH, MEDICAL AND FAMILY WELFARE (M2) DEPARTMENT
G.O.Rt.No. 719 Dated: 27-05-2013
1. Representation from Sri.M.Gopalakrishna, IAS (Retd.) President, AIS
Pensioner’s Association, A.P, Hyd., Lr.No.AISPA/MA/CHCS /01/2013,
Dated: 05-01-2013.
2. Govt. lr.No.582/M2/2013-1, HM&FW (M2) Deptt., Dated: 09-01-2013.
3. From Chief Executive Officer, Aarogyasri Health Care Trust, Hyd.,
Lr.No.115/AHCT/2013-1, Dated;16-01-2013
4.Govt. lr.No.582/M2/2013-2, HM&FW (M2) Deptt., Dated;08-04-2013
5.From the Chief Executive Officer, Aarogyasri Health Care Trust, Hyd.,
Lr.No.115/AHCT/2013, Dt:16-04-2013.
<<0>>
ORDER:
In the reference 1st read above, Sri.M.Gopalakrishna, IAS (Retd.) President, AIS Pensioner’s Association, A.P, Hyderabad has submitted representation requesting for a cashless health scheme’ for the AIS Pensioners and Family Pensioners.
2. In the reference 3rd read above, the Chief Executive Officer, Aarogyasri Health Care Trust, Hyderabad has informed that the AIS Officers working in connection with the affairs of the State of Andhra Pradesh are governed by the AIS (MA) Rules 1954. In the AIS (MA) Rules, there is no provision for reimbursement of medical expenses to the AIS Pensioners and their dependents and the AIS family pensioners.
3. The facility available to the State Government Employees to secure treatment and medical attendance at the Government Hospitals / private hospitals recognized by the State Government has been extended to the AIS Officers and their dependents borne on the cadre of AP with full reimbursement of the cost of in-patient / out-patient treatment vide G.O.Ms.No.137, G.A. (SC.X) Dept dt.05-05-2003 r/w G.O.Ms.No.174,
G.A. (SC.X) Dept 15-07-2004 and G.O.Ms.No.437 dt.31-12-2004.
4. Subsequently, in Circular Memo.No.1963/SC.X/2008-1 GA (SC.X) Dept dated: 04-09-2008, the AIS pensioners who retire while serving in connection with the affairs of the State were given option either to avail CGHS facilities or post retirement medical facilities provided by the State Government. In G.O.Ms.No.493 GA (SC.X) Dept dated 19-10-2009 it was ordered that the medical facilities that are available to serving AIS Officers borne on the cadre of AP and their dependents, for the purpose of treatment and reimbursements, shall be extended to the AIS pensioners of AP cadre, their
dependents and to the AIS family pensioners subject to the maximum ceilings
communicated by the State Government from time to time under APIMA Rules, 1972. Thus, only the AIS pensioners and their dependents and AIS family pensioners, who opt to post-retirement medical benefits provided by the State Government are entitled to treatment and reimbursement under APIMA Rules, 1972.
5. In the reference 5th read above, the Chief Executive Officer, Aarogyasri Health Care Trust, Hyderabad has informed that Trust agrees with the views expressed by the Principal Secretary, G.A. (GPM&AR) Dept and also the suggestion made by him.
Accordingly, the following courses of action are suggested for consideration:
i. A separate ‘All India Services Health Scheme (AISHS)’ ma y be formulated to provide cashless treatment to the All India Service (AIS) Officers borne on the cadre of Andhra Pradesh and working in connection with the affairs of the State endents, the AIS pensioners of Andhra Pradesh Cadre and their
dependents, and the AIS family pensioners and their dependents, which will ipso facto replace the existing medical reimbursement system under AIS (MA) Rules, 1954, with additional benefits.
ii. While formulating the ‘cashless scheme’, the orders issued in the G.O.Ms.No.307, GA (SC.X) Deptt., dated;18-07-2005 ; G.O.Ms.No.447, GA (SC.X) Deptt ., dated;11-07-2008; G.O.Ms. No.493, GA (SC.X) Deptt ., dated;19-1 0-2009; G.O.Ms.No.74,HM&FW (K1) Deptt., dated; 15-03-2005 and G.O.Ms.No.105, HM&FW (K1) Deptt., dated;09-4-2007, in so far as AIS Officers and Pensioners are concerned, may be cancelled .
6 The Chief Executive Officer, Aarogyasri Health Care Trust has also reported that a representation has already been submitted by the AIS Pensioners’ Association, requesting for a ‘cashless health scheme’ for the AIS Pensioners and Family Pensioners. It is, therefore, for consideration whether ‘AIS Health Scheme’ may be formulated to provide cashless treatment to the All India Service (AIS) Officers borne on the cadre of Andhra Pradesh and working in connection with the affairs of the State and their dependents, the AIS pensioners of Andhra Pradesh Cadre and their dependents,
and the AIS family pensioners and their dependents, which will ipso facto replace the existing medical reimbursement system under AIS (MA) Rules, 1954. Simultaneously, the Government Orders on medical re-imbursement in so far as they relate to AIS Officers / Pensioners / Family Pensioners may also be cancelled.
7. Government, after careful examination of the matter, hereby constitute a
Committee with the following members to review and make appropriate
recommendation on the proposal of All India Services Health Scheme (AISHS) to provide Cashless treatment to the All India Service (AIS) Officers borne on the cadre of AP and working in connection with the affairs of the State & their dependents, the AIS pensioners of AP Cadre & their dependents, and the AIS family pensioners & their dependents,
1. Principal Secretary to Govt., H.M. & F.W. Department.
2. Principal Secretary to Govt., G.A. (GPM&AR) Department.
3. Principal Secretary to Govt., Finance (R&E) Department.
4. Vice Chancellor of Dr. NTR University of Health Sciences.
5. Director of Medical Education, A.P., Hyderabad.
6. Chief Executive Officer, Aarogyasri Health Care Trust -- Convener
8. The Committee is therefore requested to submit their recommendations on the proposal to Government.
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G.O.Rt.No. 888 , Dated 19.11.2012
----------------------
Establishment –
HM&FW Department - Employees Healthcare Fund Scheme – Beneficiary enrolment
–Workshop for Nodal Officers - Nomination of Assistant
Secretary to
Government as “Nodal Officer” for the HM&FW Department, A.P. Secretariat -
Orders – Issued.
-------------------
HEALTH,
MEDICAL & FAMILY WELFARE (OP.I) DEPARTMENT G.O.Rt.No. 1513
Dated:11-10-2012.
Read the
following:- 1. G.O.Ms.No.186, M&FW(M2)Dept., dated 14.08.2012. 2. From General
Administration (SW.II) Dept., U.O.Note No.17515/SW.II/A1/2012-4, dt.22.09.2012.
O R D E R:
In the
Government order 1st read above, orders were issued with regard to implementation
of “Employees Health Care Fund Scheme” in Head of the Departments
and A.P. Secretariat for enrolment of all employees under their control as well
as the approval of applications by the Drawing and Disbursing Officers
concerned. It was further requested therein that a Nodal officer be nominated
for Employees Healthcare Fund to provide the information to Aarogyasri Health
Care Trust as and when required.
2. In the
circumstances, the Assistant Secretary (Drawing and Disbursing Officer),
HM&FW Department is hereby nominated as Nodal Officer for the purpose of
Health Cards to coordinate with the Aarogyasri Health Care Trust, Hyderabad and
to attend the meetings and also for furnishing the employees data of
HM&FW Department, A.P. Secretariat to the Aarogyasri Health Care Trust as
and when required.
(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA
PRADESH) K.R. KISHORE PRINCIPAL SECRETARY TO GOVERNMENT
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GOVERNMENT OF
ANDHRA PRADESH ABSTRACT
Estt.-G.A.D.-Employees
Healthcare Fund Scheme – Beneficiary enrolment – Workshop for Nodal Officers -
Nomination of Asst.Secretary to Government
(Claims, I&PR
& DDO) as “Nodal Officer” for the General
Administration Department - Orders – Issued.
--------------------------------------------
GENERAL
ADMINISTRATION (OP.I) DEPARTMENT
G.O.Rt.No. 4201
Dated:11.9.2012. Read the following:-
1.G.O.Ms.No.186,
HM&FW(K1)Dept., dated 14.08.2012.
2.U.O.Note
No.17515/SW.II/A1/2012-2, G.A. (SW.II) Deptt., dt.03.09.2012. O R D E R :
In the
Government order 1st read above, the Health Medical and Family Welfare
Department have issued orders with regard to implementation of “Employees
Health Care Fund Scheme” in HODs and in A.P. Secretariat for enrolment of
all employees under
their control as
well as the approval of applications by the DDOs concerned. It was further
requested therein that a Nodal officer be nominated for EHF to provide the
information to Aarogyasri Health Care Trust as and when required.
2. In the
circumstances, the Assistant Secretary (Claims, I&PR & Drawing and
Disbursing Officer), General Administration Department is hereby nominated as
Nodal Officer to attend the meetings and also for furnishing the employees data
to the Aarogyasri Health Care Trust as
and when
required.
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à°µెà°¬్ à°¸ైà°Ÿ్ à°•ొà°°à°•ు à°•్à°²ిà°•్ à°šెà°¯్à°¯ంà°¡ి.
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Health Medical and
Family Welfare Department – Aarogyasri Health Care Trust – Implementation of
‘Employees Health Care Fund Scheme’, EHF – Operational Guidelines – Orders –
Issued.
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HEALTH, MEDICAL AND
FAMILY WELFARE (M2) DEPARTMENT
G.O.Ms.No. 186 Dated: 14-08-2012.
Read the following:-
1.G.O.Rt.No.1049
HM&FW (M2) Dept., dated: 31-05- 2011.
2.G.O.Ms.No.329
HM&FW (M2) Dept., dated 10-11-2011.
3.From the Chief
Executive Officer, Aarogyasri Health Care Trust Letter No.EHF/254/2012
dated 05-06-2012.
4.G.O.Ms.No.184,
H.M. & F.W. (M2) Department,
dated: 14-08-2012.<<0>>
dated: 14-08-2012.<<0>>
ORDER:
In the G.O. 4th read above orders
have been issued approving the ‘Employees Health Care Fund Scheme
(EHF)’enlisting the salient features of the Scheme. It was also mentioned in
the said G.O. that Government Orders on the Operational guidelines for
concerned officers under the control of Director of Treasuries and Accounts
(DTA), Pay and Accounts Officer (PAO), Secretary to Government Information
Technology and Communications department
(Secretary IT&C), Commissioner Civil Supplies and Ex- Officio Secretary to
Government (Civil Supplies and Consumer Affairs), District Collectors and Heads
of Departments (HoD) for enrolment of beneficiaries, and operation of the Scheme
by the Chief Executive Officer, Aarogyasri Health Care Trust will be issued
separately.
2. Government after careful examination,
keeping in view the convenience of the beneficiaries under the scheme, the
following orders are hereby issued.
A. ENROLMENT OF BENEFICIARIES
i.
Beneficiaries shall mean the
categories of beneficiaries covered under
EHF.
EHF.
ii.
AHCT will be the service provider and
implementing agency; Heads of
Departments and District Collectors will be responsible for enrolment
of State Government employees, State Government pensioners and
their dependents.
Departments and District Collectors will be responsible for enrolment
of State Government employees, State Government pensioners and
their dependents.
iii. All HoDs and District Collectors
will ensure that the Drawing and
Disbursing Officers (DDOs) working under them as well as the District
Treasury Officers / Sub-Treasury Officers concerned shall follow the
process detailed below.
Disbursing Officers (DDOs) working under them as well as the District
Treasury Officers / Sub-Treasury Officers concerned shall follow the
process detailed below.
iv. The information as available at
present with the treasury offices under
HRMS with DTA will be utilised to the extent possible for enrolment.
HRMS with DTA will be utilised to the extent possible for enrolment.
v. The data shall be collected in the HRMS Enrolment System (HRMS-
ES) application maintained by AHCT as a
single point of contact for
the beneficiary. The web address will be
provided separately by
10-09-2012 for enrolment.
10-09-2012 for enrolment.
B. ROLE OF BENEFICIARY
i. Each beneficiary shall first register
with Aadhar if not already registered,
and obtain Aadhar number given at the time of enrolment.
and obtain Aadhar number given at the time of enrolment.
ii.The employees and pensioners shall
submit their application through
e-form in the HRMS-ES portal
application maintained by AHCT which
will be opened by 10-09-2012.
iii. Submission Process:
a.
Login to the web portal which will be opened by 10-09-2012.
b.
The employee code itself is the user ID and the password will be
provided to him by DDO. At the time of
first login the employee
should change his password. It shall be
particularly kept in mind
that the password shall be confidential and
the individual shall not
forget to change the password.
c.
The employee shall select his department, location and office unit,
designation, grade of pay scale,
DDO etc. from the dropdown lists
in the application, submit the
data, and attach the needed
documents.
d. The employee/pensioner must furnish
following while submitting
the e-form.
1) demographic data consistent
with Service Register
2) Digital copies of passport
photos (ICAO compliant) of each
beneficiary
3) Aadhar number or Aadhar
enrolment number
4) Scanned copy of the first two
pages of the Service Register
(pages 1 and 2 of old
service register form (or) pages 4 and 5
of new service register form
where name, date of birth and
signature of office head are
available)
5) Scanned copy of Ration card
if available
Note: Computer illiterate
employees/pensioners will approach
the DDO/STO/APPO concerned directly with the
aforementioned data/documents.
e. (i)The employee shall take a
printout and verify the accuracy of
data. If there are errors, the
same shall be corrected. A signed print
out of the filled up application shall
also be scanned and attached
to the e-form. This shall be the
selfdeclaration of the employee.
(ii) The employee shall be
responsible for furnishing correct details
of dependent family members in the
online enrolment application.
Any false declarations will entail
disciplinary action against the
employee.
f. The e-form is then submitted. After
submitting the application, the
employee will not be able to make
changes to the data.
g. The application is automatically
submitted to the DDO concerned.
h. The employee has to submit the
signed application in physical form
to the DDO duly signing the
declaration.
C. ROLE OF THE CONCERNED DDO OF THE DEPARTMENT
i. The DDO shall
login with his user ID. He will be able to see the filled up
application in the
system.
ii. DDO/STO/APPO
shall submit the applications on behalf of computer
illiterate employees/pensioners.
illiterate employees/pensioners.
iii. The
application data shall be verified with the office records and
approval will be given on the system. In case the data entered by the
employee is incorrect, the DDO will return the application to employee
within the system itself. At the time of acceptance or rejection of an
application by the DDO, the system will automatically generate an SMS
to the individual.
approval will be given on the system. In case the data entered by the
employee is incorrect, the DDO will return the application to employee
within the system itself. At the time of acceptance or rejection of an
application by the DDO, the system will automatically generate an SMS
to the individual.
iv. When the
application is rejected by the DDO, the employee will be
able to edit and resubmit the same along with a fresh signed application.
able to edit and resubmit the same along with a fresh signed application.
v. In case of
illiterate employees, the application form duly filled and
signed shall be directly submitted to the DDO. The DDO shall get the
data entry done in the presence of the employee. The photos shall also
be uploaded.
signed shall be directly submitted to the DDO. The DDO shall get the
data entry done in the presence of the employee. The photos shall also
be uploaded.
vi. After the
health cards are printed and received, the same will be
distributed to employees/pensioners. The card vendor will print and
supply the cards.
distributed to employees/pensioners. The card vendor will print and
supply the cards.
vii. The DDO shall
ensure that applications are properly scrutinised after
comparing with the
originals. Any improper scrutiny leading to ineligible
persons being
enrolled as employees/pensioners will entail disciplinary
action against the concerned DDO/STO/APPO for authenticating the
application.
action against the concerned DDO/STO/APPO for authenticating the
application.
Note: The process
stated above holds good for the pensioners also.
For all the pensioners the Sub-Treasury Officer (STO)/Assistant
Pension Payment Officer (APPO) will act as the DDO. Necessary
validations shall be done by the STO/APPO concerned in the IT
portal.
For all the pensioners the Sub-Treasury Officer (STO)/Assistant
Pension Payment Officer (APPO) will act as the DDO. Necessary
validations shall be done by the STO/APPO concerned in the IT
portal.
D. ROLE OF DIRECTOR OF TREASURIES AND ACCOUNTS (DTA)
The responsibility
of DTA is to provide the existing data relating to
employees, pensioners, and DDOs. DTA shall perform the following
duties.
employees, pensioners, and DDOs. DTA shall perform the following
duties.
i. Forward all the
updated data available in HRMS of DTA to AHCT
every two weeks.
every two weeks.
ii. Provide the
list of all employees and pensioners’ data with their codes
as available with him to AHCT which will use these codes for enrolling
all the employees and pensioners.
as available with him to AHCT which will use these codes for enrolling
all the employees and pensioners.
iii. Provide the
list of all Drawing and Disbursing Officers data along with
their codes and departments to AHCT, which will be used for
authentication of any employee/pensioner by DDO.
their codes and departments to AHCT, which will be used for
authentication of any employee/pensioner by DDO.
iv. Monthly
deductions from individual employees/pensioners shall be
made, after implementation of the Scheme and funds shall be
transferred to AHCT as the Service Provider.
made, after implementation of the Scheme and funds shall be
transferred to AHCT as the Service Provider.
E. ROLE OF COMMISSIONER OF CIVIL SUPPLIES (CCS)/
SECRETARY IT&C
The function of CCS
shall be to register all beneficiaries under Aadhar.
CCS authorised to perform the following.
CCS authorised to perform the following.
i. Aadhar centres
shall be put in place immediately at all district,
division and mandal levels for exclusive enrolment of the employees,
pensioners and their family members.
division and mandal levels for exclusive enrolment of the employees,
pensioners and their family members.
ii. The Aadhar data
consisting of the enrolled members' finger print
templates and image formats, shall be located in AP State Data
Centre, and transferred to AHCT servers in SDC every month.
templates and image formats, shall be located in AP State Data
Centre, and transferred to AHCT servers in SDC every month.
iii. Appoint a
nodal officer to coordinate the aadhar registration at district
level, coordinate with AHCT, and liase with District Collectors.
level, coordinate with AHCT, and liase with District Collectors.
iv. There are
around 45 lakh beneficiaries to be registered in the State.
For this purpose a detailed schedule shall be prepared and
communicated by the Secretary IT&C Dept., and the
Commissioner of Civil Supplies, immediately in order to complete
the registration by 20th October.
For this purpose a detailed schedule shall be prepared and
communicated by the Secretary IT&C Dept., and the
Commissioner of Civil Supplies, immediately in order to complete
the registration by 20th October.
F. ROLE OF CEO-AHCT
The functions of CEO-AHCT are to enroll all
beneficiaries, issue health
cards, and provide cashless service under EHF. CEO-AHCT is
authorized to undertake the following duties/activities.
cards, and provide cashless service under EHF. CEO-AHCT is
authorized to undertake the following duties/activities.
i. Issue of Scheme
guidelines
a.
Issue the detailed scheme guidelines based on these orders
and update the same from time to time.
and update the same from time to time.
ii. Empanelment of
Hospitals:
a. Approve
packages for listed therapies for cashless treatment
of all diseases to the beneficiaries of the ‘Employees Health
Care Fund Scheme’; while doing so, diseases that can
normally be treated in Government Hospitals would be
reserved for Government hospitals. For the treatment of
diseases so selected, the Trust would directly implement the
Scheme on the same lines on which the on-going Aarogyasri
Health Scheme is being implemented.
of all diseases to the beneficiaries of the ‘Employees Health
Care Fund Scheme’; while doing so, diseases that can
normally be treated in Government Hospitals would be
reserved for Government hospitals. For the treatment of
diseases so selected, the Trust would directly implement the
Scheme on the same lines on which the on-going Aarogyasri
Health Scheme is being implemented.
b. CEO-AHCT
will empanel additional hospitals after finalising
the prices for listed therapies.
the prices for listed therapies.
c. Pay
appropriate honorarium or consultation fee to the Team of
doctors and other staff for preparing the
medical and surgical
packages for the new Scheme, from time to time.
packages for the new Scheme, from time to time.
d. Enter into Service Agreements with
the network hospitals.
iii. Operation of
the Scheme
a. Engage
Staff with required skills and experience, finalise the
contractagreements with them, for vigilance,
operations (pre
authorisations and claims) and administration, required for
implementation of the EHS.
authorisations and claims) and administration, required for
implementation of the EHS.
b. Engage
specialist doctors for pre-authorization and claim
processing of cases referred to it under the
new Scheme on
payment on a per-case-basis.
payment on a per-case-basis.
c. Engage
BPO companies for offering support services in order
to ensure a Service Level Agreement (SLA) of 12 hours for a
preauthorisation, 7 days for a claim settlement, and clearly
defined Turn around Times (TAT) for grievance redressal.
to ensure a Service Level Agreement (SLA) of 12 hours for a
preauthorisation, 7 days for a claim settlement, and clearly
defined Turn around Times (TAT) for grievance redressal.
d. Establishment
of office in the Andhra Pradesh MARKFED
building at Jambagh, M.J. Road, Hyderabad on turnkey basis to
commence the operations by the due date.
building at Jambagh, M.J. Road, Hyderabad on turnkey basis to
commence the operations by the due date.
e. Appoint
a nodal officer to coordinate with all stakeholders and
redress the grievances.
f. Provide cashless service to all
beneficiaries holding a health
card.
card.
iv. Deployment of
IT infrastructure
a. A HRMS-ES will
be put in place by AHCT as a single point of
contact for the employee/pensioner for EHF. This application
shall be modular, customizable and be able to be used by
departments of Government at a later date. All the IPR and
source code shall vest with Government without any limitations on
use.
contact for the employee/pensioner for EHF. This application
shall be modular, customizable and be able to be used by
departments of Government at a later date. All the IPR and
source code shall vest with Government without any limitations on
use.
b. Deploy the IT
application required for the Employees Health
Scheme.
Scheme.
c. Deploy the IT
infrastructure needed for the Scheme in State Data
Centre as a private cloud duly integrating with the existing
hardware infrastructure by the due date; and authorised to finalise
the procurement and deployment through the existing vendor for
this purpose in view of urgency and for reasons of compatibility
with the existing technology.
Centre as a private cloud duly integrating with the existing
hardware infrastructure by the due date; and authorised to finalise
the procurement and deployment through the existing vendor for
this purpose in view of urgency and for reasons of compatibility
with the existing technology.
d. Engage vendor
for issue of health cards to all the beneficiaries.
G. ROLE OF DISCTRICT COLLECTORS AND HoDs
i. The District
Collectors shall take necessary action to see that the
Aadhar registration, beneficiary enrolment, and card distribution is
completed. Nodal Officers at district level will be nominated for this
purpose.
Aadhar registration, beneficiary enrolment, and card distribution is
completed. Nodal Officers at district level will be nominated for this
purpose.
ii. The heads at
district level of all departments, District Treasury Officers,
PAOs, and other staff shall be deployed by District Collectors as
needed.
PAOs, and other staff shall be deployed by District Collectors as
needed.
iii. All Heads of
Departments at State level shall supervise the enrolment
of all employees under their control, as well as the approval of
applications by the DDOs concerned.
of all employees under their control, as well as the approval of
applications by the DDOs concerned.
iv. All HoDs shall
nominate a nodal officer for EHF, provide authenticated
list of sanctioned posts under each DDO for all districts to AHCT (lists
of office units, categories of posts, number of posts, service etc.), and
also coordinate with District units, District Collectors and AHCT. Any
declaration of sanctioned posts not carrying sanction by appropriate
authority will entail disciplinary action against the HoD concerned.
list of sanctioned posts under each DDO for all districts to AHCT (lists
of office units, categories of posts, number of posts, service etc.), and
also coordinate with District units, District Collectors and AHCT. Any
declaration of sanctioned posts not carrying sanction by appropriate
authority will entail disciplinary action against the HoD concerned.
v. HoDs shall
supervise the submission of applications by beneficiaries,
approval of applications and issue of cards by DDOs in their head
offices at Hyderabad exclusively.
approval of applications and issue of cards by DDOs in their head
offices at Hyderabad exclusively.
vi. IT Department
will make all necessary arrangements at SDC for this
purpose vii. The due date for completion of enrolment and approval
shall be 20-10-2012.
purpose vii. The due date for completion of enrolment and approval
shall be 20-10-2012.
3. The CEO-AHCT, Secretary IT&C, CCS, DTA, Heads of all Departments, PAO, District Collectors, and all eligible employees and pensioners shall take necessary further action in the matter accordingly.
4. This order issues with the concurrence of Finance (Expr. HM&FW.1) Dept. vide their U.O. No.7581/260/A1/Expr.M&H-1/2012, dated: 14-08-2012.
(BY ORDER AND IN
THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)
MINNIE MATHEW,
CHIEF SECRETARY TO
GOVERNMENT.
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ORDER:
The Government, have decided to provide comprehensive health care to all Government Employees, Pensioners, and their family members, on cashless basis, through an appropriate scheme in lieu of the present medical reimbursement system under ‘The Andhra Pradesh Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)’.
2. After holding a series of meetings with the Joint Action Committee of Employees, Pensioners Associations and A.P. Secretariat Employees’ Co-ordination Committee representatives, and based on the inputs received during these meetings, Government issued orders in the G.O. 1st read above constituting a Technical Committee headed by Commissioner, Health & Family Welfare and Chief Executive Officer, Aarogyasri Health Care Trust (CEO-AHCT) as its Member-Convenor to analyse all aspects of the scheme
and make comprehensive recommendations for its effective implementation. In acceptance of the recommendations of the Technical Committee, orders were issued in the G.O. 2nd read above, constituting a State Level Committee (SLC) headed by Special Chief Secretary to Govt., HM&FW Dept., with eight (8) more official members, including CEO-AHCT as member-Convenor and the representatives of Services Associations, to examine the recommendations of the Technical Committee, and to offer recommendations on all the modalities to be adopted finally for launching of the Scheme.
3. The State Level Committee met on 22-11-2011, 19-01-2012 and on17-02-2012, and based on the decisions taken in the meetings, the CEO-AHCT submitted a ‘draft Scheme’ to Government vide his letter 3rd read above.
4. The salient features of the Scheme based on the earlier decisions were
discussed with the representatives of the various Services Associations on 03-08-2012 in the meeting convened by the Principal Secretary to Government, Health, Medical and Family Welfare Department and a consensus has been arrived at on the salient features of the Employees Health Care Fund Scheme (EHF) and on the ‘Operational guidelines
relating to the issue of Identity Cards to all the beneficiaries under the Scheme’.
5. Government, after careful examination of the matter, have decided to approve the ‘Employees Health Care Fund Scheme (EHF)’ and hereby issue the following orders for implementation of EHF.
i) AHCT will be the implementing agency as a service provider for the Scheme, initially for a period of two (2) years.
ii) The salient features of the Scheme are given in the annexure to this
Government Order.
iii) A Steering Committee headed by the Chief Secretary will monitor the Scheme and review its implementation from time to time. Principal Secretary-Finance, Secretary(Services) GAD, Principal Secretary-Medical and Health,
Commissioner Family Welfare, Director of Medical Education, Director of Health and Family Welfare, Commissioner of APVVP, Director of Treasuries and Accounts, Pay and Accounts Officer, and representatives of employees and pensioners associations as identified by GAD Services Department will be members, and Chief Executive Officer-AHCT the member-convenor for this committee.
iv) Government Order on the Operational guidelines for concerned officers under the control of Director of Treasuries and Accounts (DTA), Pay and Accounts Officer (PAO), Secretary to Government-Information Technology and Communication department (Secretary IT&C), Commissioner Civil Supplies and Ex-Officio Secretary to Government (Civil Supplies and Consumer Affairs), District Collectors and Heads of Departments (HoD) for enrolment of beneficiaries, and operation of the Scheme by the Chief Executive Officer, Aarogyasri Health Care Trust will be issued separately.
v) 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. The CEO-AHCT will separately furnish the detailed estimates based on the fund forecast for this year.
vi) AHCT will ensure maximum coverage of employees and pensioners through the District Collectors and the HoDs concerned, so that EHF can be launched on 1st November 2012 for implementation of the Scheme in the entire State.
6. The Chief Executive Officer Aarogyasri Health Care Trust, Director of Treasuries and Accounts, Pay and Account Officer, District Collectors, Secretary IT&C, Commissioner Civil Supplies, and all Heads of Departments shall take necessary further action in the matter accordingly.
7. This order issues with the concurrence of Finance (Expr. M&H.1) Department vide their U.O. No.7581/260/A1/Expr.M&H-1/2012, dated: 14-08-2012.
(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)
MINNIE MATHEW,
CHIEF SECRETARY TO GOVERNMENT.
-----------------------------------------------------------
ANNEXURE to the G.O.Ms.No.184, HM&FW(M2) Dept. Dated: 14-08-2012
SALIENT FEATURES OF EMPLOYEES HEALTH CARE FUND SCHEME (EHF)
1) Employees Health Care Fund 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)’.
2) 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.
3) The scheme will provide treatment in Network Hospitals for all the listed
therapies.
4) 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, besides follow-up packages.
5) The sum insured is Rs.3.00 lakhs per family per annum on floater basis. Orders in respect of the monthly premium contribution will be issued separately. The ward entitlement will be as per the existing APIMA Rules, 1972.
6) The following will constitute the family.
(i) Parents (either adoptive or biological, but not both);
(ii) One legally wedded wife and her dependent parents in case of a male
employee/ service pensioner;
(iii) Husband and his dependent parents in case of a female employee/ service pensioner; and
(iv) Wholly dependent legitimate children (including step children and adopted
children).
7) Dependency will have the following meaning.
i) In case of parents, those who are dependent on the employee for their
livelihood;
ii) In case of unemployed daughters, those who are unmarried or widowed or
divorced or deserted; and
iii) In case of unemployed sons, those who are below the age of 25 years or
disabled with a disability which renders them unfit for employment.
8) The categories of beneficiaries covered under EHF will cease to be covered under the APIMA rules upon commencement of EHF.
9) The categories of beneficiaries covered under EHF at present is given in table below.
BENEFICIARY CATEGORIES
MINNIE MATHEW,----------------------------------------------------------------
GOVERNMENT OF ANDHRA PRADESH
ABSTRACT
Health Medical and Family Welfare – Aarogyasri Health Care Trust – Implementation of ‘Employees Health Care Fund Scheme (EHF) – Orders – Issued.
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HEALTH, MEDICAL AND FAMILY WELFARE (M2) DEPARTMENT
G.O.Ms.No.184, Dated: 14-08-2012.
Read the following:-
1.G.O.Rt.No.1049 HM&FW (M2) Dept., dated: 31-05-2011.
2.G.O.Ms.No.329 HM&FW (M2) Dept dated 10-11-2011.
3.From the Chief Executive Officer, Aarogyasri Health Care Trust
Letter No.EHF/254/2012, dated 05-06-2012.
<<0>>
ORDER:
The Government, have decided to provide comprehensive health care to all Government Employees, Pensioners, and their family members, on cashless basis, through an appropriate scheme in lieu of the present medical reimbursement system under ‘The Andhra Pradesh Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)’.
2. After holding a series of meetings with the Joint Action Committee of Employees, Pensioners Associations and A.P. Secretariat Employees’ Co-ordination Committee representatives, and based on the inputs received during these meetings, Government issued orders in the G.O. 1st read above constituting a Technical Committee headed by Commissioner, Health & Family Welfare and Chief Executive Officer, Aarogyasri Health Care Trust (CEO-AHCT) as its Member-Convenor to analyse all aspects of the scheme
and make comprehensive recommendations for its effective implementation. In acceptance of the recommendations of the Technical Committee, orders were issued in the G.O. 2nd read above, constituting a State Level Committee (SLC) headed by Special Chief Secretary to Govt., HM&FW Dept., with eight (8) more official members, including CEO-AHCT as member-Convenor and the representatives of Services Associations, to examine the recommendations of the Technical Committee, and to offer recommendations on all the modalities to be adopted finally for launching of the Scheme.
3. The State Level Committee met on 22-11-2011, 19-01-2012 and on17-02-2012, and based on the decisions taken in the meetings, the CEO-AHCT submitted a ‘draft Scheme’ to Government vide his letter 3rd read above.
4. The salient features of the Scheme based on the earlier decisions were
discussed with the representatives of the various Services Associations on 03-08-2012 in the meeting convened by the Principal Secretary to Government, Health, Medical and Family Welfare Department and a consensus has been arrived at on the salient features of the Employees Health Care Fund Scheme (EHF) and on the ‘Operational guidelines
relating to the issue of Identity Cards to all the beneficiaries under the Scheme’.
5. Government, after careful examination of the matter, have decided to approve the ‘Employees Health Care Fund Scheme (EHF)’ and hereby issue the following orders for implementation of EHF.
i) AHCT will be the implementing agency as a service provider for the Scheme, initially for a period of two (2) years.
ii) The salient features of the Scheme are given in the annexure to this
Government Order.
iii) A Steering Committee headed by the Chief Secretary will monitor the Scheme and review its implementation from time to time. Principal Secretary-Finance, Secretary(Services) GAD, Principal Secretary-Medical and Health,
Commissioner Family Welfare, Director of Medical Education, Director of Health and Family Welfare, Commissioner of APVVP, Director of Treasuries and Accounts, Pay and Accounts Officer, and representatives of employees and pensioners associations as identified by GAD Services Department will be members, and Chief Executive Officer-AHCT the member-convenor for this committee.
iv) Government Order on the Operational guidelines for concerned officers under the control of Director of Treasuries and Accounts (DTA), Pay and Accounts Officer (PAO), Secretary to Government-Information Technology and Communication department (Secretary IT&C), Commissioner Civil Supplies and Ex-Officio Secretary to Government (Civil Supplies and Consumer Affairs), District Collectors and Heads of Departments (HoD) for enrolment of beneficiaries, and operation of the Scheme by the Chief Executive Officer, Aarogyasri Health Care Trust will be issued separately.
v) 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. The CEO-AHCT will separately furnish the detailed estimates based on the fund forecast for this year.
vi) AHCT will ensure maximum coverage of employees and pensioners through the District Collectors and the HoDs concerned, so that EHF can be launched on 1st November 2012 for implementation of the Scheme in the entire State.
6. The Chief Executive Officer Aarogyasri Health Care Trust, Director of Treasuries and Accounts, Pay and Account Officer, District Collectors, Secretary IT&C, Commissioner Civil Supplies, and all Heads of Departments shall take necessary further action in the matter accordingly.
7. This order issues with the concurrence of Finance (Expr. M&H.1) Department vide their U.O. No.7581/260/A1/Expr.M&H-1/2012, dated: 14-08-2012.
(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)
MINNIE MATHEW,
CHIEF SECRETARY TO GOVERNMENT.
-----------------------------------------------------------
ANNEXURE to the G.O.Ms.No.184, HM&FW(M2) Dept. Dated: 14-08-2012
SALIENT FEATURES OF EMPLOYEES HEALTH CARE FUND SCHEME (EHF)
1) Employees Health Care Fund 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)’.
2) 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.
3) The scheme will provide treatment in Network Hospitals for all the listed
therapies.
4) 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, besides follow-up packages.
5) The sum insured is Rs.3.00 lakhs per family per annum on floater basis. Orders in respect of the monthly premium contribution will be issued separately. The ward entitlement will be as per the existing APIMA Rules, 1972.
6) The following will constitute the family.
(i) Parents (either adoptive or biological, but not both);
(ii) One legally wedded wife and her dependent parents in case of a male
employee/ service pensioner;
(iii) Husband and his dependent parents in case of a female employee/ service pensioner; and
(iv) Wholly dependent legitimate children (including step children and adopted
children).
7) Dependency will have the following meaning.
i) In case of parents, those who are dependent on the employee for their
livelihood;
ii) In case of unemployed daughters, those who are unmarried or widowed or
divorced or deserted; and
iii) In case of unemployed sons, those who are below the age of 25 years or
disabled with a disability which renders them unfit for employment.
8) The categories of beneficiaries covered under EHF will cease to be covered under the APIMA rules upon commencement of EHF.
9) The categories of beneficiaries covered under EHF at present is given in table below.
BENEFICIARY CATEGORIES
Sl.No.
Name of Category of beneficiaries covered under EHF at present
-------------------------------------------------------------------------------------------------------
I.
SERVING
---------------------
1 All regular State Government
Employees.
-----------------------------------------------------------------------------------------------------
2 Provincialised Employees of local
bodies
------------------------------------------------------------------------------------------------------
II.
RETIRED
--------------------
1 All service pensioners
----------------------------------------------------------------------------------------------------
2 Family pensioners without dependents
----------------------------------------------------------------------------------------------------
3 Re-employed service pensioners
---------------------------------------------------------------------------------------------------
III.
EXCLUDED BENEFICIARIES
----------------------------------------------
1 Those who are covered for the listed
therapies under other Insurance
Schemes such as CGHS, ESIS, Railways,
RTC, Arogyabhadratha of Police
Department
--------------------------------------------------------------------------------------------------------
2 Law Officers (Advocates General,
State Prosecutors, State Counsels,
Government Pleaders and Public
Prosecutors)
--------------------------------------------------------------------------------------------------------
3 Dependents of Family Pensioners
---------------------------------------------------------------------------------------------------------
4 Casual and daily paid workers
--------------------------------------------------------------------------------------------------------
5 Biological parents if adopted
parents exist
------------------------------------------------------------------------------------------------------
6 All independent children
--------------------------------------------------------------------------------------------------------
7 All AIS officers and pensioners who
opt for CGHS
---------------------------------------------------------------------------------------------------------
Note: Orders regarding those
categories not covered here but listed under
APIMA rules will be issued separately.
------------------------------------------------------------------------------------------------------------
CHIEF SECRETARY TO GOVERNMENT
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