Employee Health Scheme by Government of Andhra Pradesh

The Employee Health Scheme in Andhra Pradesh actually came into effect on 5th December, 2013. This was a result of a series of orders from the government which replaced the older medical reimbursement system for state employees.

The EHS is implemented through the health trust of the state of Andhra Pradesh, which is the Dr NTR Vaidya Seva Trust. It administers the scheme and issues EHS cards used for cashless treatment. Read on to know more.

What is EHS Andhra Pradesh?

The Employee Health Scheme in Andhra Pradesh is also referred to as EHS in the state of Andhra Pradesh. It is a flagship initiative which has been designed to offer cashless medical treatment facilities to the serving State Government employees, retired Government employees and all of their dependent family members.

With the EHS, patients do not need to worry anymore about the stress of hospital bills, insurance paperwork or reimbursements. Rather, the entire process is managed electronically through the government-run portal and empanelled hospitals.

Key Features and Benefits of EHS Andhra Pradesh

Wondering what are some of the key features and benefits of EHS Andhra Pradesh? Well, here are a few of them:

Cashless Inpatient Treatment

The EHS Andhra Pradesh provides cashless inpatient treatment at empanelled hospitals. The beneficiaries get hospital care without having to make any upfront payments. This scheme also covers medicines for up to 10 days after discharge and treats the eligible complications which arise within a period of 30 days.

Chronic Disease Coverage

The EHS Andhra Pradesh covers outpatient treatment for chronic conditions such as diabetes, hypertension, COPD, hypothyroidism and rheumatoid arthritis. The beneficiaries get doctor consultations, diagnostic tests, and prescribed medicines at designated hospitals during scheduled hours.

This kind of long-term support helps patients to manage their chronic illnesses effectively while still reducing recurring healthcare expenses and improving continuity of treatment.

Follow-Up Care

EHS Andhra Pradesh covers follow-up care for selected treatments for up to one year. The beneficiaries can access follow-up consultations, diagnostic tests and prescribed medicines as a part of their approved package.

This kind of extended care supports recovery, monitors progress, and prevents any complications.

Annual Health Check-Ups

The EHS Andhra Pradesh offers annual preventive health check-ups for employees aged 40 years and above. These screenings help to detect medical conditions early on and encourage timely treatment before any complications develop.

Regular health assessments also promote preventive healthcare, improve overall well-being and reduce the risk of any serious illnesses through early diagnosis and intervention.

Financial Coverage

EHS Andhra Pradesh provides financial coverage of up to ₹2 lakhs for each illness episode under an approved treatment package. The beneficiaries can claim multiple episodes when eligible.

The Dr YSR Aarogyasri Health Care Trust reviews these claims which exceed the prescribed limit for approved high-cost procedures. This ensures additional support in deserving medical cases.

Hospital Stay by Pay Grade

The EHS Andhra Pradesh allocates hospital accommodation according to an employee's pay grade.

1. Slab A and B: These employees get semi-private ward facilities
2. Slab C: These employees get private ward accommodation.

This kind of structured approach ensures that beneficiaries get hospital facilities which match their eligibility while still maintaining organised and equitable healthcare services.

Also Read: Why MHCP EDGE PLUS Can Help You Manage Rising Medical Costs?

What is Not Covered Under the EHS of the Government of Andhra Pradesh?

Now that we have covered the features and benefits of the employee health scheme govt of Andhra Pradesh, let us move on, as it is equally important to understand the exclusions. This is because not every employee or service falls under the EHS coverage.

1. Individuals already covered under CGHS or ESIS are not eligible for the EHS benefits.
2. Employees of Indian Railways, RTC and certain departmental welfare schemes are also excluded.
3. AIS officers and their pensioners are not covered under the scheme.
4. Daily wage and casual workers are also not covered under the scheme.
5. Independent children and certain law officers such as government pleaders and public prosecutors are also excluded from EHS coverage.

What is the Eligibility Criteria for EHS Andhra Pradesh?

The Employee Health Scheme of Andhra Pradesh is only available to eligible serving and retired state government employees, along with their dependent family members. Here are the particulars which you need to know about the scheme:

How to Enrol in EHS Andhra Pradesh? –Step-by-Step Guide

There are two different methods for Andhra Pradesh employees health card and pensioners to enrol for EHS in Andhra Pradesh:

For Employees

1. First, you need to visit the official portal of EHS, which is https://ehf.ap.gov.in. Then log in using your employee ID and password.
2. Then enter all of the mandatory data, upload your documents and click on the save button.
3. After verification, submit your application to your DDO or Drawing and Disbursing Officer.
4. After approval, download the EHS health card and laminate it for use.

For Pensioners

1. Gather all of your required documents such as Aadhaar, photograph, disability certificate, DOB certificate, pension ID, etc.
2. If you do not know your user ID, you can call 104 or even contact the Sub Treasury Officer (STO).
3. Now fill in your pensioner details, attach required documents and submit them online.
4. Finally, upload the signed application to the official portal and submit it at the nearest STO office.

Note: You can get a temporary EHS card printed at any of the nearest Mee Seva Centre for ₹25.

Also Read: Deductible In Health Insurance Policy: A Complete Guide

Chronic Out-Patient Treatment Coverage

One of the core strengths of EHS Andhra Pradesh is its chronic outpatient treatment for over 25 long-term conditions. Some of them include:

1. Type 1 & 2 Diabetes
2. Hypertension
3. Hypothyroidism/Hyperthyroidism
4. Rheumatoid Arthritis
5. Bronchial Asthma
6. Stroke
7. Cardiac Failure
8. Chronic Kidney Disease
9. COPD
10. Depression and Psychosis
11. Parkinson’s Disease (added as per official list)
12. SLE and other Connective Tissue Disorders
13. Gout
14. Coronary Artery Disease (CAD) - Medical Management
15. Convulsive Disorder
16. Inflammatory Bowel Disease
17. Vascular Occlusive Disorder of Extremities
18. Psoriasis
19. Chronic Hepatitis
20. Cirrhosis
21. Nephrotic Syndrome
22. Arrhythmias

Services available include consultations, lab investigations, radiology, and medicines. Outpatient services are available between 2 PM and 4 PM on weekdays at designated hospitals.

Tracking Enrollment & Medical Reimbursement Status

The beneficiaries can check application status or even their reimbursement status online with only a few steps. There are two separate procedures for checking enrollment status and medical reimbursement status. Here is an overview of both of them:

To Check Enrollment Status:

1. First, visit the official EHS portal.
2. Then select the option of 'Search Employee' or 'Employee Enrollment Status'.
3. Next, enter details such as name, DOB, DDO and department name.
4. The application status will show as 'approved' or ' not enrolled'.

To Check Medical Reimbursement Status:

1. First, click on the Employee Medical Reimbursement status or Pensioner Medical Reimbursement status which is available under the relevant section.
2. Then enter the Trust number and the DME number.
3. The portal will then display the current status.

How to Download or Update Your Health Card?

Here is an overview of the ways to download and update your EHS card:

Download Process:

1. First, you need to log in to the EHS portal.
2. Then click on the Download Health Card button.
3. Finally, enter your User ID and download the card.

Update Card Details:

1. First, log in and click on Edit Card Details.
2. Then modify name, DOB and relationship, etc.
3. Finally, submit and download the updated card.

Also Read: Health Insurance for Self-Employed Individuals: What You Need to Know

Empanelled Hospitals for EHS Andhra Pradesh

The EHS scheme partners with the NWS (Network Hospitals) and NABH-accredited hospitals across the state of Andhra Pradesh. To find the nearest empanelled hospital, follow these steps:

1. First, you need to visit the official EHS portal.
2. Then click on 'List of Empanelled Hospitals'.
3. Then select your speciality and district.
4. You will see a list of hospitals with addresses and specialities.

Comparing EHS Andhra Pradesh with Private Health Insurance Plans: What’s Better for You?

While the Employee Health Scheme in Andhra Pradesh offers significant benefits to eligible state government employees and pensioners, many individuals often wonder whether it's enough. The reality is that public health schemes, although well-intentioned and supportive, can have limitations in scope, flexibility, and geographical access. This is where private health insurance plans from Bajaj General Insurance Limited step in to provide a broader safety net.

Let us break down the primary differences between EHS and a private health insurance policy. This will help you understand how you can make an informed decision for health coverage.

Coverage Scope

EHS Andhra Pradesh:

1. Covers only listed treatments under empanelled government or private hospitals within the state.
2. Has a cap of INR 2 lakhs per illness episode.
3. Treatment must follow predefined packages under government pricing.

Private Health Plans:

1. Offer customisable coverage with options ranging from INR 5 lakhs to INR 1 crore or more.
2. Cover a wider range of medical procedures, including international treatments or advanced surgeries.
3. Allow you to include additional benefits, such as maternity, dental, vision, or critical illness riders.

Using a health insurance premium calculator, you can estimate how much additional coverage will cost based on your family's needs and pre-existing conditions.

Hospital Network and Accessibility

EHS Andhra Pradesh:

1. You must visit the empanelled hospitals (Network Hospitals – NWH) within Andhra Pradesh.
2. Emergency treatment outside the state may not be covered unless the Trust later approves it.

Private Health Plans:

1. Provide access to an 18,400+ PAN-India network of hospitals, including tier-1 cities.
2. If you or your dependents frequently travel or reside outside Andhra Pradesh, private health insurance becomes crucial for uninterrupted medical support.

Claims and Flexibility

EHS Andhra Pradesh:

1. The claim is initiated and managed by the hospital post-discharge.
2. No flexibility in choosing treatments outside the listed ones.

Private Health Plans:

1. Offer direct claims support, 24/7 customer assistance, and easy reimbursement options.
2. Allow you to choose doctors, hospitals, and even alternative treatments like Ayurveda or Homoeopathy, depending on the plan.

Moreover, Bajaj General Insurance Limited offers fast-track claim processing and app-based management tools that simplify paperwork.

Family Inclusion and Add-ons

EHS Andhra Pradesh:

1. Covers only dependents as defined by the government (spouse, children, parents, etc.).
2. Cannot add extended family members or customise inclusion criteria.

Private Health Plans:

1. You can customise family floater policies to include parents-in-law, multiple children, siblings (in some plans), and more.
2. Add-ons such as room rent waivers, no-claim bonuses, and wellness benefits improve value over time.

When to Combine Both?

EHS is an excellent foundational health support scheme, but it works best when combined with a private health plan. This combo ensures:

1. Higher sum insured
2. National and international coverage
3. Emergency support outside the EHS network
4. Preventive health check-ups and wellness benefits

By using a health insurance premium calculator, you can get accurate premiums based on your age, income, health history, and desired coverage level, making it easier to pick the best health plan that fills any gaps in your EHS coverage.

Also Read: What is Restoration Benefit in Health Insurance & How Does it Work?

Conclusion

The Employee Health Scheme in Andhra Pradesh offers valuable financial support for eligible government employees and pensioners by covering specified medical treatments. However, its coverage may not be sufficient for every healthcare need or unexpected medical expense.

For broader financial protection, you may consider supplementing EHS with a comprehensive health insurance policy. Bajaj General Insurance is one of the options you can evaluate based on your healthcare requirements, coverage benefits, and claim support.

FAQs

Q1. What is the Employee Health Scheme (EHS) Andhra Pradesh?

The Employee Health Scheme Andhra Pradesh provides cashless healthcare to the serving and retired state government employees and to their eligible dependents. The Dr YSR Aarogyasri Healthcare Trust manages the scheme.

It covers hospitalisation, chronic disease treatment, follow-up care and post-hospitalisation services at the empanelled hospitals. A private health insurance can supplement coverage for treatments beyond just the scheme.

Q2. Who is eligible for EHS Andhra Pradesh?

The EHS Andhra Pradesh covers state government employees, pre-visualised local body staff, pensioners and the eligible dependents. The dependents include a spouse, children, dependent parents, and eligible unemployed or disabled children.

Family pensioners also qualify under certain conditions. For instance, people covered under CGHS, ESIS or similar schemes cannot enrol in EHS Andhra Pradesh.

Q3. What is the maximum financial coverage offered under EHS?

EHS Andhra Pradesh provides a financial coverage of up to ₹2 lakhs for each illness episode. The beneficiaries can claim for multiple episodes if the treatments fall under approved packages. The Trust reviews higher-value treatments individually.

Since there are some expenses which may remain uncovered, there are many people who choose an additional private health insurance for extra protection.

Q4. Does EHS Andhra Pradesh cover chronic disease treatment?

The EHS Andhra Pradesh covers outpatient treatment for several chronic diseases, including those of diabetes, hypertension, COPD, hypothyroidism and rheumatoid arthritis. The beneficiaries can get consultations, diagnostic tests, and prescribed medicines at the designated hospitals during defined hours.

A private health insurance policy can offer wider coverage for treatments and specialists.

Q5. How can a state employee enrol in EHS Andhra Pradesh?

State employees can enrol in EHS Andhra Pradesh through an official portal by logging in with their employee ID, and then by entering personal details along with family details, and submitting the application online.

Post-verification by the DDO, they can download the temporary health card. Pensioners complete an additional verification through their respective STO or APPO offices.

Q6. Is the EHS Health Card mandatory for availing treatment?

The beneficiaries need to present an EHS Health Card to get cashless treatment at empanelled hospitals. The card stores all beneficiary and family details. It then confirms all eligibility under the scheme.

Users can easily download it from the EHS portal or collect it from a Mee Seva Centre after approval.

Q7. How do pensioners register and use EHS Andhra Pradesh?

Pensioners register by uploading required documents, completing online applications and submitting signed copies to STO or APPO. After a successful verification, they get an EHS Health card for cashless treatment.

Those without login details can contact the EHS helpline or even visit the STO office for assistance during registration.

Q8. Can I check my enrollment or reimbursement status online?

The EHS portal allows all beneficiaries to track enrollment and reimbursement status online. Users can enter their details such as name, department, and reference number to see the updates.

The system improves this transparency and reduces the paperwork. Reimbursements generally follow hospital submissions after a treatment.

Q9. Are treatments outside Andhra Pradesh covered under EHS?

EHS Andhra Pradesh mainly covers treatment at empanelled hospitals within the state. The scheme may approve out-of-state treatment only during specific emergencies. This kind of limitation can affect people who travel often or live elsewhere.

There are many beneficiaries who purchase private health insurance to ensure nationwide cashless treatment.

Q10. How does Bajaj General Insurance Limited complement EHS Andhra Pradesh?

Bajaj General Insurance Limited complements EHS Andhra Pradesh by covering treatments beyond the limits of the scheme. It offers flexible health plans, critical illness cover, maternity benefits and access to a vast hospital network across India.

Combining EHS with private insurance can help beneficiaries get access to better healthcare coverage and would effectively reduce expenses during expensive treatments.

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**Tax benefits are subject to change in prevalent tax laws.

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Claims are subject to terms and conditions set forth under the health insurance policy.

The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional.