Health, Medical & Family welfare – Medical Reimbursement – Employees Health Scheme – Enhancement of Monthly Subscription for both Employees / Pensioners and Government contribution – Inclusion of other categories of Employees / Pensioners under EHS- Orders- Issued.
In the G.O. first read above, orders were issued for implementations of Employees Health Scheme, with effect from 05-12-2013, to provide cashless treatment to the Government employees, pensioners, and their family members in empanelled Hospitals for the listed therapies which shall ipso facto replace reimbursement system under APMIA rules,1972. In Para 6.2 of the said
G.O. under the heading ‘FINANCING’, the financing arrangement for the Scheme is defined as follows:-
“The monthly contribution will be Rs.90/- (for Slab A consisting of employees with Pay Grades from I to IV, and Slab B consisting of employees with Pay Grades from V to XVII) and Rs.120/- (for Slab C consisting of employees with Pay Grades from XVIII to XXXII). The Pay Grades for the three Slabs under other Pay Scales, such as University Grants Commission Pay Scales, will be those equivalent to the corresponding Pay Grades under the State Government. The eligibility for Slab-A and Slab-B will be semi-private ward, and for Slab-C will be private ward. The contribution for service Pensioners or family pensioners will be according to the present Pay Grade of the post from which the pensioner retired from service”.
a. Enhancement of Monthly contribution share of the Employees and Government:
i. The Monthly Contribution for the Scheme is enhanced from Rs.90/- and Rs. 120/- to Rs. 225/- and Rs. 300/- respectively as per the Slabs and Pay grades as specified in the G.O.Ms.No.174 HM&FW (M2) Dept, dated 1.11.2013.
ii. In the same way, the Government Contribution per employee should also be enhanced from Rs. 90/- and Rs. 120/- to Rs. 225/- and Rs. 300/- respectively as the share of the Government and Employees/Pensioners is 50:50 as per GO 2nd read above.
iii. This enhancement should be applied with effect from the salaries/Pensions payable to the Employees / Pensioners from the month of December, 2019.
iv. The Director Treasuries and Accounts should release the monthly contributions of Employees/Pensioners by 10th of subsequent month.
v. The Green channel payment option should be given to the payments related to the EHS for quick disposal of claims to the NWHs.
b. Inclusion of Certain Categories of Employees under EHS:
i. The Employees Health Scheme can be implemented to the employees and Pensioners of the departments/ Society/ University/ Management of any Government body who are not covered under the scheme till now, subject to condition that the Employer contribution for those
employees/pensioners should borne by the concerned Management/Departments.
ii. For which, the concerned management should submit the Acceptance letter in this regard to the Chief Executive Officer, Dr YSRAHCT and in turn the CEO should include such employees and pensioners under the scheme.
iii. The concerned departments/Managements have to generate the Challan pay the subscription of Employees/Pensioners through CFMS module where the subscription payment option for EHS is already available in CFMS portal.
iv. Further the option to pay the Employer Contribution may also be provided in the CFMS portal for these categories of employees.
C. Collection of Contribution from the deputation/foreign service employees:
i. The deduction of Monthly contribution from Employees should be treated as mandatory payment like EPF etc.. Hence, the Director Treasuries and Accounts should see that the subscription has to deduct from every employee even from the deputation employees.
ii. The Data of the new deputation employees should be shared to Dr YSR Aarogyasri Health Care Trust on monthly basis.
iii. The CEO, Dr YSRAHCT should issue Health cards to those employees also as per the data provided by the DTA.
6. The General Administration (SW) Department is requested to take necessary action to amend the G.O.Rt.No.1541, G.A.(SW) Department, dt: 19.07.2016, for inclusion of the Director of Treasuries & Accounts, Andhra Pradesh and the CEO, Comprehensive Financial Management System (CFMS), in
the Management Committee of the Employment Health Scheme for Government Employees and Pensioners.
7. The Chief Executive Officer, Dr YSR Aarogyasri Health Care Trust and the Director Treasuries and Accounts shall take necessary immediate action in this matter.
8. This order issues with the concurrence of the Finance (FMU-HM&FW) Department vide their U.O.No.FIN01-FMU0MISC/516/2019(Computer No:970313), Dated.29.12.2019.
