Health Medical and Family Welfare Employees Health Scheme (EHS)– Providing Cashless medical treatment to the State Government Employees, Pensioners and their dependent family members - Certain amendment to G.O.Ms.No.174, HM & FW (M2) Dept., dated.01.11.2013– Orders – Issued.
HEALTH MEDICAL AND FAMILY WELFARE (M2) DEPARTMENT, G.O.Ms.No.26 Dated 05.02.2014
Read the following:
1..G.O.Ms.No.174, HM & FW (M2) Dept.,. dt.01.11.2013
2.G.O.Ms.No.176, HM & FW (M2)Dept.,.dt.01.11.2013
3.From the C.E.O., AHCT, Lr.No.6428/EHS/P&C/2013, dated.11.12.2013.
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In the G.O. first read above, orders were issued notifying the ‘Employees Health Scheme’ with the objective of providing cashless treatment to the employees and pensioners of the State Government and their dependent family members, which will ipso facto replace the existing medical reimbursement system under APIMA Rules, 1972, with additional benefits such as post – operative care and treatment of chronic diseases which do not require hospitalization and treatment in empanelled hospitals. In the G.O.2nd read above, the Final Therapy Prices for the various packages under the Scheme, were adopted and notified.
2. In his 3rd read above, the Chief Executive Officer, Aarogyasri Healthcare Trust, which is the implementing agency, has stated that the package prices adopted and notified in the G.O. 2nd read above include cashless service from the point of OP Registration of a patient till the expiry of 10 days after discharge as Inpatient with a 30 day warranty after discharge and therefore the prices are inclusive of pre-evaluation cost of OP cases which need to be screened before an IP case is identified. He has expressed the view that this aspect has to be specifically indicated in the G.O., first read above under “Hospital Payments’ so as to avoid ambiguity and scope for misinterpretation. He has, therefore, suggested that a clause be inserted in the above G.O., clearly defining the package so as to include pre-evaluation cost.
In para 5.2, of the G.O., under the heading ‘Hospital Payments’ the following shall be inserted as ‘d’:
d) “The package will also include pre-evaluation of patients, including consultation and investigations even in the cases which do not finally end up with admission for IP treatment. The network hospital shall not raise any claim for such pre-evaluation”
4. The Chief Executive Officer, Aarogyasri Health Care Trust shall take necessary action.
5. This order issues with the concurrence of the Finance (Expr.M&H-I) Department vide their U.O.No.34359/471/A1/Expr.M&H-I/13, dated.04.01.2014