EMPLOYEES HEALTH SCHEME OVER THE PRESENT REIMBURSEMENT SCHEME Sl. No. AP Integrated Medical Attendance Rules Benefits under EHS 01. The Employee or Pensioner has to first pay for the treatment from his pocket and get the amount reimbursed. This causes financial burden to the employees especially to the pensioners. The Scheme is totally cashless where the employee or Pensioner and their dependent family members can walk into the hospital and walk out after treatment without paying a single rupee, using his / her Health Card. 02. The present reimbursement procedure is lengthy and may take even more than 6 months in some cases to get the reimbursement. It is totally cashless treatment and the employee need not run around anywhere. 03. Maximum ceiling limit of Rs.2.00 lakhs for major ailments and beyond which relaxation of rules by the Government is required. Rs.2.00 lakhs per episode with no limit on the number of episodes in a year. Even in the cases where the cost exceeds Rs.2.00 lakhs, treatment may continue with the prior approval of the Aarogyasri Trust. Pre-determined package price and close monitoring ensures comprehensive treatment gets provided. 04. Treatment in private recognized hospitals, NIMS and SVIMS is permitted for Bypass Surgery, CABGS., Double Valve Replacement, Kidney Transplantation, Cancer and Neuro-surgery to Brain. Treatment in empanelled hospitals (which include Government, Private, Specialist and Super-specialty hospitals) for 1885 procedures. 05. There are no follow-up packages after surgery / therapy. There are several follow-up packages after discharge up to 1 year during which consultation, investigations and medicines will be provided to the patients free of cost, which are part of the package prices. 06. There is no monitoring mechanism for the treatment provided by hospitals. The entire process from admission to the discharge followed by claim, is monitored by specialist panel doctors as well as Trust doctors of the Aarogyasri Healthcare Trust, thereby safeguarding the interest of each patient. 07. A patient may incur heavy expenditure and the entire expenditure may not be reimbursed. The package prices are already predetermined and the entire process is a transparent online procedure. 08. It is difficult to monitor implementation of the APIMA Rules and settlement of reimbursement across the State. A Steering Committee headed by the Chief Secretary to Government and comprising of representatives from the Government and Employee Associations, will monitor the scheme, from time to time and take decisions for its effective implementation. 09. Dependents of family pensioners are not eligible for reimbursement. Dependents of Family Pensioners have been included in the Cashless Scheme. 10. Master Check up for employees above 40 years is only for three times in the entire career of the employee. Annual health check up for the serving employees who crossed 40 years. --------------
Posted on: Mon, 04 Nov 2013 07:48:08 +0000
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