Lr.6380 Doubts - Clarifications on AP Health Cards - Frequently Asked Questions (FAQs) (Updated)

Lr.No.6380/EHS/2013 Dated 10.12.13 Doubts and Clarifications on AP Health Cards-Frequently Asked Questions (FAQs). CEO of Aarogyaasri Trust Released Clarifications on Employees issues. It has been noticed that Most of the Employees and Teachers are getting Doubts and asking for Clarifications for their problems in enrolling Health Cards. Hence EHF has released some clarifications on the FAQs asked by Employees. As per the Letter No.6380 of EHS Trust the Details mentioned below are Modified.

Clarifications as per Lr No.6380/EHS/2013 Dated 10.12.13

Updated as per Lr.No.6380 on 11/12/13
  1. If Both Spouses are Government Employees/Pensioners, Then One of them will Enroll under EHS Scheme. Their Spouse will be enrolled as Dependent of the Employee. The Parents (Father and Mother) of the Enrolled Employee will be eligible as Dependents (If Eligible).
  2. White Ration Card Holders / Old age Pensioners/Aarogya Sri Card Holders are not eligible as Dependents.
  3. Brothers and Sisters are not eligible as Dependents.
  4. If One of the Spouse is a Central Government/ RTC/ Bank/ LIC Employee and availing Health Scheme facility from the Concerned Department, then they cannot be Enrolled as Dependents. If they Want to Enroll under EHS, they must and should give declaration letter that they have withdrawn their Dept's Health Scheme.
  5. Medical Reimbursement facility will be cancelled to the Employees coming under EHS.
  6. Those who got EHS Cards before 31st December can avail the facility of Cashless Treatment from January 2014.
  7. Those who are Not Enrolled and Not Received the Cards are not eligible for any Reimbursement or EHS Scheme.
  8. Deduction of Monthly Premium will be started from Jan 2014 irrespective of their Enrolment in EHS Scheme for Employees and Pensioners.
  9. Those Parents or Dependents who have White Ration Cards, or in Widow Pensioners/ Old age Pensioners Scheme are not Eligible to be enrolled as Dependents.
  10. For any Doubts and Clarifications Employees can contact  "104" Number.

More Frequently Asked Questions on Dependents and Family

Who are Eligible?
Employees Health Scheme is intended to provide cashless treatment to all the state Government employees including the State Government pensioners, along with their dependent family members. The categories of beneficiaries covered under EHS will cease to be covered under the APIMA rules upon commencement of EHS. Following are the categories of beneficiaries:
SERVING
All regular State Government Employees.
Provincialised Employees of local bodies
RETIRED
All service pensioners
All Family pensioners without dependents
Re-employed service pensioners

The following will constitute the family.
Parents (either adoptive or biological, but not both).
One legally wedded wife and her dependent parents in case of a male employee/ service pensioner.
Husband and his dependent parents in case of a female employee/ service pensioner.
Wholly dependent legitimate children (including step children and adopted children).

Dependency will have the following meaning.
In case of parents, those who are dependent on the employee for their livelihood.
In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted.
Husband and his dependent parents in case of a female employee/ service pensioner.
Wholly dependent legitimate children (including step children and adopted children).
There shall be no duplication of dependent family members at the time of enrolment in case both the spouses are eligible employees/services pensioners. Those who are covered under other Government health insurance schemes such as CGHS etc. are not covered.

Are the work charged employees, nominal muster role workers and out sourcing employees eligible?
No. They are not eligible. Only regular employees and provincialised employees of local bodies, all service pensioners, and family pensioners without dependents are alone eligible under the scheme.
Are unemployed daughters if not married eligible under the scheme?
Yes. Unemployed daughters who are unmarried or widowed or divorced or deserted are eligible. Once she is married she is not eligible.

Are the institutions like Zilla Grandhalaya Samstha, or societies covered under the scheme?
As on 14-08-2012 only the regular government employees are eligible under the scheme. However separate instructions are awaited from Government regarding inclusion of the societies, corporations, universities, aided teachers etc.

If the parents of the employee have Aarogyasri Card, are they eligible under the scheme?
Aarogyasri Card (White Card) will be given only to the BPL families. If parents are dependent on the Government servant, their white card will be cancelled and disciplinary action will be initiated against the employee for using a benefit meant for the poor. However in case the parents are living independently and have an Aarogyasri Card they are not eligible to be included under the Scheme by the employee.

An employee is working but retires at the time of enrolment. To what category does he belong under the scheme?
The status of the employee at the time of enrolment is the only criteria. If he is retired, he will be a pensioner irrespective of the fact whether his pension is settled or not.

In case of a male employee are his in-laws (parents of his wife) also eligible?
No, Parents of the employee are eligible.

Are adopted children or adopted parents covered under the scheme?
Yes. Either adopted parents or biological parents are eligible but not both. Similarly adopted children are eligible provided such adoption is legal.

If an unemployed son continues to be a dependant on the employee even after attaining the age of 25 years, is he eligible under the scheme?
No. Once he attains the age of 25 years he will become ineligible under the scheme. Though physical card is available with him it automatically ceases to function.

If either of the spouse is in Government service and one spouse is having ESI, or private medical insurance is she/he eligible under the scheme?
In case of private medical insurance spouse is allowed to join the scheme but in case of coverage under ESI it is not possible.

Under the Aarogya Bhadratha Scheme for the police department certain coverage is provided to the employee only. Whether he and/or his dependants are eligible under the scheme?
No. As on 14-08-2012 the employees covered under Aarogya Bhadratha Scheme are not eligible though their parents are not covered under the said scheme.

Is unemployed daughter if not married eligible under the scheme?
Yes. Unemployed daughters who are unmarried or widowed or divorced or deserted are eligible. Once she is married she becomes ineligible.

Frequently Asked Questions on Health Cards Enrolment

If an employee is not enrolled under the scheme, does he have to contribute for the scheme?
The deduction of contribution to the scheme will be done by automativally by DDOs as per his scale of pay irrespective of whether he has applied for enrolment in the scheme or not. It is compulsory to enroll in the scheme, in his own interest, as his contributions will deducted regularly under the scheme.

Is a single card like ration card given for the entire family under the scheme?
No. Individual cards will be issued to the employee and his dependents. For this purpose, passport size photographs, which are ICAO compliant, are required to be uploaded. The photo studios can understand the ICAO complied passport size photographs. Such photos are not uncommon but usually given for getting passports. Any other photographs, or group photos are not accepted.

If both the spouses are govt. employees who has to pay the contribution?
(Updated as per GO.331 Dated 11.12.13)-Govt clarified that If both Spouse are Govt employees, Contribution by One of the Spouse is sufficient.

I forgot my password. How can I get my Password?
After clicking on Sign-in button on home page, click on 'forgot password'. The password created by the user will be sent as SMS to the mobile number mentioned.

Some details were incorrectly filled and the application was submitted to DDO/STO/APPO. It is pending with to DDO/STO/APPO. How to correct and my application ?
The DDO/ STO/ APPO can correct the details, based on the attachments made to the application form OR the application form has to be rejected by DDO/ STO/ APPO, enabling the applicant to correct the same and resubmit.

My mobile number has been incorrectly entered at the time of changing password. What shall I do?
The details of user ID, Name, mobile number entered in the portal and correct mobile number may be sent to ehf@aarogyasri.gov.in for suitable action.

My mobile number has been incorrectly fed into the application and the application has been submitted to DDO/STO/APPO. How to correct it?
Please get in touch with DDO/STO/APPO for necessary correction at his level, before approval by DDO / STO/ APPO.

When I wanted to 'log in' for submission of application for enrolment, I found that already some other person has opened it and filled the application and submitted it to unknown DDO/STO/APPO. How can I submit my application now?
The details of user ID, Name, date of birth and pensioner ID may be sent to ehf@aarogyasri.gov.in for suitable action.

When I wanted to log in with the given user id and password, the alert message reads as 'invalid user id or password'. When I clicked on 'forgot password', the alert message indicates 'your new password has been sent to your mobile no......................'. But the said mobile number does not belong to me. What should I do.
The details of user ID, Name, date of birth, pensioner ID and correct mobile number may be sent to ehf@aarogyasri.gov.in for suitable action.

My application has been rejected by the DDO/STO/APPO with certain remarks. What is the process for resubmission?
Please login with your user ID into the portal and save the application rejected by the DDO/ STO/APPO, then enter the correct details as per remarks of DDO/ STO/APPO, save, edit dependents details, if necessary submit application for approval.

My date of birth has been incorrectly fed into the application and the application has been submitted to DDO/STO/APPO how to rectify it?
The DDO/ STO/ APPO can correct the details, based on the attachments made to the application form OR the application form has to be rejected by DDO/ STO/ APPO, enabling the applicant to correct the same and resubmit
My name entered in the service records is slightly different from that in the aadhar card. Which name should I enter?
Enter the name, as it appears in the service record.

I have entered the aadhaar number / aadhaar enrolment number incorrectly and the application was submitted to STO / APPO. How can it be rectified / corrected.
Aadhaar number cannot be edited either by the beneficiary or DDO/STO/APPO. The details may be mailed to ehf@aarogyasri.gov.in

Why there are so many cases of invalid user IDs ?
It is observed that the applicants while enrolling their application, at any internet centre, are not collecting their changed password. In such cases, the message "Invalid user ID or Password" will appear.
In all such cases, the applicants should send their current user ID and mobile number to ehf@aarogyasri.gov.in for sending the new password through SMS.

What is the cut off date for enrolment?
There is no 'cut off' date for enrolment.

Internet centres are charging heavily for enrolment.
The Government / the Director, ESD (mee-Seva) issued instructions to mee-Seva centres for enrolment of employees / pensioners for health cards at the following rates:
1. Rs.35/- for employee / pensioner.
2. Rs.15/- for each dependent family member
3. Rs.2/- for physical printed application (per application).
The services at mee-Seva centres may be availed at the above rates.

STOs / APPOs are not attending to the job of clearing applications.
Government have directed the STOs / APPOs to clear the applications. The grievances have been brought to the notice of DTA for necessary action.

FAQs on Health Cards Scheme Coverage

What is the benefit cover?
Check the website for list of therapies covered. 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.

What is the financial cover?
The sum insured under EHS scheme is Rs.3.00 lakhs per family per annum on floater basis. 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. 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.

The financial coverage is Rs. 3.00 lakhs per family. Can it be increased if the treatment cost exceeds the said limit?
Yes. Additional amount as required will be available from a separate corpus to treat the needy cases. Treatment will not be denied merely due to the reason of amount exceeding the financial cover of Rs. 3 lakhs.

What is the difference between the present Aarogyasri Card holders and the Employees under the proposed the Employees Health Scheme (EHS) in treatment, facilities, ceiling of amount etc?
The sum insured under Aarogyasri Scheme per family per annum is only Rs.2.00 lakhs covering only 938 procedures where as in case of employees under EHS Scheme it is Rs.3.00 lakhs covers about 2,000 procedures with an additional amount which can be drawn in case of need.

Employees Health Care Fund Scheme is intended to provide cashless treatment. Is OP care available?
No. OP is not available. However in certain chronic cases like diabetes, hypertension etc. are covered.

Will the coverage limit be enhanced automatically as under CGHS?
Coverage remains the same at Rs.3 lakhs. However if any beneficiary needs treatment beyond financial cover, treatment will not be denied.

How are the 'OP' patients for chronic diseases going to be given medicines regularly?
At present the employees of secretariat are getting medicines in the Secretariat Dispensary every month.
OP treatment for chronic diseases like diabetes etc. will be given through a NWHs. The patient needs to take his drugs from a notified hospital.

At present under "Aarogyasri" guidelines, 133 procedures which are most commonly done, are under the reserved list, and limited to only Government and Aided Hospitals. Will the same procedure be adopted under the proposed Employees Health Care Fund Scheme?
No. Aarogyasri Scheme has a different reserved list. The reserved list under EHS will be notified through this website after a decision by Government.
  1. For Details on Health Cards Coverage and Packages Click Here
The procedures and treatments like hydrocele, Hernia Repair, Cataract Surgery, General fever, Respiratory Infections, Diarrhea etc. are not covered currently under the Rajiv Aarogyasri Scheme. Are the said treatments going to be covered under the E.H.F.?
Under Aarogyasri, only 933 procedures are covered where as under ECHF about 2,000 procedures are proposed to be covered. All of the above IP treatments will be included, and chronic OP treatments covered. For details of coverage see EHS website.

FAQs on Health Cards Hospitals

What are the empanelled hospitals?
The Employee Health Care Fund Scheme is implemented through a network of empanelled hospitals. For list of empanelled hospitals check the EHS website.

Are the wards same as Aarogyasri wards in private hospitals or are any separate wards allotted for the employees ?
The Aarogyasri wards are exclusive wards for Aarogyasri scheme and not meant for employees and pensioners. The ward entitlement to employees and pensioners will be as per APIMA rules 1972.

Will the employees be treated on par with the common public who avail treatment on payment of cash?
Yes. They will be treated on par with the patients making cash payment. Cash will be transferred by AHCT based on pre-agreed prices with the hospitals electronically.
Are the names of the posts with DDO code enough or are names of the incumbents also need to be filled up in table 5?
No. Only the name of the DDO office unit must be given with DDO code allotted by the DTA. Ex: For Director of Town and Country Planning, the DDO is statistical officer by designation whereas the DDO office unit name is Director of Town and Country Planning. The names of the employees working in those posts shall not be entered anywhere.

What is the difference between employee ID cards and Health Cards?
Employee ID cards are issued by Government to establish and authenticate a Government employee. The employee health card is issued by the implementing agency of any health scheme in order to access the health care service at an empanelled hospital. Employee ID card is issued only to an employee and is valid only as long as the employee is in service and is not issued after retirement. A health card is issued to each and every dependent family member of the employee and is valid even after retirement.

38 comments:

  1. Replies
    1. This comment has been removed by a blog administrator.

      Delete
  2. sir..ur putting many doubts of questions ..i have in spouse category ,when i enrolled my wife as a dependent, my wife enrolled separately dependents her parents...shall i enroll as dependnt my wife...kindly clarify my doubt...

    ReplyDelete
    Replies
    1. As per Lr.No.6380 of the EHS Dated 10.12.13, If Both Spouse are Employees, One should enroll for Health Cards, and the Parents of the Enrolled as Dependents. The spouse will be enrolled as dependents.

      Delete
  3. IN list of options available of dependents..wife, husband,son,daughter,parents,father/mother-in-law...what about sister, brother,,,,both options are not in add beneficiary dependents,,in GO enroll without agening of unmarried woman ..below 25 men..kindly put the option as brother&sister...MBREDDY, TPRTUIEEJA MANDAL President.

    ReplyDelete
    Replies
    1. Brother and Sisters are Not eligible to enrolled as Dependents

      Delete
  4. i didnot enrolled for health card till now(as on 10th Dec) i should go for a surgery with in 15 days of time as per doctor advice. am i eligible for Reimbursement? if not what should i do? is there any scope to take permission as a special case? plz reply me.. thank u. B.Srinivas Goud. Nizamabad.

    ReplyDelete
  5. sir, is the address of office in respect of s.g.t. working in mandal parishad primary school, school address? or Mandal Educational Officers Office?or Mandal Parishad Development Officers Office?

    ReplyDelete
  6. sir, please give me information about how to fill the columns in CARD ISSUING CENTER DETAILS

    ReplyDelete
  7. Zakir Bhai ek question?
    >For a female employee(Married), her Mother-In-Law and Father in Law are dependents on her.

    "Same as for a male employee do his Mother In Law and Father In Law are dependents?"

    ReplyDelete
  8. IF A LADY WILL BE ENROLLED AS DEPENDENT ,AS PER THE GOVT.CLARIFICATION SHE HAS LOST HER RIGHT TO ENROLL HER PARENTS AS DEPENDENTS IS IT TRUE

    ReplyDelete
    Replies
    1. YES . IF SHE WISH TO ENROLL THEIR PARENTS SHE ENROLL SEPARATELY WITHOUT INCLUDING IN HUSBEND ENROLLMENT BY M.V.SUBBA RAO S.A-Z.P.H.S -V.CH.PUDI CELL:9490253200

      Delete
  9. sir ,i am working as school assistant,and my father died,i have two un married sisters shall i add them as dependents?-surya

    ReplyDelete
    Replies
    1. Sorry Sir, You Can't add your sisters. Sisters are not eligible as dependents

      Delete
  10. sir i am a govt employ female.recently i have married.i have a doubt regarding my parents.can i register my parents as dependents or my husbands parents

    ReplyDelete
  11. RESPECTED SIR
    i am submitted health card employee data... but employee said his wife's information incorrect data... how to change....how to rectify the problem even once submit how to modify pls tell me sir...my office employees are completed health card...but this person data how to modify sir....pls tell me

    ReplyDelete
    Replies
    1. registered a complaint against the problem in www.ehf.gov.in website

      Delete
  12. Sir, i am submitted data, but i fill incorrect data in GRADE COLOUM my grade is "xx" but i fill "vii" how to correct it.present i checking my status it is PENDING.plz kindly give the information.

    ReplyDelete
  13. Give the information of residential school teachers for health cards.

    ReplyDelete
  14. Sir , I am in spouse category . I want to enter my wife as dependent.Shall i have to upload my wife's SR scanned copies also ?
    Which pages ? What is last date ? Plz reply sir.

    ReplyDelete
    Replies
    1. Yes Sir. You have to Upload Your Spouse's SR Scanned Copy. But it may take only One Page to upload. Hence better to scan the First Page. Remaining Not needed.

      Delete
  15. sir, my 4year daughter have no govt birth certificate right now, adhar card is not valid for under 5 year, so, what can i submit for date of birth proof? can I add details in future?

    ReplyDelete
  16. This comment has been removed by the author.

    ReplyDelete
  17. how can i know hod? can u please indiacate hod for mpup school having ddo code as 08030308004

    ReplyDelete
  18. sir dependents(only parents ki )ration card unte cancel avthunda why they are not eligible they hav no arogya sri

    ReplyDelete
    Replies
    1. Dear Srivardhan garu,
      Dependents of Government Employees should NOT have White Ration Holders. I Think You better know, to whom the White Ration Cards are issued. Only to Below Poverty Line (BPL) People. How is it possible that a Govt Employee dependents comes under BPL ?. White Ration Card Holders can apply for Aarogya Sri..

      Delete
  19. Sir dependents ki white card undakudadani official ga guidelines vachaya

    ReplyDelete
  20. Dear sir.,
    Is LASIK ( laser in situ keratomileusis) Surgery for the correction of eye site can be done under health cards?

    ReplyDelete
  21. hello sir
    i fill up my data,after i stopped it and i want to add my self in spouse category but my aadhar no not retrieving there how can i add my self in beneficer of my spouse.and other phone number have for complaint for this only 104 is the complaint no or other nos are there please tell me other phone nos (Nodal Officers )
    thanks

    srinil

    ReplyDelete
  22. Sir, I am working in BSNL covering under CGHS. My wife working as SGT . If I cancel my BSNL MRS and join in my wife's EHS, is my mother can be added in my spouse enrolment as dependent? What is the cut off date for enrolment?

    ReplyDelete
  23. Sir, I am working in Police Dept., My father is a retd. APSRTC employee. shall i enroll him as dependent in EHS?

    ReplyDelete
  24. Is SISTERS are not elegible to Apply As Beneficieries..

    ReplyDelete
  25. sir please tell me where is the card issue center in hyderabad district

    ReplyDelete
  26. SIR,IAM SANDHYARANI,WORKING AS SGT,IN MAHABOOBNAGAR DT,MY FATHER IS A RETIRED BANK EMPLOYEE,HE IS DRAWING PENSION,BUT HE IS NOT COVERED BY ANY OF MEDICAL REIMBURSEMENT SCHEME.SHALL I ADD MY PARENTS AS MY DEPENDENTS.PLEASE GIVE THE CLARIFICATION SIR

    ReplyDelete
  27. Hello Sir,

    My father retired in 2009. He Got heart attack in Aug-2013 and operated at Prime hospital. We have submitted all the documents for reimbursement in Nov-2013 (Strike Period, hence submission delayed). Its almost 5 months and we did not hear any thing from any department. Do we need to follow up. If so to whom we need to meet. Please suggest.

    ReplyDelete
  28. Hi Sir,
    My Father applied for EHF Health Card under Pensioners, application status shows "Pending With DDO/STO" . Is health card valid in Hospitals for Surgeries. Please explain Thanks.!

    ReplyDelete
  29. Sir, If any parent of an employee holds white card and he is enrolled as dependent on the employee under Employees Health Scheme, is the employee have to eliminate them from ehs, further is it compulsory for the elimination, please guide us the process how to eliminate them ( parents) from this scheme.

    ReplyDelete
  30. sir please my parents have white ration card so how to reject my parents health cards.........

    ReplyDelete