GO.79 Committee to Look into the EHF Cases where the Treatment Cost exceeds 2 Lakhs

GO.79 Committee to Look the EHF Cases where the Treatment Cost exceeds 2 Lakhs. Government has constituted a Three Member Committee to Look into the Cases where the Cost of Treatment exceeds 2 Lakhs-Health Medical & Family Welfare Department – Employees Health Scheme (EHS) – Constitution of Technical Committee to look into the cases where the cost of treatment exceeds Rs.2.00 lakhs – Orders Issued.

G.O.Rt.No. 79 Dated:21.01.2014.

Read the following:
1.G.O.Ms.No.174, HM & FW (M2) Dept., dt.01.11.2013
2.From the Chief Executive Officer, Aarogyasri Health Care Trust, Letter No.186/EHS/P&C/2014, dated.10.01.2014.
O R D E R:
  1. In the G.O.1st read above, Government have issued orders for implementation of Employees Health Scheme (EHS) which is intended to provide cashless treatment to the State Government Employees / Pensioners and their dependent family members in empanelled network hospitals 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.
  2. 2. In the letter 2nd read above, the Chief Executive Officer, Aarogyasri Health Care Trust has stated that in para 4.3 of the G.O.Ms.No.174, HM & FW (M2) Department, dated.01.11.2013 under ‘Financial Coverage’, the following is mentioned:
    a. The employees, pensioners and their dependent family members will be eligible for a sum of Rs.2.00 lakhs (Rupees Two Lakhs only) per  episode of illness with no limit on the number of episodes as existing in APIMA Rules, 1972. However, in the cases where the cost of treatment exceeds Rs.2.00 lakhs, cashless treatment will continue. No network hospital shall deny the treatment in such cases.
    b. The limit of Rs.2.00 lakhs will not apply in cases where predetermined package rates are above Rs.2.00 lakhs. 
    c. Chief Executive Officer, Aarogyasri Healthcare Trust will settle the claims which exceed Rs.2.00 lakhs, following the standard claims settlement process after obtaining the approval of the Technical committee constituted by the Government.
  3. 3. The Chief Executive Officer, Aarogyasri Health Care Trust has further stated that already 10,44,000 temporary health cards have been generated under the Scheme, in respect of the Employees / Pensioners and their family members who have already enrolled. As many as 396 beneficiaries have undergone surgeries so far. In order to meet any eventuality where the cost of treatment exceeds Rs.2.00 lakhs, it is necessary to constitute a Technical Committee in terms of para.4.3 (c) of G.O.Ms.No.174, HM & FW (M2) Dept., dated.01.11.2013.
  4. 4. The Chief Executive Officer, Aarogyasri Health Care Trust has requested the Government that a ‘Technical Committee’ with the following composition may be constituted in terms of para.4.3 (c) of G.O.Ms.No.174, HM & FW (M2) Dept., dated.01.11.2013.
    1. Director of Medical Education - Member
    2. Commissioner, APVVP - Member
    3. Executive Officer (P&C), AHCT - Member-Convener 
  5. He has also stated that the panel doctors of the Trust, who are specialists in the respective fields, will assist the Committee in the process of examining and making recommendations in the above process.
  6. 5. Government after careful examination hereby constitute a ‘Technical Committee’ with the following composition in terms of para.4.3 (c) of G.O.Ms.No.174, HM&FW (M2) Dept., dated.01.11.2013.
    1. Additional Director of Medical Education - Member
    2. Joint Commissioner, APVVP (Medical) - Member
    3. Executive Officer (P&C), AHCT - Member-Convener
  7. The panel doctors of the Trust, who are specialists in the respective fields, will assist the Committee in the process of examining and making recommendations in the above process.
  8. 6. The Committee shall take further action in matter

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