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Thursday 25 February 2016

Employees Health Scheme and Medical Reimbursement system under APIMA Rules 1972 – Reviewed the Scheme and orders for effective implementation of EHS

As Per G.O.Ms.No.174, HM&FW(M2) Dept., 1-11-2013 & G.O.Ms.No.134,HM&FW(I.1) Dept., dt.29-10-2014  orders were issued for implementing  Employees Health Scheme to provide cashless treatment to the State Government employees, pensioners and their eligible dependent family  members in replacement of the medical reimbursement system under APIMA Rules, 1972.
The grievances of employees associations on implementation of the Scheme have been reviewed in detail on 13-1-2016 and certain decisions have been taken for effective of implementation of scheme.

     Government after careful examination hereby issue the following orders for effective implementation of Employees Health Scheme.

a) The total project cost to implement the Employees Health Scheme works out to Rs.400 Crs. per annum.  The  Employees Unions have agreed to contribute 50% (Rs.200 Crs) towards this.

b) The representatives of ASHA and CEO, NTR Vaidya Seva Trust shall work out revised package rates under Employees  Health Scheme which is reasonable,  just and mutually agreeable. The entire exercise shall be completed within six weeks and the advice of the  Advisor to  Govt. Medical & Health and other experts shall also be taken in this regard.

c)  The ASHA shall issue directions to the network hospitals to implement the Employees Health Scheme with immediate effect. The package rates at commencement of the scheme  shall be as per the revised  rates to be finalized by  the CEO., Dr. NTR Vaidya Seva Trust. The employees share of 50% shall also commence with the onset of the scheme.

d) The contribution of the employees under the Employees Health Scheme shall  be parked with the NTR Vaidya Seva Trust in an account  created exclusively  for this  purpose.

e) The recoveries from the employees  and pensioners made by the DTA, PAO and other agencies etc., shall be transferred to the Dr.NTR Vaidya Seva Trust  by 15th of every month by respective agency.

f) The Finance Dept., shall issues necessary instructions to ensure that the operation of PD account for the EHS., is simplified such that the payments can be made to the Hospitals within a fortnight of the submission of scrutinized bills.

g) The Share of Government shall be released  quarterly by the Finance Dept., to the Dr.NTR Vaidya Seva Trust and also transfer the presently available amount with Finance Dept., to the Trust with immediate effect.

h) The Finance Department shall give access data of all eligible employees and pensioners and also data relating to Teachers of Municipal Corporations of Visakhapatnam and Kurnool to Dr.NTR Vaidya Seva Trust by Finance Department with  immediate effect.

i)  A  separate Management Committee within the NTR Vaidya Seva Trust shall  be constituted to monitor the implementation of the Employee Health Scheme which will have representatives from the recognized employees unions. The GA (Ser. Welfare) Dept., shall issue separate orders accordingly.

j)  The steering committee shall review the scheme from time to time and  ensure its effective implementation. 
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