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Instructions to the network hospitals regarding Medical Reimbursement and EHS

 CIRCULAR

Dr. YSRAHCT/EHS/03/2020, dated: 09.08.2020

Dr. YSR AHCT EHS - In pursuance of the orders issued by the Government with regard to the extension of the Medical Reimbursement till 31.07.2020 and instructions to the NWHs regarding Medical Reimbursement - Issue of Circular to hospitals - Reg.

Ref: 

1.G.O.RT.No.321, Health, Medical & Family Welfare (D) Department, dated: 16.07.2020.
2. No.Dr.NTRVST/2900/EHS/Extof MR/2018, dated:16.07.2018.
3.G.O.Ms.No.54, Health, Medical & Family Welfare (I) Department, dated: 06.05.2020.

    It is that, ride reference cited above, Government have issued orders pertaining to extension of Medical Reimbursement facility under APIMA rules, 1972 till 31* July 2020.Further, vide reference 2nd cited above where as certain instructions issued by the Trust for successful implementation of the Employees Health Scheme. Further, it has been observed by the Trust that the Hospitals empanelled under the EHS are admitting the EHS patients under the cash mode and counselling the EHS beneficiaries for Medical Reimbursement even though the required treatment/ surgery is enlisted under EHS.

   In view of the above, it is to inform that in addition to the earlier instructions vide circular 2nd cited above, all the hospitals who are empanelled under the Employees Health Scheme are here with informed that:

  1. The Government has issued orders for extension of Medical Reimbursement from 01012020 to 31072020 only.
  2. Trust has cleared majority of the claims to the hospitals and the remaining payments will also be settled shortly.
  3.  Vide G.O 3rd cited above, the monthly contribution for the scheme is enhanced from Rs.90/- and Rs.120/- to Rs.225/- and Rs.300/- respectively. Further, in order to provide the quality health care services to the Employees/Pensioners under the scheme, the Government also enhanced its contribution on the same lines as applicable to the Employees.
  4. The Government has issued orders to DTA to release the monthly contribution of the Employees / pensioners by 10th of the subsequent month to Trust to ensure payments to the NHWs under EHS in time.
  5. Further, all the NWHs are instructed to counsel the patients properly and not to misguide the beneficiaries for opting the medical reimbursement, If any such issues noticed by the Trust viz., denial of admission, money collection from the EHS beneficiaries and referring the patients for Medical Reimbursement will be viewed very seriously and following actions shall be initiated against the respective NWHs.

Disciplinary actions:

  • i. Hospital will be penalised 10 times on cost of the Treatment/money collected from the EHS beneficiaries.  
  • ii. Suspension of the hospital in all the schemes implemented by the Trust for a period of 3 months.

6. Hence, the Trust is expecting qualitative and responsible services from the NWHS to the beneficiaries of EHS.

     In this regard, all the NWHs empanelled under Employees Health Scheme are he instructed to strictly follow the above instructions. Further, the District Coordinator Trust are instructed to hold video meetings and ensure to provide necessary treatment EHS beneficiaries for all the entitled procedures under the scheme and common circular to all the NWHS.

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