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Latest 204 procedures/diseases shall be continued as cashless under Employees Health Scheme

Latest 204 procedures/diseases shall be continued as cashless under Employees Health Scheme
Government have issued orders pertaining to the extension of Medical Reimbursement facility under APIMA rules, 1972 till 31st December, 2018. In addition to the extension of Medical reimbursement scheme certain orders were also issued by the Government with regard to the exclusion of some procedures from Medical reimbursement, applying of EHS packages for the reimbursement of remaining EHS procedures.

All the hospitals who are performing the reimbursement cases are herewith informed that:

  1. Extension of Medical reimbursement from 01.04.2018 to 31.12.2018 in parallel to the Employees Health Scheme.
  2. 204 procedures which are mentioned as Annexure in the referred GO are removed from the Medical Reimbursement with effect from 01.08.2018.
  3. The above said 204 procedures shall be continued as cashless under Employees Health Scheme.
  4. The employees working in A.P. Secretariat; HoDs; and Retired employees and their dependents stationed at Hyderabad along with the employees working in A.P. Bhavan, New Delhi shall be eligible to continue Medical Reimbursement facility for all Employees Health Scheme (EHS) procedures until suitable arrangements are made, as issued in the G.O.Ms.No.12, HM&FW(I.1) Department, dt.23.01.2017.
  5. In view of point b and c, all the hospitals which are recognised by the DME for Reimbursement are instructed to notice these changes and strictly adhere with the orders issued in the GO. The Hospitals empanelled under EHS are instructed to do the listed 204 procedures under EHS scheme and the hospitals which are not empanelled under the EHS and recognised by the DME for reimbursement are instructed to refer such cases to the nearby EHS empanelled hospitals.
  6. The reimbursement for the remaining 1695 procedures shall be reimbursed on par with the EHS rates. Hence all the hospitals are instructed to not collect money more than the EHS package rates.
  7. Denial of admission, money collection from the EHS beneficiaries for the listed 204 procedures and wrong counselling by the empanelled hospitals in this regard shall be viewed seriously and necessary action will be initiated against the erring hospitals as per the disciplinary clauses of Service contract agreement.
Latest added 204 procedures/diseases in EHS under cashless treatment

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