‘Employees Health Care Fund Scheme’ & Implementation

 

 Employees Health Care Fund Scheme & Implementation

To download GO MS NO 184, dt.14.08.2012 Click here

To download GO MS NO 186, dt.14.08.2012 Click here 

 

The AP Government, have decided to provide comprehensive health care to all Government Employees, Pensioners, and their family members, on cashless basis, through an appropriate scheme in lieu of the present medical reimbursement system under ‘The Andhra Pradesh Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)’.

2. After holding a series of meetings with the Joint Action Committee of Employees, Pensioners Associations and A.P. Secretariat Employees’ Co-ordination Committee representatives, and based on the inputs received during these meetings, Government

issued orders in the G.O. 1st read above constituting a Technical Committee headed by

Commissioner, Health & Family Welfare and Chief Executive Officer, Aarogyasri Health

Care Trust (CEO-AHCT) as its Member-Convenor to analyse all aspects of the scheme

and make comprehensive recommendations for its effective implementation. In acceptance of the recommendations of the Technical Committee, orders were issued in

the G.O. 2nd read above, constituting a State Level Committee (SLC) headed by Special

Chief Secretary to Govt., HM&FW Dept., with eight (8) more official members, including

CEO-AHCT as member-Convenor and the representatives of Services Associations, to

examine the recommendations of the Technical Committee, and to offer recommendations on all the modalities to be adopted finally for launching of the Scheme.

3. The State Level Committee met on 22-11-2011, 19-01-2012 and on17-02-2012, and based on the decisions taken in the meetings, the CEO-AHCT submitted a ‘draft Scheme’ to Government vide his letter 3rd read above.

4. The salient features of the Scheme based on the earlier decisions were discussed with the representatives of the various Services Associations on 03-08-2012 in the meeting convened by the Principal Secretary to Government, Health, Medical and Family Welfare Department and a consensus has been arrived at on the salient features

of the Employees Health Care Fund Scheme (EHF) and on the ‘Operational guidelines relating to the issue of Identity Cards to all the beneficiaries under the Scheme’.

5. Government, after careful examination of the matter, have decided to approve the ‘Employees Health Care Fund Scheme (EHF)’ and hereby issue the following orders for implementation of EHF.

i) AHCT will be the implementing agency as a service provider for the Scheme,

initially for a period of two (2) years.

ii) The salient features of the Scheme are given in the annexure to this

Government Order.

iii) A Steering Committee headed by the Chief Secretary will monitor the Scheme and review its implementation from time to time. Principal Secretary-Finance, Secretary(Services) GAD, Principal Secretary-Medical and Health, Commissioner Family Welfare, Director of Medical Education, Director of Health and Family Welfare, Commissioner of APVVP, Director of Treasuries and Accounts, Pay and Accounts Officer, and representatives of employees and pensioners associations as identified by GAD Services Department will be members, and Chief Executive Officer-AHCT the member-convenor for this committee.

iv) Government Order on the Operational guidelines for concerned officers under the

control of Director of Treasuries and Accounts (DTA), Pay and Accounts Officer (PAO), Secretary to Government-Information Technology and Communication department (Secretary IT&C), Commissioner Civil Supplies and Ex-Officio Secretary to Government (Civil Supplies and Consumer Affairs), District Collectors and Heads of Departments (HoD) for enrolment of beneficiaries, and operation of the Scheme by the Chief Executive Officer, Aarogyasri Health Care Trust will be issued separately.

v) 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. The CEO-AHCT will separately furnish the detailed estimates based on the fund forecast for this year.

vi) AHCT will ensure maximum coverage of employees and pensioners through the District Collectors and the HoDs concerned, so that EHF can be launched on 1st November 2012 for implementation of the Scheme in the entire State.

6. The Chief Executive Officer Aarogyasri Health Care Trust, Director of Treasuries and Accounts, Pay and Account Officer, District Collectors, Secretary IT&C, Commissioner Civil Supplies, and all Heads of Departments shall take necessary further action in the matter accordingly.

7. This order issues with the concurrence of Finance (Expr. M&H.1) Department vide their U.O. No.7581/260/A1/Expr.M&H-1/2012, dated: 14-08-2012.

In the G.O. 184 orders have been issued approving the ‘Employees Health Care Fund Scheme (EHF)’enlisting the salient features of the Scheme.  It was also mentioned in the said G.O. that Government Orders on the Operational guidelines for concerned officers under the control of Director of Treasuries and Accounts (DTA), Pay and Accounts Officer (PAO), Secretary to Government Information Technology and Communications department (Secretary IT&C), Commissioner Civil Supplies and Ex-Officio Secretary to Government (Civil Supplies and Consumer Affairs), District Collectors and Heads of Departments (HoD) for enrolment of beneficiaries, and operation of the Scheme by the Chief Executive Officer, Aarogyasri Health Care Trust will be issued separately. 

2.         Government after careful examination, keeping in view the convenience of the beneficiaries under the scheme, the following orders are hereby issued.

A.  ENROLMENT OF BENEFICIARIES

1. Beneficiaries shall mean the categories of beneficiaries covered under EHF.
2. AHCT will be the service provider and implementing agency; Heads of Departments and District Collectors will be responsible for enrolment of State Government employees, State Government pensioners and their dependents.
3. All HoDs and District Collectors will ensure that the Drawing and Disbursing Officers (DDOs) working under them as well as the District Treasury Officers / Sub-Treasury Officers concerned shall follow the process detailed below.
4. The information as available at present with the treasury offices under HRMS with DTA will be utilised to the extent possible for enrolment.
5. The data shall be collected in the HRMS Enrolment System (HRMS-ES) application maintained by AHCT as a single point of contact for the beneficiary.  The web address will be provided separately by 10-09-2012 for enrolment.

B. ROLE OF BENEFICIARY

1. Each beneficiary shall first register with Aadhar if not already registered, and obtain Aadhar number given at the time of enrolment. 
2. The employees and pensioners shall submit their application through e-form in the HRMS-ES portal application maintained by AHCT which will be opened by 10-09-2012.
3. Submission Process:

a.    Login to the web portal which will be opened by 10-09-2012.

b.    The employee code itself is the user ID and the password will be provided to him by DDO. At the time of first login the employee should change his password.  It shall be particularly kept in mind that the password shall be confidential and the individual shall not forget to change the password.

c.    The employee shall select his department, location and office unit,  designation, grade of pay scale, DDO etc. from the dropdown lists in the application, submit the data, and attach the needed documents.

 

a.    The employee/pensioner must furnish following while submitting the e-form.

1)    demographic data consistent with Service Register

2)    Digital copies of passport photos (ICAO compliant) of each beneficiary

3)    Aadhar number or Aadhar enrolment number

4)    Scanned copy of the first two pages of the Service Register (pages 1 and 2 of old service register form (or) pages 4 and 5 of new service register form where name, date of birth and signature of office head are available)

5)    Scanned copy of Ration card if available

Note: Computer illiterate employees/pensioners will approach the DDO/STO/APPO

          concerned directly with the aforementioned data/documents.

b.    (i)The employee shall take a printout and verify the accuracy of data. If there are errors, the same shall be corrected. A signed print out of the filled up application shall also be scanned and attached to the e-form.  This shall be the self-declaration of the employee.

(ii) The employee shall be responsible for furnishing correct details of dependent family members in the online enrolment application.  Any false declarations will entail disciplinary action against the employee.

c.    The e-form is then submitted.  After submitting the application, the employee will not be able to make changes to the data.

d.    The application is automatically submitted to the DDO concerned.

e.    The employee has to submit the signed application in physical form to the DDO duly signing the declaration.

C. ROLE OF THE CONCERNED DDO OF THE DEPARTMENT

1. The DDO shall login with his user ID. He will be able to see the filled up application in the system.
2. DDO/STO/APPO shall submit the applications on behalf of computer illiterate employees/pensioners.
3. The application data shall be verified with the office records and approval will be given on the system. In case the data entered by the employee is incorrect, the DDO will return the application to employee within the system itself. At the time of acceptance or rejection of an application by the DDO, the system will automatically generate an SMS to the individual.
4. When the application is rejected by the DDO, the employee will be able to edit and resubmit the same along with a fresh signed application.
5. In case of illiterate employees, the application form duly filled and signed shall be directly submitted to the DDO. The DDO shall get the data entry done in the presence of the employee. The photos shall also be uploaded.
6. After the health cards are printed and received, the same will be distributed to employees/pensioners. The card vendor will print and supply the cards.
7. The DDO shall ensure that applications are properly scrutinised after comparing with the originals.  Any improper scrutiny leading to ineligible persons being enrolled as employees/pensioners will entail disciplinary action against the concerned DDO/STO/APPO for authenticating the application.

Note:  The process stated above holds good for the pensioners also. For all the pensioners the Sub-Treasury Officer (STO)/Assistant Pension Payment Officer (APPO) will act as the DDO. Necessary validations shall be done by the STO/APPO concerned in the IT portal.

D. ROLE OF DIRECTOR OF TREASURIES AND ACCOUNTS (DTA)

The responsibility of DTA is to provide the existing data relating to employees, pensioners, and DDOs.  DTA shall perform the following duties.

1. Forward all the updated data available in HRMS of DTA to AHCT every two weeks.
2. Provide the list of all employees and pensioners’ data with their codes as available with him to AHCT which will use these codes for enrolling all the employees and pensioners.
3. Provide the list of all Drawing and Disbursing Officers data along with their codes and departments to AHCT, which will be used for authentication of any employee/pensioner by DDO.

1. Monthly deductions from individual employees/pensioners shall be made, after implementation of the Scheme and funds shall be transferred to AHCT as the Service Provider.

E. ROLE OF COMMISSIONER OF CIVIL SUPPLIES (CCS)/ SECRETARY IT&C

The function of CCS shall be to register all beneficiaries under Aadhar.  CCS authorised to perform the following.

      i.        Aadhar centres shall be put in place immediately at all district, division and mandal levels for exclusive enrolment of the employees, pensioners and their family members.

2. The Aadhar data consisting of the enrolled members' finger print templates and image formats, shall be located in AP State Data Centre, and transferred to AHCT servers in SDC every month.
3. Appoint a nodal officer to coordinate the aadhar registration at district level, coordinate with AHCT, and liase with District Collectors.
4. There are around 45 lakh beneficiaries to be registered in the State.  For this purpose a detailed schedule shall be prepared and communicated by the Secretary IT&C Dept., and the Commissioner of Civil Supplies, immediately in order to complete the registration by 20^th October.

F. ROLE OF CEO-AHCT

The functions of CEO-AHCT are to enroll all beneficiaries, issue health cards, and provide cashless service under EHF.  CEO-AHCT is authorized to undertake the following duties/activities.

i. Issue of Scheme guidelines

a.    Issue the detailed scheme guidelines based on these orders and update the same from time to time.

ii. Empanelment of Hospitals:

a.    Approve packages for listed therapies for cashless treatment of all diseases to the beneficiaries of the ‘Employees Health Care Fund Scheme’; while doing so, diseases that can normally be treated in Government Hospitals would be reserved for Government hospitals.  For the treatment of diseases so selected, the Trust would directly implement the Scheme on the same lines on which the on-going Aarogyasri Health Scheme is being implemented.

b.    CEO-AHCT will empanel additional hospitals after finalising the prices for listed therapies.

c.    Pay appropriate honorarium or consultation fee to the Team of doctors and other staff for preparing the medical and surgical packages for the new Scheme, from time to time.

d.    Enter into Service Agreements with the network hospitals.

iii. Operation of the Scheme

a.    Engage Staff with required skills and experience, finalise the contract agreements with them, for vigilance, operations (pre authorisations and claims) and administration, required for implementation of the EHS.

b.    Engage specialist doctors for pre-authorization and claim processing of cases referred to it under the new Scheme on payment on a per-case-basis.

c.    Engage BPO companies for offering support services in order to ensure a Service Level Agreement (SLA) of 12 hours for a preauthorisation, 7 days for a claim settlement, and clearly defined Turn around Times (TAT) for grievance redressal. 

d.    Establishment of office in the Andhra Pradesh MARKFED building at Jambagh, M.J. Road, Hyderabad on turnkey basis to commence the operations by the due date.

e.    Appoint a nodal officer to coordinate with all stakeholders and redress the grievances.

f.     Provide cashless service to all beneficiaries holding a health card.

 

Deployment of IT infrastructure

a.    A HRMS-ES will be put in place by AHCT as a single point of contact for the employee/pensioner for EHF.  This application shall be modular, customisable and be able to be used by departments of Government at a later date.  All the IPR and source code shall vest with Government without any limitations on use.

b.    Deploy the IT application required for the Employees Health Scheme.

c.    Deploy the IT infrastructure needed for the Scheme in State Data Centre as a private cloud duly integrating with the existing hardware infrastructure by the due date; and authorised to finalise the procurement and deployment through the existing vendor for this purpose in view of urgency and for reasons of compatibility with the existing technology.

d.    Engage vendor for issue of health cards to all the beneficiaries.

G. ROLE OF DISCTRICT COLLECTORS AND HoDs

1. The District Collectors shall take necessary action to see that the Aadhar registration, beneficiary enrolment, and card distribution is completed.  Nodal Officers at district level will be nominated for this purpose.
2. The heads at district level of all departments, District Treasury Officers, PAOs, and other staff shall be deployed by District Collectors as needed.
3. All Heads of Departments at State level shall supervise the enrolment of all employees under their control, as well as the approval of applications by the DDOs concerned.
4. All HoDs shall nominate a nodal officer for EHF, provide authenticated list of sanctioned posts under each DDO for all districts to AHCT (lists of office units, categories of posts, number of posts, service etc.), and also coordinate with District units, District Collectors and AHCT.  Any declaration of sanctioned posts not carrying sanction by appropriate authority will entail disciplinary action against the HoD concerned.
5. HoDs shall supervise the submission of applications by beneficiaries, approval of applications and issue of cards by DDOs in their head offices at Hyderabad exclusively.
6. IT Department will make all necessary arrangements at SDC for this purpose
7. The due date for completion of enrolment and approval shall be 20-10-2012.

3.         The CEO-AHCT, Secretary IT&C, CCS, DTA, Heads of all Departments, PAO, District Collectors, and all eligible employees and pensioners shall take necessary further action in the matter accordingly.

4.         This order issues with the concurrence of Finance (Expr. HM&FW.1) Dept. vide their U.O. No.7581/260/A1/Expr.M&H-1/2012, dated: 14-08-2012.