Employees Health Scheme Telangana

Employees Health Scheme is formulated to provide cashless treatment to the employees, pensioners of the State Government and their dependent family members, which will replace the existing medical reimbursement system, with additional benefits such as post-operative care and treatment of Chronic diseases, which do not require hospitalization and treatment in empanelled Hospitals. 

Eligible Beneficiaries

1. Serving Employees:

   • All regular State Government Employees. A State Government Employee will have the meaning as defined under Fundamental Rules.

   • Provincialized Employees of local bodies.

2. Retired Employees:

   • All service pensioners

   • Family pensioners without dependents

   • Re-employed Service Pensioners

Beneficiaries not covered:

1. Those who are covered under other insurance schemes such as CGHS,

2. ESIS, Railways, RTC., Aarogya Bhadratha of Police Department and Aarogya Sahayatha of Prohibition & Excise Department;

3. Law officers (Advocate General, State Prosecutors, State Counsels, Government Pleaders and Public Prosecutors);

4. Casual and Daily paid workers;

5. Biological parents if adopted parents exist;

6. All independent children; and

7. AIS officers and AIS pensioners.

Family:

The following will constitute the family:

1. Dependent Parents (either adoptive or biological, but not both).

2. One legally wedded wife in case of a male employee/ service pensioner.

3. Husband in case of a female employee/ service pensioner.

4. Wholly dependent legitimate children (including step children and adopted children); and

5. Dependents of family pensioners shall also be eligible as in the case of Service Pensioners.

Dependency:

1. In case of parents, those who are dependent on the employee for their livelihood.

2. In case of unemployed daughters, those who are unmarried or widowed or divorced or deserted.

3. In case of unemployed sons, those who are below the age of 25 years

4. Disabled children with a disability which renders them unfit for employment.

Health Card

The eligible beneficiaries will be provided with health cards also called eligibility cards.

The procedure of verification of eligibility of beneficiary under the scheme shall be by online authentication of the Health Card details. The beneficiary shall provide either the eligibility card or the card number in case the card is unavailable. The staff at the kiosk in the Network Hospital shall verify the details online by accessing the database. Once the authentication is complete, the eligibility verification ends.

BENEFIT COVERAGE

In-Patient Treatment:

• The scheme will provide Inpatient treatment for the listed therapies for identified diseases under all specialties in the empanelled hospitals. List of IP therapies

• Package includes the following services:

  • End-to-end cashless service offered through a NWH from the time of reporting of a patient till ten days post discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a "listed therapy(ies);

  • Free OP evaluation of patients for listed therapies who may not undergo IP treatment including consultation and investigations

Follow-up Services:

Follow-up services are provided for a period of one year through fixed packages to the patients whoever requires long term follow-up therapy in order to get optimum benefit from the procedure and avoid complications. Follow-up package includes consultation, investigations, drugs etc., for one year for listed therapies. List of IP therapies

Outpatient Treatment for identified chronic diseases:

OP treatment for pre-defined long-term (chronic) diseases will be provided in notified hospitals. Orders on the modalities and provision of budget to the notified hospitals will be issued separately.

Hospital Stay:

The eligibility for Slab-A (consisting of employees with Pay Grades from I to IV), and Slab B (consisting of employees with Pay Grades from V to XVII) will be semi-private ward, and for Slab- C (consisting of employees with Pay Grades from XVIII to XXXII) will be private ward.

FINANCIAL COVERAGE

• The total cost on implementation of Employees Health Scheme shall be borne by the Government and no contribution will be collected from the employees/pensioners. There shall be no upper limit on the financial coverage and the total cost of treatment of the patient for the enlisted therapies will be covered under the scheme.

How Pensioner can enroll for Health Card?

BEFORE LOGIN, KEEP THE FOLLOWING DOCUMENTS/PHOTOS READY WITH :

SELF (Scanned copies):

• Aadhar card/Aadhar Enrolment receipt.

• Pension payment order of pensioner. (Not mandatory)

• Digital copy of ICAO complaint Passport size photo (45mm X 35mm)

• Disability Certificate, if disabled

DEPENDENTS (Scanned copies):

• Aadhar card/Aadhar Enrolment receipt

• Digital copy of ICAO complaint Passport size photo (45mm X 35mm)

• Birth certificate in case of children below 5 years.

• Disability Certificate, if disabled.

• Whether spouse is a government employee/Pensioner Need to add the service register/Pension Payment Order scanned copies

NOW LOG IN TO: www.ehf.gov.in

• Click on Sign-in (Top right side of the screen)

• Your User ID & Password is available with the STO/APPO (or) can be obtained from 104 Seva Kendram by dialing ‘104’.

• Your user ID is: Your Pensioner ID (available with your STO).

• Password is also: Your Pensioner ID (i.e. user ID as above)

• Login as: Select the Employee/Pensioner from the desired dropdown list.

• After login: change your password (The new password should contain minimum “3” characters and maximum “8” characters, out of which one should be an alphabet, one numerical number and one special character such as “@,#,$”etc).

• Enter your ‘mobile number’

• Enter your ‘e-mail ID’

• New password will be sent to your mobile through “SMS” / e-mail.

• After you sign-in: Click on "Registrations" at the left side

• Then click on: "Initiate Health Card"

• Now click on : Aadhar No/ Aadhar Enrolment No, as the case may be 

• Enter Aadhar No/ Aadhar Enrolment number as indicated below:

  1. If you have Aadhar Card enter the 12 digit number of it in the Aadhar number box.

  2. If you have only Aadhar Enrolment Acknowledgement, please check the 14 digit "Enrolment number" on the left hand side of the Acknowledgement copy obtained upon Aadhar registration. Fill this 14 digit number in the EHS e-form under Identification details Eg: Enrolment No. 1111/15210/02106. Please fill in this 14 digit number in the EHS e-form under "Identification Details" as 11111521002106

  3. Please check the "Date" column on the right hand side of the acknowledgment copy along with the time-stamp in the format: Date (2 digits)/month (2 digits)/year (4 digits), and hours (2 digits): minutes (2 digits): seconds (2 digits), a total of 14 digits.

  4. Convert this into a continuous number by writing "Date" from right to left without slashes and time without colons as in the below example: Date: 11/08/2011 16:48:44 should be converted as 20110811164844.

  5. Please enter the number so obtained, in continuation to the 14 digit Enrolment No. The 28 digit Enrolment ID is made up of 14 digit Enrolment number and date & Timestamp. Example: 1111152100210620110811164844

  6. Enter this 28 digit number in the ‘Aadhar enrolment number’ box.

• Now click on "Retrieve Details"

• Application form appears

• Enter the details as required

Note: The date of birth recorded in ‘Aadhar data base’ will automatically get displayed in the date of birth column of the application. This is not editable. If the date of birth is not recorded in the ‘Aadhar data base’, the date of birth has to be manually entered in the date of birth column of the application.

• After entering details click on the ' Save ' Button.

• Then click on "Add attachments"

  • Before uploading attachments see that their size should be less than 200KB. You can reduce the resolution while scanning.

  • You can compress the picture through 'edit option' in MS Office picture manager (or) MS-Paint, so that memory size will be below 200 KB.

  • Remember to name the attachments without spaces or special characters and also to identify easily while uploading.

• Now add family members by clicking 'Add Beneficiary’

• Upload photo & Aadhar Card of family members

• Verify the correctness of the details

• If there are any errors in attachments you may select check box with the name of next and click 'remove attachment' option and now browse and add correct attachment in correct place.

Note: Employee ID/Pensioner ID of spouse, in case spouse is a State Government Employee / Service Pensioner, need to be entered in the given space of the application.You are responsible for furnishing correct details of dependent family members in the online enrolment application. Any false declarations will entail disciplinary action against you.

• ‘Save’ the enrolment form

• Now 'submit' the application by clicking “Submit application” tab After clicking 'submit application' option you cannot edit any data.

• You will receive the following message on your mobile: "Application submitted successfully; Your health card enrolment ID:…;

• Your signed application uploading is pending"

• Now ‘print’ the Application Form

• Sign the printed application and make a scan copy

• Now you may need to login again as the session may expire.

• Now upload signed application by clicking "add attachment"

• Now 'submit application for approval'

• Task will be sent to your STO/APPO login.

• Now you will receive one more message on your mobile, as indicated below: "Application submitted successfully with enrollment ID………… and Pending with STO/APPO .... Code"

• If the STO/APPO rejects the application, you will receive a message on your mobile.

• Then you need to login again and you can edit for minor changes or reset and feed data afresh if there are major changes.

• The details or attachments of the Beneficiary will become editable only after the employee clicks the 'save' option ('Add beneficiary' option and 'remove' option beside the beneficiary details will now be seen).

• Click on “Submit application”.

• Print the application, sign and upload scanned signed-copy.

• Click on “Submit for approval” tab. The application reaches the STO/APPO Login.

• Physical copy of the application signed by you shall be handed over to the STO/APPO

• If approved by the STO/APPO you will receive the following message “Health Card Enrollment Application Approved by STO/APPO.. code"

• When your Health Card is ready, you will receive an intimation on your mobile / email. 

How to add beneficiaries under EHS scheme?

Follow the below steps to add beneficiaries under EHS scheme

• Login to the EHS web portal.

• Login as Employee with respective Employee ID & Password.

• Click on 'Registrations' tab.

• Click on Initiate New/Rejected Beneficiaries.

• Click on Add Beneficiary.

Conditions for adding beneficiary:

1. If the dependent family member DOB is above 5years, then it requests for Aadhaar card certificate and Photo.
2. If the dependent family member DOB is below 5years, then it requests for DOB certificate and Photo.
3. Beneficiary once added for any relationship, cannot be added twice in dependent family members details.
4. Son's age greater than 25 can not be added. If son is disabled, then age greater that 25 will be accepted.
5. Dependent's daughter age greater than 25 is acceptable.
6. Relationship and Gender must match.