Employee Health Scheme by Government of Andhra Pradesh

Healthcare is not just a need; it’s a right. For thousands of government employees in Andhra Pradesh, this right is being delivered through a progressive initiative called the Employee Health Scheme Andhra Pradesh (EHS Andhra Pradesh). Spearheaded by the Government of Andhra Pradesh and implemented by Dr. YSR Aarogyasri Health Care Trust, the EHS ensures that both serving and retired employees, along with their dependents, receive cashless medical treatment across empanelled hospitals in the state.

This blog explores everything you need to know about EHS Andhra Pradesh, including its features, eligibility, coverage, registration process, and how it compares with the best health plan options available in India. We’ll also show how tools like the health insurance premium calculator from Bajaj Allianz General Insurance Company can help you make smart decisions when it comes to protecting your health and finances.

What is EHS Andhra Pradesh?

The Employee Health Scheme Andhra Pradesh, also known as EHS Andhra Pradesh, is a flagship initiative designed to provide cashless medical treatment to:

• Serving State Government employees
• Retired Government pensioners
• Their dependent family members

Administered by the Dr. YSR Aarogyasri Health Care Trust, this scheme replaces the traditional medical reimbursement system with a streamlined and digital health benefits model. Patients no longer need to worry about the stress of hospital bills, reimbursements, or insurance paperwork. Instead, the entire process is managed electronically through a government-run portal and a network of empanelled hospitals.

Key Features and Benefits of EHS Andhra Pradesh

What sets EHS Andhra Pradesh apart is its comprehensive healthcare support, covering everything from outpatient care to post-hospitalisation services. Here’s a quick look at its standout features:

1. Cashless Inpatient Treatment

Beneficiaries receive end-to-end cashless medical services, including 10 days of post-discharge medication and coverage for complications up to 30 days post-discharge.

2. Chronic Disease Coverage

Special provision for chronic outpatient treatments such as hypertension, diabetes, COPD, and rheumatoid arthritis, ensuring long-term health support.

3. Follow-Up Care

Follow-up services (consultations, tests, and medicines) are covered for up to one year for selected therapies.

4. Annual Health Check-ups

Employees above 40 years are eligible for annual preventive health check-ups, a critical step in early diagnosis and prevention.

5. Financial Coverage

Up to INR 2 lakhs per episode of illness. For high-cost treatments exceeding INR 2 lakhs (predefined packages), the Trust reviews and processes claims that exceed the limit.

6. Hospital Stay by Pay Grade

Accommodation is based on pay grade:

• Slab A (I–IV): Semi-private ward
• Slab B (V–XVII): Semi-private ward
• Slab C (XVIII–XXXII): Private ward

While this state-supported program is robust, employees should also evaluate supplementary coverage with private insurers, Bajaj Allianz General Insurance Company, which offers comprehensive health plan options tailored to their income, family size, and medical history.

Eligibility Criteria for EHS Andhra Pradesh

The Employee Health Scheme Andhra Pradesh outlines clear eligibility rules for enrollment:

Eligible Beneficiaries Include:

• Regular Employees of the state government
• Provisionalised employees of local bodies
• Service Pensioners (including family and re-employed pensioners)
• Dependent family members:
• • One legally wedded spouse
  • Dependent children (biological/adopted/stepchildren)
  • Dependent parents (either biological or adopted, not both)
  • Disabled children
  • Unemployed sons (up to 25 years)
  • Unemployed daughters (unmarried/widowed/divorced/deserted)

Not Covered Under EHS:

• Those covered under CGHS or ESIS
• Employees of Indian Railways, RTC, Police Welfare Schemes
• AIS Officers
• Casual/daily wage workers
• Independent children and law officers (public prosecutors, pleaders)

Also Read: Difference Between Health Insurance and Critical Illness Insurance

How to Enroll in EHS Andhra Pradesh?: Step-by-Step Guide

For Employees:

1. Visit the EHS Web Portal
   Go to https://ehf.ap.gov.in and log in using your Employee ID and password.
2. Fill in Personal and Family Details
   Enter mandatory data, upload documents, and click Save.
3. Print and Submit Application
   After verifying, submit the application to your Drawing and Disbursing Officer (DDO).
4. Download Health Card
   Once approved, download the EHS health card and laminate it for use.

For Pensioners:

1. Gather Required Documents
   Aadhaar, photograph, disability certificate (if applicable), pension ID, DOB certificates, etc.
2. Log in or Call EHS Helpline
   If you don’t know your User ID, call 104 or contact the STO.
3. Fill and Submit Application
   Fill in pensioner details, attach documents, and submit online.
4. Print and Upload Signed Form
   Upload the signed application to the portal and submit it at your STO/APPO office.

Note: You can also get your temporary EHS card printed at any Mee Seva Centre for INR 25.

Chronic Out-Patient Treatment Coverage

One of the core strengths of EHS Andhra Pradesh is its chronic outpatient treatment for over 25 long-term conditions. These include:

• Type 1 & 2 Diabetes
• Hypertension
• Hypothyroidism/Hyperthyroidism
• Rheumatoid Arthritis
• Bronchial Asthma
• Stroke
• Cardiac Failure
• Chronic Kidney Disease
• COPD
• Depression and Psychosis
• Parkinson’s Disease (added as per official list)
• SLE and other Connective Tissue Disorders
• Gout
• Coronary Artery Disease (CAD) - Medical Management
• Convulsive Disorder
• Inflammatory Bowel Disease
• Vascular Occlusive Disorder of Extremities
• Psoriasis
• Chronic Hepatitis
• Cirrhosis
• Nephrotic Syndrome
• Arrhythmias

Services available include consultations, lab investigations, radiology, and medicines. Outpatient services are available between 2 PM and 4 PM on weekdays at designated hospitals.

Tracking Enrollment & Medical Reimbursement Status

Beneficiaries can check the status of their applications or reimbursements online with just a few steps:

To Check Enrollment Status:

1. Go to the EHS portal.
2. Click on Search Employee Enrollment Status.
3. Enter details like name, DOB, department, and DDO.
4. Application status will be shown as Approved or Not Enrolled.

To Check Medical Reimbursement Status:

1. Click on Employee Medical Reimbursement Status or Pensioner Medical Reimbursement Status under the relevant section.
2. Enter Trust Number and DME Number.
3. The portal will display the current status.

No manual follow-up is required, as the Trust processes the claim once the hospital submits it.

How to Download or Update Your Health Card?

Download Process:

1. Log in to the EHS portal.
2. Click on Download Health Card.
3. Enter User ID and download the card.

Update Card Details:

1. Log in and click on Edit Card Details.
2. Modify name, DOB, relationship, etc.
3. Submit and download the updated card.

Empanelled Hospitals for EHS Andhra Pradesh

The EHS scheme partners with Network Hospitals (NWH) and NABH-accredited hospitals across Andhra Pradesh. To find the nearest empanelled hospital:

1. Visit the official EHS portal.
2. Click on List of Empanelled Hospitals.
3. Select your district and specialty.
4. A list of hospitals with addresses and specialties will appear.

Comparing EHS Andhra Pradesh with Private Health Insurance Plans: What’s Better for You?

While the Employee Health Scheme Andhra Pradesh offers significant benefits to eligible state government employees and pensioners, many individuals often wonder whether it's enough. The reality is that public health schemes, although well-intentioned and supportive, can have limitations in scope, flexibility, and geographical access. This is where private health insurance plans from Bajaj Allianz General Insurance Company step in to provide a broader safety net.

Let’s break down the key differences between EHS and private insurance policies to help you understand how to make an informed health coverage decision.

1. Coverage Scope

EHS Andhra Pradesh:

• Covers only listed treatments under empanelled government or private hospitals within the state.
• Has a cap of INR 2 lakhs per illness episode.
• Treatment must follow predefined packages under government pricing.

Private Health Plans:

• Offer customisable coverage with options ranging from INR 5 lakhs to INR 1 crore or more.
• Cover a wider range of medical procedures, including international treatments or advanced surgeries.
• Allow you to include additional benefits, such as maternity, dental, vision, or critical illness riders.

Using a health insurance premium calculator, you can estimate how much additional coverage will cost based on your family's needs and pre-existing conditions.

2. Hospital Network and Accessibility

EHS Andhra Pradesh:

• You must visit the empanelled hospitals (Network Hospitals – NWH) within Andhra Pradesh.
• Emergency treatment outside the state may not be covered unless the Trust later approves it.

Private Health Plans:

• Provide access to an 18,400+ PAN-India network of hospitals, including tier-1 cities.

If you or your dependents frequently travel or reside outside Andhra Pradesh, private health insurance becomes crucial for uninterrupted medical support.

3. Claims and Flexibility

EHS Andhra Pradesh:

• The claim is initiated and managed by the hospital post-discharge.
• No flexibility in choosing treatments outside the listed ones.

Private Health Plans:

• Offer direct claims support, 24/7 customer assistance, and easy reimbursement options.
• Allow you to choose doctors, hospitals, and even alternative treatments like Ayurveda or Homeopathy, depending on the plan.

Moreover, Bajaj Allianz General Insurance Company offers fast-track claim processing and app-based management tools that simplify paperwork.

4. Family Inclusion and Add-ons

EHS Andhra Pradesh:

• Covers only dependents as defined by the government (spouse, children, parents, etc.).
• Cannot add extended family members or customize inclusion criteria.

Private Health Plans:

• You can customise family floater policies to include parents-in-law, multiple children, siblings (in some plans), and more.
• Add-ons such as room rent waivers, no-claim bonuses, and wellness benefits improve value over time.

5. When to Combine Both?

EHS is an excellent foundational health support scheme, but it works best when combined with a private health plan. This combo ensures:

• Higher sum insured
• National and international coverage
• Emergency support outside the EHS network
• Preventive health check-ups and wellness benefits

By using a health insurance premium calculator, you can get accurate premiums based on your age, income, health history, and desired coverage level, making it easier to pick the best health plan that fills any gaps in your EHS coverage.

Also Read: What is Restoration Benefit in Health Insurance & How Does it Work?

Use a Health Insurance Premium Calculator Before Choosing the Best Plan

Want to know how much you’ll pay for comprehensive health coverage?

The health insurance premium calculator by Bajaj Allianz General Insurance Company helps you:

• Estimate premiums based on age, sum insured, and family size
• Compare individual vs. family floater plans
• Identify tax-saving opportunities under Section 80D

By combining the Employee Health Scheme Andhra Pradesh with a private best health plan, you get peace of mind, higher limits, pan-India coverage, and better hospital access.

Conclusion

The EHS Andhra Pradesh is a visionary step by the state government to make affordable and accessible healthcare a reality for its employees and pensioners. It’s not just a scheme; it’s a commitment to wellness, dignity, and quality of life for those who serve the public.

Yet, it is wise to remember that public health schemes often come with limitations. For complete protection, pairing EHS with a best health plan from Bajaj Allianz General Insurance Company ensures you’re covered for emergencies, bigger bills, and beyond-state treatment needs. Use a health insurance premium calculator today and find the plan that secures your tomorrow.

FAQs About EHS Andhra Pradesh

Q1. What is the Employee Health Scheme (EHS) Andhra Pradesh?

EHS Andhra Pradesh is a government health initiative that provides cashless treatment to active and retired state government employees and their dependent family members. It is implemented by the Dr. YSR Aarogyasri Health Care Trust and replaces the older medical reimbursement system. The scheme covers hospitalisation, chronic disease treatment, post-hospitalisation care, and follow-up services across empanelled hospitals in the state. Beneficiaries can avail of treatment without paying upfront charges. For added protection beyond the state’s network, private health insurance plans like those from Bajaj Allianz General Insurance Company can serve as a supplement for nationwide or high-cost treatment coverage.

Q2. Who is eligible for EHS Andhra Pradesh?

Eligibility for EHS Andhra Pradesh includes all regular employees of the state government, provisionalised local body staff, retired pensioners, and their eligible dependents. Dependent family members can include one legally wedded spouse, dependent children (biological, step or adopted), dependent parents (either biological or adopted), and unemployed or disabled children. Family pensioners are also covered if they do not have earning dependents. Individuals already covered under CGHS, ESIS, or other specific departmental schemes are excluded. To ensure complete protection for all family members, many users opt to combine this with a private plan via the Bajaj Allianz General Insurance Company’s health insurance premium calculator.

Q3. What is the maximum financial coverage offered under EHS?

Under EHS Andhra Pradesh, beneficiaries can receive up to INR 2 lakhs per episode of illness. There is no limit on the number of episodes, but the scheme only covers treatments listed in the approved package. For therapies that exceed INR 2 lakhs, claims are reviewed and processed by the CEO of Dr. YSR Aarogyasri Health Care Trust. It’s important to remember that not all hospitals or treatments fall within the network. To fill this gap, having a backup policy like Bajaj Allianz General Insurance Company’s best health plan ensures high-value claims are taken care of without financial stress.

Q4. Does EHS Andhra Pradesh cover chronic disease treatment?

Yes, one of the most important features of EHS Andhra Pradesh is the inclusion of chronic outpatient treatment for diseases like diabetes, hypertension, COPD, hypothyroidism, rheumatoid arthritis, and more. These services are available on weekdays between 2 PM to 4 PM at designated hospitals. Beneficiaries receive doctor consultations, lab tests, and prescribed medicines under this scheme. For individuals with multiple conditions or requiring specialist care outside the listed treatments, private health insurance from providers like Bajaj Allianz General Insurance Company offers broader coverage. You can use a health insurance premium calculator to compare options based on pre-existing illnesses.

Q5. How can a state employee enrol in EHS Andhra Pradesh?

A serving government employee can enrol in EHS by visiting the official web portal (https://ehf.ap.gov.in). Log in using your Employee ID, enter the required personal and family details, and submit the application online. After verification by the Drawing and Disbursing Officer (DDO), a temporary health card is issued, which can be downloaded and laminated. For pensioners, enrollment involves uploading documents and signing the application before submission at the respective Sub-Treasury Office (STO). While EHS handles standard needs, for more robust protection, using Bajaj Allianz’s health insurance premium calculator can help find complementary private plans.

Q6. Is the EHS Health Card mandatory for availing treatment?

Yes, the EHS health card is necessary to avail services at empanelled hospitals. This card contains your beneficiary ID and family member details and ensures seamless access to cashless services. Once your application is approved, you can download the card from the EHS portal using your User ID and password. You may also collect it from a Mee Seva Centre for a nominal fee. However, it is wise to have a secondary health policy, especially for use at private or non-empanelled hospitals. Bajaj Allianz General Insurance Compay offers user-friendly options that can be explored via their health insurance premium calculator.

Q7. How do pensioners register and use EHS Andhra Pradesh?

Pensioners need to upload scanned documents such as Aadhaar, photographs, DOB proof, and dependent details on the EHS web portal. They must fill out the online application form and submit a signed hard copy to their respective STO or APPO. Once verified, a health card will be issued. If they don’t have login credentials, they can call the EHS toll-free helpline (104) or approach the STO office. Since EHS is state-specific, retirees often choose to buy additional private coverage for PAN-India protection. Tools like Bajaj Allianz General Insurance Company’s health insurance premium calculator can help assess these needs efficiently.

Q8. Can I check my enrollment or reimbursement status online?

Yes, the EHS portal provides real-time tracking of both enrollment and reimbursement applications. You can check your Employee Enrollment Status or Medical Reimbursement Status by entering basic details like your name, department, and DME or Trust number. These tools allow transparency and reduce paperwork. However, reimbursement under EHS is mostly hospital-initiated post-treatment. For faster access to funds or treatment beyond EHS’s scope, consider investing in an individual health plan from Bajaj Allianz General Insurance Company. Use their health insurance premium calculator to find a plan that fits your medical and financial requirements.

Q9. Are treatments outside Andhra Pradesh covered under EHS?

EHS is designed to operate primarily within Andhra Pradesh through its network of empanelled hospitals. Treatments outside the state may not be covered unless explicitly approved by the Trust in emergency scenarios. This limitation makes it risky for those who travel frequently or live part-time outside the state. A smart strategy is to purchase a national-level private insurance plan that ensures seamless coverage across India. Bajaj Allianz General Insurance Company offers wide hospital networks and cashless facilities across states, and with the health insurance premium calculator, you can easily estimate costs based on your location and healthcare needs.

Q10. How does Bajaj Allianz General Insurance Company complement EHS Andhra Pradesh?

While EHS Andhra Pradesh is comprehensive for government employees, it may not be sufficient in all situations, such as treatments outside the empanelled list, hospitalisation in other states, or major surgeries exceeding coverage limits. That’s where Bajaj Allianz General Insurance Company comes in. As a leading health insurance provider, it offers customisable plans, add-ons such as critical illness cover, maternity benefits, and international healthcare access. Using the health insurance premium calculator, you can explore and choose the best health plan that complements your EHS benefits, ensuring you and your family are fully protected, regardless of where or how treatment is needed.

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**Tax benefits are subject to change in prevalent tax laws.

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The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional.