empanelled hospital will guide and facilitate
the movement of EHS patient from the time
of registration till the time of discharge.
e) The network hospital will earmark one of their
staff as EHS liaison assistant to liaise with EHS
patients.
4.2.2.Outpatient Treatment for identified chronic
diseases:4.2.2.1 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.
4.3 FINANCIAL COVERAGE
a). The employees, pensioners and their
dependent
family members will be eligible for
a sum of Rs.2.00 lakhs (Rupees two lakhs only)
per episode of illness with no limit on the number
of episodes as existing in APIMA Rules, 1972.
However, in the cases where the cost of treatment
exceeds Rs.2.00 lakhs, cashless treatment will
continue. No network hospital shall deny the
treatment in such cases.
b). The limit of Rs.2.00 lakhs will not apply in cases
where predetermined package rates are above
Rs.2.00 lakhs.
c). Chief Executive Officer, Aarogyasri Health Care
Trust will settle the claims which exceed Rs.2.00
lakhs, following the standard claims settlement
process after obtaining the approval of the
Technical Committee constituted by the
Government.
5. HOSPITALS:
The empanelment and hospital payments is as follows.
5.1 Hospital Empanelment
a. Guidelines for empanelment of hospitals within
the State and outside, preauthorization
and other modalities while implementing the
scheme will be in conformity with the existing
standard procedures being followed by AHCT.
The list of empanelled hospitals will be made
available in the official website www.ehf.gov.in
b. Empanelled hospitals resorting to irregularities
or misuse shall be blacklisted and entire amount
recovered besides launching criminal action.
c. Any irregularities or misuse committed by the
beneficiaries coming to the notice of Government
or AHCT will entail disciplinary action as per A.P.
C.S. (CCA) Rules, 1991