Andhra Pradesh’s Employees’ Health Scheme (EHS), introduced in 2013 to provide cashless, quality medical care, is under scrutiny after state government employees voiced serious concerns about its performance. The scheme, which covers over 13 lakh employees, pensioners, and their families, is reportedly failing to deliver on its core promise of financial protection and accessible healthcare.
At a recent EHS Managing Committee meeting held at the NTR Aarogyasri Trust Office in Mangalagiri, representatives from AP JAC Amaravati highlighted systemic issues in the scheme’s implementation. Delayed reimbursements to empanelled hospitals were cited as a key concern. Due to these delays, patients are frequently forced to pay upfront for medical services, pushing many into debt. Current government reimbursements reportedly cover only around 30 per cent of actual treatment costs.
Employee leaders demanded urgent reforms to address these lapses. Among their key proposals were the regular scheduling of EHS committee meetings at both state and district levels to ensure better oversight, and a complete shift from offline to online reimbursement processes for retired employees. They also sought to increase the medical reimbursement cap from Rs 2 lakh to Rs 5 lakh to reflect rising healthcare costs.
Additional demands included free outpatient consultations and diagnostics for EHS beneficiaries at all network hospitals, special coverage packages for commonly- performed procedures, and the adoption of Ayushman Bharat standards for trauma and critical care—currently not fully covered under EHS.
While the CEO of NTR Aarogyasri Trust acknowledged the issues and promised follow-up action, including a forthcoming steering committee meeting led by the Chief Secretary, employee associations continue to seek timely and concrete reforms to ensure that EHS meets its original objectives.