Employee Health Assurance Scheme (EHAS) 2022 has been rolled out by Assam government from 1 February 2021. From this scheme, around 4.3 lakh state govt employees would be benefited. The Request for Proposal (RFP) to implement EHAS Scheme was published recently. It stated that the Assam Employee Health Assurance Scheme would also cover newly recruited employees and their family and all civil officers serving under the Assam government on an optional basis.
Assam Employee Health Assurance Scheme 2022
As per the provisions of the Assam Employee Health Assurance Scheme 2022, all the state govt. employees will mandatorily be members of EHAS. This compulsory membership of state government employees will come in effect from first day of commencement of EHAS Scheme.
The Assam government will pay EHAS Insurance Premium Amount on behalf of employees and pensioners to the insurance company. It is estimated that approx. 4.3 lakh state government employees will be the beneficiaries of the Assam Employee Health Assurance Scheme 2022.
In addition to this, the state govt. pensioners may be allowed to join the EHAS Scheme in future on an optional basis in case of such a requirement in the future. The Employee Health Assurance Scheme envisages cashless treatment facility to beneficiaries through an insurance company and a network of empanelled hospitals as per the criteria specified by the Assam government.
Benefit Package in Employee Health Assurance Scheme
The benefit package in EHAS Scheme would be finalized by an expert committee constituted by Dept. of Health & Family Welfare for revision of packages and costing. An illustrative Basic Benefit Package and Additional Benefit Package for catastrophic procedures including transplant surgeries is included. The scheme will also cover all pre-existing diseases of the beneficiaries from the inception of the scheme. However, out-patient treatment will not be covered under EHAS scheme. The 2 types of benefit package in Employee Health Assurance Scheme are described below.
Basic Benefit Package
The costing of basic benefit package includes procedure cost, implant cost, if any, and room charges. As part of the basic benefit package, the insurer will pay all expenses, as per package costs specified, incurred in course of medical treatment availed by the beneficiaries in empanelled hospitals for the medical, surgical and day-care procedures as enlisted.
Additional Benefit Package
In this package, the insurance coverage is to be given over and above the basic coverage for catastrophic illnesses specified. All diseases under the scheme will be covered from day one and there will not be any waiting period
Unspecified Procedures in EHAS Scheme Assam
Unspecified Procedures should be covered under basic benefit package of EHAS Scheme Assam. This coverage would be based on the pre-authorization process initiated by insurance company and authority. It will be limited to Rs. 3 lakhs per annum during the block period of three years.
COVID-19 Coverage in Assam Employee Health Assurance Scheme
New diseases like Covid-19 will also be covered based on the regulatory provisions issued by IRDA from time to time. Currently, the medical treatment for Assam government employees and their family members is covered under the Assam Medical Attendance Rule, 2008 (dated 15th Nov 2008 and as amended from time to time).
The employees are eligible for medical reimbursement for both out-patient and in-patient medical care from government hospitals and empanelled private hospitals.