PRTUTS: REVISED GUIDELINES FOR IMPLEMENTATION OF NEHS

1. Beneficiary Coverage & Eligibility

Serving Employees Covered: Includes all regular State Government employees, provincialised employees of local bodies, and employees of Model Schools, Gurukul/Residential Educational Institutions, Government-aided institutions, Agricultural Market Committees, State Universities, and Government-supported Libraries.
Retired Employees Covered: Covers all Service Pensioners, Family Pensioners, and Re-employed Service Pensioners.
Eligible Dependents: Includes dependent parents (either biological or adoptive, but not both), a legally wedded spouse, wholly dependent legitimate children (including stepchildren/adopted children), and dependents of family pensioners.
Dependency Limits: Unemployed daughters remain eligible while unmarried, widowed, divorced, or deserted. Unemployed sons are covered up to the age of 25. Disabled children unfit for employment remain eligible indefinitely.
Exclusions: Excludes individuals covered under other government arrangements (e.g., CGHS, ESIS, Railways, RTC), Law Officers, casual/daily workers, and All India Service officers (unless specifically included).
Dual-Spouse Rule: If both spouses are government employees or pensioners, only one makes a monthly contribution under a single shared family account.
New Employees Health Scheme important links

Digital Enrolment: Registration and data validation will be conducted through an online module integrated with the Integrated Financial Management Information System (IFMIS) and other authoritative databases.
Electronic Health Cards: Cards are generated digitally via a web portal or mobile app. Existing EHS cards remain valid during the transition period. The digital card grants access to cashless treatments and specific outpatient concessions.
Read in TELUGU

CGHS Framework: The scheme adopts the Central Government Health Scheme (CGHS) treatment and package framework (covering 2,594 medical/surgical procedures), including pre-hospitalization OPD and post-discharge follow-up.
Non-Package Treatments: For procedures outside the standard package, the cashless ceiling is enhanced from ₹2.00 lakh to ₹5.00 lakh per episode. Cases exceeding ₹5.00 lakh require approval from the EHCT Board of Trustees.
Non-Empanelled Hospitals: Treatment in non-empanelled areas is permitted if EHCT is notified within 24 hours of admission. Reimbursement is capped up to ₹50,000 for non-emergencies and up to ₹1,00,000 for emergency episodes.

Primary Contact: Wellness Centres handle basic outpatient needs, diagnostics, chronic disease management, and medicine supply. High-end diagnostic tests will be referred to empanelled NABL-accredited labs.
Expansion: Existing Wellness Centres will transfer to the Employees Health Care Trust (EHCT). New centres will expand into 24 districts and Hyderabad using a dedicated ₹44.00 crore government budget provision.
Master Health Check-up: Beneficiaries aged 40 and above are entitled to one cashless comprehensive preventive health check-up per financial year.
Hospital Concessions: Beneficiaries receive a 50% concession on out-patient consultations and investigations at empanelled hospitals when using their electronic Health Card.
AYUSH Integration: Ayurveda and other recognized Indian systems of medicine will be brought under the scheme for notified chronic disease treatments.

Consolidated Network: The initial network brings together 943 hospitals, combining 435 existing EHS hospitals and 508 hospitals from the Medical Reimbursement system.
Out-of-State Care: Suitable hospitals in locations outside Telangana (such as Vijayawada and Kurnool) will be empanelled to ensure accessibility.
Classification: Network hospitals are categorized into Category 1 (Non-NABH and standard NABH) and Category 2 (NABH Super-Specialty Hospitals).

Funding Structure: Financed through a monthly beneficiary contribution matching an equal contribution from the State Government.
Contribution Rate: Serving employees contribute 1.5% of their Basic Pay, and pensioners contribute 1.5% of their Basic Pension. Funds are directly remitted to the EHCT Trust Fund Account by the Finance Department.
Room Accommodations: Hospital room entitlements are tied directly to the monthly contribution amount:
- Contributions up to and including ₹1,000/month: Semi-Private / Sharing Room.
- Contributions over ₹1,000/month: Private / Single Room.

Technical Committees: A Technical Committee will review package changes, complex/high-cost treatments, and AYUSH protocols. A Pharma Committee will govern the procurement of drugs and consumables.
Anti-Fraud Measures: Employs real-time IT monitoring of claims, mandatory daily reporting of hospital admissions by field staff, and strict blacklisting penalties for fraudulent hospitals.
Grievance Redressal: A trackable four-level system handles disputes:
- Level 1: Hospital EHS Liaison Assistant/Nodal Officer.
- Level 2: EHCT District Cell (resolved within 7 working days).
- Level 3: Office of the CEO, EHCT (resolved within 15 working days).
- Level 4: EHCT Board (final administrative appellate authority).

Timeline: The government aims to begin implementing the electronic NEHS Health Card system by 17.07.2026, with technical components operationalized in phases.
Continuity: Pending dues from the legacy EHS and Medical Reimbursement schemes will be cleared by the Government in instalments. Authorized ongoing treatments will not be disrupted due to the transition.
Board Update: The Secretary of Aarogya Bhadratha (Police Department) is officially added as a Member of the Board of Trustees of EHCT.