ANDHRA PRADESH PROHIBITION & EXCISE DEPARTMENT



AROGYA SAHAYATHA

ANDHRA PRADESH P ROHIBITION & EXCISE DEPARTMENT

EMPLOYEES HEALTH AND MEDICAL WELFARE TRUST

FROM: To:

…………………………………….. The Managing Director,

……………………………………. …………………………..

O/o the…………………………….. ……………………………

No: AS/ /2006/UNIT Dated

Subject: Medical treatment under Arogya Sahayatha for Sri/Smt/Kumari_______________

Desig. Unit suffering with_____________________

(Arogya Sahayatha. No. )

* * *

Sir,

Sri/Smt. /Kumari ______________________Sex Male/Female Aged _________Employee/

Dependent of Sri/Smt_______________________related as_____________a beneficiary of Arogya Sahayatha Scheme with No. ________ suffering from “________________________________________

________________” and she/he was admitted in your hospital on _______________ for medical treatment. He/She may be provided necessary medical treatment under the terms of the Scheme.

The bills accepted by the patient (as far as possible the employee) for the admissible amount

(in triplicate) duly countersigned by the treating doctor, may be raised in the name of Secretary, AS Scheme, Hyderabad as per tariff indicated by the A.P. State Govt. G.O. Ms.No.74, Health Medical & FW (K1) Dept, Dated, 15.4.2005 or special tariff if any approved by the AS trust. These may be sent to Secretary, Arogya Sahayatha Office of the Commissioner, Prohibition & Excise A.P., Hyderabad along with the copies of investigation reports, discharge summary and other documents prescribed by the Arogya Sahayatha Trust and the State Govt. for processing and payment.

Appendix II & Annexure II are sent herewith to support the bill of the hospital for claiming payment for services.

It may be noted that the present letter of authorization is for the treatment of the ailment/ medical condition mentioned above if covered by the list of ailments approved under the scheme and does not cover other ailments / medical conditions, which do not find mention in the Circular Memorandum No. A. Sah/1/Hospitals/2006, Dt.25.01.2006. Treatment of any ailment / medical condition other than mentioned in this letter, but covered under the scheme, would require a fresh authorization letter.

Thanking You,

Yours faithfully,

( ) (mention Name in Full)

Copy to:

1. Secretary, Arogya Sahayatha, Office of the Commissioner, Prohibition & Excise Nampally, Hyderabad, A.P. along with 1 set Copies of Annexure-II and Appendix-II.

APPENDIX – II

Application for claiming refund of Medical Expenses incurred in connection with Medical Attendance and or treatment of Government of servant and their families.

(NB: Separate form should be used for each patient)

1. Name & Designation of Govt. Servant :

(in Block letters)

2. Office in which employed :

3. Pay of Govt. Servant and defined in F. Rs. :

and other emoluments which should

be shown separately.

4. Place of duty :

5. Full residential address with :

door. No. & Name of Mohalla

6. Name of the patient and his / her :

Relationship to the employee.

7. Place at which the patient fell ill :

8. Nature of illness and its duration :

9. Details of amount claimed cost of :

Medicines purchased from the market/ list

of medicines, cash memos & Essentiality

Certificate should be approached each

Treatment Doctor.

10. Total amount claimed :

11. List of enclosures : 1. Cash memos:

2. Essentiality

Certificate.

DECLARATION TO BE SIGNED BY THE GOVT. SERVANT

I here by declare that the statement in this application are true to the best of my knowledge and belief and that the person for whom medical expenses were incurred is a member of my family as defined under the Govt. servant Medical Attendance Rules and wholly dependent upon me.

Signature of the

Govt. Servant & Office

Attested

Unit Officer.

ANNEXURE – II

Undertaking by member employee of Arogya Sahayatha Scheme authorizing Secretary, Arogya Sahayatha to claim reimbursement for medical expenses incurred by the scheme under the provisions of G.O. Ms. No. 1081 dated 31/05/2005 of Revenue (Ex.II) Dept.

I, sri/smt/Kum__________________________Designation____________working at_______________ (mention the name of the Unit) and a member of Arogya Sahayatha Scheme vide membership No.___________ (mention Arogya Sahayatha Scheme A/c No. )

Hereby authorize Secretary, Arogya Sahayatha Scheme to claim reimbursement of medical expenses under the relevant rules incurred on my or my family member’s treatment by the Arogya Sahayatha Scheme. The amount so claimed may be credited to Arogya Sahayatha Trust.

I, also undertake that I shall not claim reimbursement from the department / unit separately under APIMA rules or AIS (MH) Rules to the extent of the treatment availed by me or my family member’s under the provisions of Arogya Sahayatha Scheme.

Signature of the Member Employee

Attested

Unit Officer.

APPENDIX - I

ANDHRA PRADESH PROH. & EXCISE DEPARTMENT HEALTH AND MEDICAL

WELFARE TRUST – AROGYA SAHAYATHA

LIST OF SERIOUS AILMENTS/ MEDCIAL CONDITIONS COVERED UNDER

AROGYA SAHAYATHA

1. GENERAL SURGERY

AILMENT COVERED AILMENT NOT COVERED

a) Perforated peptic ulcer a) Viral Hepatitis

b) Acute Peritonitis b) Liver Abscess

c) Acute Pancreatitis c) T. B. Liver

d) Acute Appendicitis (Laparoscopic Appendicectomy) d) Cirrhosis Liver

/ Open Surgery

e) Choleeystitis and gall stone removal (Laparoscopic e) Amoebiasis

Cholecycetetomy) / Open Surgery

f) Acute intestinal obstruction f) Gastritis

g) Acute Intussuption g) Gastroenteritis

h) Gangrene Intestine h) Peptic Ulcer

2. ONCOLOGY

AILMENT COVERED AILMENT NOT COVERED

a) All Malignant tumor requiring – Cancer Surgery, a) Benign tumors’ except

Chemotherapy, Radiotherapy space occupying lesions of

Brain requiring Debulking surgery

______________________________________________________________________________

3. NEPHROLOGY & UROLOGY

AILMENT COVERED AILMENT NOT COVERED

a) Renal Failure requiring Acute and chronic –Dialysis a) Hydronephrosis

(for one year)

b) CAPD, Renal Transplantation b) Pyelonephrititis

c) Traumatic repture – Ureter, Bladder, Urethra, c) Incontinence of Urine

Renal Calculus – Lithotripsy, ESWL, Open

Procedure, PCNL

d) Ureteric Calculus d) Urethral Stricture

e) Bladder Calculus e) Phimosis

f) Nephrectomy (Removal of Kidney) f) Circumsicision

g) Renal angiogram followed by stenting /

Renal Angioplasty

______________________________________________________________________________

4. ORTHO

AILMENT COVERED AILMENT NOT COVERED

a) Open reduction & Fixation of fracture a) Rheumatoid Arthritis

b) Management of Compound & commuted fracture b) Ankylosing Spondylitis

c) Acute posttraumatic joint replacement c) Osteoarthrosis

d) Laminectomy, Discectomy for PIVD d) Osteomyelitis

e) Amputations in accidents or in any other Pathological e) Suppurative arthritis

Conditions

5. VASCULAR SURGERY

AILMENT COVERED AILMENT NOT COVERED

a) Aneuraysm (only if surgery indicated by Arterography) a) Embolism & Thrombosis

(Unless acute cases requiring

Intensive care or surgical intervention)

b) Acquire Arteriovenous fistula (Post Traumatic) b) Arteriovenous fistula (congenital)

6. ENT

AILMENT COVERED AILMENT NOT COVERED

a) Foreign Body Removal Larynx and Lower down a) Any Inflammation & Infection

b) Cochlear implant (Post Traumatic)

7. CARDIOLOGY

AILMENT COVERED AILMENT NOT COVERED

a) Angioplasty with stent implant (stent cost not to a) Angiogram perse

exceed Rs. 50,000/-)

b) Management of MI

8. C. T. SURGERY

AILMENT COVERED AILMENT NOT COVERED

a) Congenital heart disease – Cyanotic and a) Pleural Effusion

A cyanotic requiring Surgery

b) Valvular disease-closed Valvotomy Balloon Valvuloplasty

c) Valve replacement

d) Ischemic heart disease (CABG)

e) Pneumonectomy and Haemothrax ( Post Traumatic)

f) Disease of Lung requiring Lobectomy or Pneumonectomy

g) Traumatic Diaphragmatic Hemia

h) All Thoracic Surgeries including Lobectomy.

9.DENTAL

AILMENT COVERED AILMENT NOT COVERED

a) Only Malignant Tumor covered a) Caries

b) Alveolar Abscess, Root Abscess

c) Jaw swelling – Inflammatory &

Odon tomes, Cyst

10. OPTHALMOLOGY

AILMENT COVERED AILMENT NOT COVERED

a) Comcal Transplant (Post - traumatic) a) Cataract

b) Foreign Body Removal b) Retinal Detachment

c) Burns – Chemical and Thermal

d) Blast injury – blow out – Fracture, Laceration

11.NEUROLOGY / NEURO SURGERY

AILMENT COVERED AILMENT NOT COVERED

a) Head injury, Acute Extradural, Subdural a) Intra Cranial Abscess

Haematoma

b) Haemorrhage, Cerebral concussion, Contusion, b) Cranial Nerve Palsy

Laceration

c) Spinal Cord Injury

d) Fracture, Dislocation Spine

e) Post Traumatic (acute) Peripheral Nerve injury

f) Acute CVA requiring – Angio, Stenting, Thrombolysis,

g) Anti-coagulant therapy and ventilator support

h) Laminectomy / Disectomy

______________________________________________________________________________

12. CONGENITAL DISEASE

AILMENT COVERED AILMENT NOT COVERED

a) Congenital Diaphgaramatic Hernia a) Congenital Dislocation of Hip, Club Foot

Syndactyly of webbed finger

b) Cerebral Palsy (only if surgical intervention b) Osteogenesis imperfecta, Congenita

required Torticolis, scoliosis

c) Tracheo Esophageal Fistula c) Meningomyclocele, Hydrocephalous,

Poliomyelitis, Congenital Hernia

d) Anorectal Anomalies d) Encephalocele, Spina bifida, Cleft Lip &

Palate, Pyeloric Stenosis

e) Congenital abnormalities of Kidney.

13. GENERAL

AILMENT COVERED AILMENT NOT COVERED

a) Neonatal recustation / Asphyxia, Jaundice a) Disease of Muscle, Tendon and Fascia

b) Any Surgical / Medical condition requiring b) Disease relating to or arising out of

Ventilator support of Intensive care. Malnutrition

c) Any Trauma / Accident requiring c) Normal Delivery, Caesarian section for

In – Patient treatment any reason

d) Any kind of Poisoning d) Any Endocrinal or hormonal disorder

e) Management of Diabetes, Goiter

f) Any skin disorder

g) Any gynecological disorder (only

treatment of malignant tumors covered)

h) Plastic Surgery not covered unless

reconstruction surgery (post trauma on duty only for the employees)

14. OBSTRACTICS & GYNECOLOGY

AILMENT COVERED AILMENT NOT COVERED

a) Ectopic Pregnancy a) Any other disease related to Obstratics /

Gynecology

b) Ante partum Hemorrhage

c) Pregnancy Induced hypertension

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|LIST OF HOSPITALS COVERED UNDER AROGYA SAHAYATHA |

| | | | |

|SL |Name of the Hospital |Phone Number |Others |

|1 |Kamineni Hospital - Hyderabad |39879700 |39879999 |

|2 |NIMS, Hyderabad |23320332 |CCU 23489357 |

|3 |Yashoda Hospital, Malakpet |24555555 |  |

|4 |Usha Mullapudi Cardiac Center |23090669 |  |

|5 |Care Hospital - Nampally |24733051 |66200434 |

|6 |Indo-American Cancer Institute & Research Centre - Banjarahills |23552131 |Bills Ex. 287 |

|7 |Image Hospital - Ameerpet |55519999 |23750000 |

|8 |Aditya Hospital - Tilak Road |24754117 |9347321266 |

|9 |Sowmya Hospital - Secunderabad |27741234 |27743456 |

|10 |Dr. Ramesh Cardiac & Multi Speciality Hospital - Vijayawada |0866-2470283 |2470881 |

|11 |SVR Neuro Hospital - Vijayawada |0866 - 2494930 & 31 |  |

|12 |Swatantra Hospital - Rajamundry |0883 - 2400400 to 409 |  |

|13 |Care Hospital - Vizag |0891 - 2714014 |  |

|14 |Cancer Treatment & Research Centre - Vizag |0891 - 2543214 |  |

|15 |Jaya Hospital - Warangal |0870 - 255335 |  |

|16 |Bollineni Super Speciality Hospital - Nellore |0861 - 2312777 |  |

|17 |SVIMS – Tirupati |08774 - 2287152 |  |

|18 |Gouri Gopal Hospital - Kurnool |08518 - 255499 |255898 |

|19 |Vishwabharathi Super Speciality Hospital - Kurnool |08518 - 229966 &67 |  |

|20 |Alluri Sitharamaraju Super Speciality Hospital - Eluru |08812 - 249361, 62 & 65 |  |

|21 |Narayana Medical Institutions - Nellore |0861 - 2317963, 64 & 68 |  |

|22 |Surya Narsing Home- Karimnagar, VV Reddy 9885748777 |0878 - 2264401 |9959269291, devender |

|23 |Sun Shine Super Speciality Hospital - Paradise |040-64636363,43444546 |  |

|24 |NRI Academy of Sciences, Chinnakakani, Guntur |08645-236777, 237401,2,3,4 |  |

|25 |Apolo Reach Hospitals, Karimnagar |  |  |

| |M/s Alankit Health Care TPA Ltd |66178222 - 28 |66178221 |

| |Dr. Rajesh |9704290368, 40300814 | |

| |Mr. Abhishek, Manager |9000063007 | |

| |Alankit medical receiption |40300807 | |

| |Nagarjuna reddy, Auditor |40300806 | |

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