ECHS

1. ECHS Scheme. Government had sanctioned the Ex-servicemen Contributory Health Scheme (ECHS) on 30 Dec 02 and formally launched on 01 Apr 03, to be established over a time span of five years ie by 31 Mar 08. It involved augmentation of 106 Armed Forces Clinics (AFCs) at military stations and establishment of 121 new polyclinics (PCs) at non military stations. All 227 polyclinics have been operationalised. The total membership of ECHS is 20,24,622. There are 12.54 lacs pre-2003 retirees who have not yet taken ECHS membership.

2. Acceptance of ECHS Application Forms. It is brought out that there is no last date for seeking ECHS membership.

3. Empanelment of Private Hospitals. Detailed list of empanelled hospitals and future changes is provided in ECHS website www.indianarmy.nic.in/arechs.htm

4. Smart Cards. It normally takes 6-8 weeks to obtain smart cards on submission of application. In the interim the receipt issued on submission of application by Station HQs/Director ECHS (N) is valid for two months till receipt of smart cards for availing entitled medicare. Apart from Master Smart Card, 3 �Add-on Cards� and one Lifetime Card, for disabled dependents, are permissible.

5. Loss of Smart Card. Following documents are required to be submitted by AFV to nearest Station HQs/Regional Centre ECHS:-

(a) ECHS application form duly completed.

(b) Affidavit that,� I have lost my ECHS Smart Card and in case it is found later I will deposit it with Station HQ/ Regional Centre and will be responsible for any loss/expenditure incurred by the Govt consequent to the misuse of the lost Smart Card.

6. Change of Address. Following documents are required to be submitted by AFV to nearest Station HQs/ Regional Centre ECHS:-

(a) ECHS application form duly completed.

(b) Undertaking certificate.

(d) Old smart card/ cards to be deposited.

(e) Demand draft@ Rs90/- per card.

7. Procedure to Avail ECHS Facility.

(a) Routine Treatment.

(i) Report to polyclinic.

(ii) For hospital admission/ specialist opinion & treatment, Oi/c Polyclinic refers beneficiary to service hospital/empanelled facility. Beneficiary to collect referral form for empanelled facility of his choice from MO/specialist polyclinic duly countersigned and stamped by Oi/c Polyclinic. Report to referred hospital for required consultation/ treatment /diagnostic procedure. No payment is to be made by ECHS member to the referred medical facility/ diagnostic centre.

(b) During Emergency (Empanelled Medical Facility).

(i) Preferably report to service hospital/ empanelled facility.

(ii) Prove identity through ECHS smart card/acknowledgement slip.

(iii) Hospital representative to inform ECHS polyclinic at the earliest (but not later than 48 hrs) with the following details:-

(aa) Photocopy of ECHS membership card / receipt, diagnosis date & time of admission, Hospital to which admitted (Oi/c Polyclinic will make arrangements for verification of the facts).

(ab) After verification the patient will be referred formally (emergency referral).

(ac) No Payment is to be made by beneficiary to the empanelled hospital/medical facility.

(c) During Emergency (Non Empanelled Medical Facility). ECHS member may not be able to follow the normal referral procedure. Hence the following:-

(i) No embargo on proceeding to non-empanelled hospital.

(ii) Inform nearest ECHS polyclinic within 48 hrs of such admission with following details:-

(aa) Photocopy of ECHS membership card/receipt, date and time of admission, hospital to which admitted (Oi/c polyclinic will make arrangement for verification of facts).

(ab) After verification formal Emergency Information Report (EIR) will be initiated and handed over to representative of AFV. Bills of the concerned non empanelled hospital/medical facility will be cleared by the beneficiary.

(ac) Member submits bills along with summary of the case and EIR to the concerned polyclinic within one month from the date of discharge from hospital for reimbursement.

(ad) Sanction for reimbursement as per approved rates will be accorded by Central Organisation ECHS.

(ae) Payment is to be made by Cash Assignment Officer at station HQ.

8. Treatment of Senior Citizens. Henceforth, priority will be given to following senior citizens for treatment in ECHS polyclinics:-

(a) Male - 75 yrs & above

(b) Female - 70 yrs & above

9. Revision of Rates for Cardiac Stents. Following ceiling rates excluding VAT for various types of �Cardiac Stents� are applicable for ECHS payments with immediate effect:-

(a) Cypher Stent - Rs 95,000/-

(b) Taxus Stent - Rs 67,000/-

(d) Science VEERS - Rs 95,000/-

(e) Yukon Choice - Rs 55,000/-

10. Free Cardiac Check up.

(a) Escort Heart Institute, MAX hospital and Metro hospital have commenced free cardiac OPDs at the following polyclinics as per days and time below:-

Hospital	Polyclinic	Days	Timing
Escort	Gurgaon	Mon& Fri	10am-1pm
Max Heart	Gurgaon	Tue	10am-1pm
Max Heart	Faridabad	2^nd & 4^thThu	11am-1pm
Metro Heart	Gwalior	Wed	11am-1pm
Metro Heart	Mathura	Fri	11am-1pm
Escort Heart	NOIDA	Sat	11am-1pm
Escort Heart	Lodhi Road	Tue, Thu & Sat	11am-1pm

(b) Patients are advised to confirm availability of facility from the polyclinics before going for check up.

11. Dialysis Treatment for ECHS Beneficiaries. In military/non military stations without facility of dialysis, patients may be referred to the nearest station having Govt/ empanelled hospitals and where Haemodialysis is available. Haemodialysis can be permitted as an �urgent treatment� in non-empanelled hospitals also, subject to following conditions:-

(a) Emergency Information Report (EIR) should be raised by Oi/C polyclinic with clear endorsement stating that Haemodialysis facility is not available in service/government/empanelled hospitals in station.

(b) Bills are to be processed for a period of one month at a time.

12. Referral Policy. The policy is as follows: -

(a) In military stations, ECHS beneficiaries will be directed to local service hospital subject to availability of bed space and/or specialist facility.

(b) Patients are referred directly to civil empanelled facilities by MO/medical specialist (as applicable) at ECHS polyclinics in case of non-existence of medical facility at the MH.

(d) Patients desirous of treatment in service hospitals will be referred to service hospital even from non-military stations.

13. Conditions of Emergency. Conditions of emergency are as follows: -

(a) Acute cardiac conditions/syndromes.

(b) Vascular catastrophies.

(d) Acute respiratory emergencies.

(e) Acute abdomen.

(f) Life threatening injuries.

(g) Acute poisoning and snake bite.

(h) Acute endocrine emergencies.

(j) Heat stoke and cold injuries of life threatening nature.

(k) Acute renal failure.

(l) Severe infections leading to life threatening situations.

(m) Any other condition in which delay could result in loss of life or limb.

14. Pre-2003 Retirees (Pensioners). Pre-2003 retirees are advised to join ECHS as Kendriya Sainik Board and INBA are not considering reimbursement or financial assistance.

15. Pre-1996 Retirees. Supreme Court has given judgment regarding exemption of ECHS contribution for Pre-1996 retirees. The case for refund of ECHS contribution to Pre-1996 retirees is sub-judice. The same will be intimated on receipt of the Apex Court decision.

16. Refund of Excess Contribution. ECHS members who joined the scheme after 01 Apr 2004 and paid subscription as per old rates are entitled for refund of excess contribution as 50% DA merged with basic pay as dearness pay wef 01 Apr 2004.

17. Rates of Contribution. Those retired prior to 01 Jan 96 and Battle Casualties/ war widows are exempted. For others the rates are:-

Pension. (Uncommuted Basic Pension plus Dearness Pension)	Rates of contribution
Up to Rs 3000/-	Rs 1800/-
Between Rs 3001/- to 6000/-	Rs 4800/-
Between Rs 6001/- to 10000/-	Rs 8400/-
Between Rs 10001/- to 15000/-	Rs 12000/-
Above Rs 15001/-	Rs 18000/-

18. Ward Entitlement to ECHS Members in Private Hospitals.

(a) Officers - Private

(b) JCOs - Semi private

19. Reimbursement for Medicine in Exceptional Cases Only.

(a) Permitted only if patient was referred by polyclinic for certain special treatment and the medicines were prescribed to be taken with immediate effect on discharge from hospital. Specialty conditions are:-

(i) Post operative cases of Major Cardiac Surgery/Interventional Cardiology.

(ii) Oncology.

(iii) Post operative organ transplant.

(iv) Post operative joint replacement.

(v) Post operative major neurosurgical/ neurology.

(b) Suitable prescription for demand of medicines for the above conditions is to be provided to the Oi/c polyclinic immediately after discharge. Oi/c polyclinic will arrange for procurement of medicines in such cases. Cost of medicines purchased by ECHS member is re-imbursable for a period of maximum 30 days only.

(i) Application from ECHS member.

(ii) Photocopy of smart card/ ECHS registration slip.

(iii) Referral no of the polyclinic.

(iv) Professional advice of specialist.

(v) Contingent bill (specimen format available at Stn HQ/regional centre/polyclinic).

(vi) Bills in original.

20. Ex-servicemen Non-pensioners. Not entitled for any medicare in ECHS/MHs.

21. Exemption from Payment of Contribution � Retired Officers Retired Prior 01 Jan 1996. Consequent to judgment of Hon�ble Supreme Court regarding ECHS membership for defence personnel retired prior to 01 Jan 1996, GOI / MOD has exempted from payment of contribution under ECHS in respect of those ESM drawing pension from CDA and have retired prior to 01 Jan 1996.

Authority. GOI / MOD letter No 17 (10)/06/OS (WE)/D (Res) dated 13 Apr 2007.

22. Policy on Submission/ Acceptance of ECHS Application Form Without PPO. Policy on submission / acceptance of ECHS application forms is as follows: -

(a) The ECHS application forms without PPO have been allowed to be processed provided discharge book gives authentic proof of dependents.

(b) ECHS application forms in respect of personnel who are proceeding on retirement at

short notice will be accepted by record officers even one day before retirement.

23. Issue of Prescribed Medical Equipment.

(a) Hearing Aids. ECHS member is entitled hearing aid on the recommendations of service ENT specialist after clinical and audiometric justification. Once approved for issue by concerned senior adviser ENT, the hearing aid equipment is to be made available.

(b) Artificial Limbs/Appliances.

(i) On referral by polyclinic, the artificial limbs/appliances can be obtained through service facilities and will be fitted at Artificial Limb Centre (ALC), Pune or Artificial Limb Sub Centre at Base Hospital, Delhi Cantt.

(ii) When treatment is undertaken in civil empanelled facilities, CGHS rates will apply.

(i) Issued to ECHS members, when use of such equipment is considered absolutely essential on medical grounds and specifically recommended by medical specialist of the ECHS polyclinic/service hospital/empanelled hospital.

(ii) Approval of senior adviser and consultant in medicine under whose jurisdiction the ECHS polyclinic is located will be obtained.

(iii) The Oi/c Polyclinic will procure equipment as per local purchase procedures.

(d) CIPAP/BIPAP Machine.

(i) Issued to ECHS member on recommendations of a specialist of a Service Hospital/ Empanelled Hospital.

(ii) Approval of senior adviser and consultant of the concerned speciality under whose jurisdiction the ECHS polyclinic is located will be obtained.

(iii) The Oi/c polyclinic will procure machine as per local purchase procedures.

(iv) Details of issue of machine will be recorded in ECHS Smart Card of member.

(v) Machine will be issued once in a lifetime and maintenance and cost of upkeep of machine will be borne by the ECHS member.

(e) Spectacles.

(i) Spectacles will not be provided under ECHS system except in conventional cataract surgery, where specifically recommended by the surgeon.

(ii) Cost of spectacles in such cases will be limited to Rs 200/- (Rupees two hundred only).

(iii) Patients will submit the bills for re-imbursement towards cost of spectacles to Oi/c polyclinic.

(iv) The payment will be made by Cash Assignment Officer at Station HQ.

(v) Replacement of spectacles is admissible once in three years on the advice of the Medical Officers of the polyclinic or empanelled consultant.

Note: No other medical equipment is authorized for issue to ECHS member at present.

(f) Dental Treatment:-

(i) Dentures will be permitted on advise of Dental Officer ECHS Polyclinic/ Service Dental Centre.

(ii) Partial/complete denture presently is permitted on one time basis only.

24. Forfeiture of Fixed Medical Allowance. Ex-servicemen joining the scheme are to forfeit fixed medical allowance (FMA) of Rs 100/- drawn by them, as per the rules. Accordingly, PCDAs have instructed the DPDOs / PDAs to stop FMA payment. ECHS members, who continue to draw medical allowance, need to know that there is a provision of recovery in installments.

25. Admissibility of Traveling Allowance to ECHS Beneficiaries.

(a) TA for journey undertaken for medical treatment is admissible to ECHS beneficiaries for treatment in another city, if such treatment is not available in the same city. Referral to outstation specialized centers will only be on the recommendations of an authorized service medical officer or an ECHS doctor. The actual referral will have to be signed by the Oi/C of the polyclinic.

(b) Non availability of treatment in the city implies that there is no service/central/state Govt/private empanelled hospital providing the required treatment in the town/city of dependent ECHS polyclinic.

(c) Other city referrals and corresponding traveling allowance will be applicable only to the nearest station where such medical treatment facility is available and not as per choice of the patient. It is to be determined by service/ECHS medical officer and authenticated by the Oi/C polyclinic prior to resorting to such outstation referrals.

(d) For details on authorized mode and class of entitlement, contact your nearest polyclinic.

26. Enhancement in Diet Charges of Patients. As a result of consistent effort by the central organisation ECHS, MOD has revised the diet charges wef 05 Dec 06. The ECHS beneficiaries during hospitalization in empanelled hospitals will be entitled to free diet in accordance with the following stipulations: -

Condition

Basic Pension Plus DA

Monetary ceiling for free diet.

Up to Rs 6,075/-

Monetary ceiling for free diet in the case of beneficiary suffering from TB or mental diseases.

Up to Rs 9,000/-

27. DO�s & DON�Ts for Members

DO�s

DON�Ts

� Do visit your ECHS polyclinic whenever you need medical aid.

� Do carry your ECHS registration slip and identification documents/smart card when visiting ECHS clinic. � Do avail all diagnostic and therapeutic facilities at the polyclinic.

� Do exercise your option of being referred to empanelled facility of your choice but only when referral is advised by polyclinic and service hospital facilities are not available.

� Do carry your referral form and smart card/ECHS registration slip to the empanelled facility.

� Do try to choose a service/empanelled hospital in an emergency-you won�t have to pay.

� Do inform your polyclinic within 48 hrs when admitted in an emergency.

� Do allow some time to polyclinic to procure super-specialty drugs prescribed to you, if not readily available.

� Do not go to empanelled hospital without referral from ECHS polyclinic except in emergency.

� Do not pay bills in empanelled hospitals. There is no provision for re-imbursement. ECHS will clear hospital bills.

� Do not insist for referral for facilities available in the polyclinic, it is not authorized.

� Do not insist on particular brand name of drug from polyclinic � you may be issued different brand but with same pharmacological composition. Trust your doctor.

� Do not ask for drugs prescribed by private doctors without referral from polyclinic.

� Do not purchase drugs yourself and ask for re-imbursement. It is not authorized.

� Do not accept sub-standard treatment at empanelled hospital. Report to your ECHS polyclinic for any ill�treatment/ sub standard medical treatment.

28. Grievances. ECHS members are advised to address their grievances regarding their entitled medicare to the local station HQs/ local ECHS office and refrain from corresponding directly to higher organisations.

29. ECHS Review. On completion of five years of ECHS a committee has been set up on 28 May 08 to review the functioning of ECHS which includes members from MOD & MOD Finance, ECHS Central Organisation etc. The committee has completed visits to various ECHS formations within the country. Final report alongwith recommendations, is under preparation and will be put up to MOD for approval shortly. Government policy letter on this review will be disseminated to all concerned.

30. Information and Queries. All information regarding ECHS can be obtained from website www.indianarmy.nic.in and www.irfc.nausena.nic.in.

31. Progress on Revision of ECHS Package Rates. Central Organisation vide their letter no. B/49773/AG/ECHS/CGHS dated 30 Jul 08 had informed the following:-

(a) Consequent to downward revision of ECHS rates several multi speciality hospitals in certain stations had refused to extend credit facility to ECHS beneficiaries. To overcome the crisis Raksha Mantri approved re-imbursement of expenditure to empanelled facilities at pre-revised CGHS rates as an interim measure.

(b) As a permanent measure it has been decided to delink from CGHS rates. In view of this, evolving of fresh ECHS rates became a critical issue. A Board of Officers has been ordered by all HQ Commands including those of Navy and Air Force to carry out a detailed analysis of prevailing rates for medical treatment/ diagnosis and evolve reasonable rates for implementation to be made applicable for ECHS in their respective stations under their area of jurisdiction.

(c) The board proceedings have been received from some stations and are awaited from others. The inputs would be collated and analysed by a high powered committee under the Def Secy. The ECHS rates so approved would be disseminated for implementation.

32. Procedure for Payment and Reimbursement of Medical Expenses under ECHS. Copy of Central Organisation letter no 49778/AG/ ECHS/Policy dated 19 Aug 08 is reproduced below:-

(a) Reference GOI, MoD letter 24(8)/ 03/US(WE)/ D(Res) dt 19 Dec 03 and Central Organisation letter no B/49778 /AG/ ECHS/Policy dt 16 May 07.

(b) Presently, all individual medical bills are being processed through Central Organisation. It has been decided that the time taken for processing of these bills needs to be reduced without compromising on the efficiency of scrutiny.

(i) The procedure is time consuming.

(ii) Virtually no value addition after SEMO/ Stn HQ level.

(iii) Avoidable paper work and additional effort.

(iv) Result in dissatisfaction amongst the veterans.

(d) In order to overcome the above difficulties and based on the directions of Secy (ESW), the authority is delegated to lower HQ since there is no loss to the State. Therefore, the individual medical claims will also be processed and sanctioned like claims for reimbursement to empanelled hospitals, by the appropriate CFA.

(e) This procedure will be implemented with immediate effect. Bills already despatched to Regional Centre/ Central Organisation, ECHS will be processed as done hitherto fore.

(f) For further details contact your nearest Regional Centre/ Polyclinic.

33. Suggestions. Suggestions regarding management of ECHS may be forwarded to Director ECHS (N) at the following address:-

           Director ECHS (Navy)
           6^th Floor, Chanakya Bhavan
           Chanakya Puri, New Delhi -110021         Tel: 011-24101319

ECHS

Pension.

27. DO�s & DON�Ts for Members