Organisation : Ex-Servicemen Contributory Health Scheme ECHS
Service Name : SOP for Online Bill Processing
Applicable States/ UTs : All India
Home Page : https://desw.gov.in/en/about-echs
Terms & Conditions : https://www.statusin.in/uploads/37443-OBP.pdf
ECHS SOP for Online Bill Processing
ECHS was launched to provide comprehensive healthcare to all Ex-Servicemen pensioners or those in receipt of Disability Pension, as also their dependents.
Related : ECHS Smart Card / Employment Application Form : www.statusin.in/18662.html
The Scheme is also applicable to Next of Kins of deceased pensioners who are drawing Family/Special Family/Liberalized Family Pension.
This document lays down guidelines for processing of bills pertaining to empanelled Hospitals/Nursing Homes/Diagnostic Centers to which an ECHS beneficiary has been referred to for treatment, in case of non-availability of accommodation or required facility for treatment in the Service hospital.
Aim
The aim of the ECHS is to provide quality health care to Ex-Servicemen pensionsers and their dependents.
The following categories are eligible to avail ECHS membership :
(a) Ex-servicemen drawing Pension/ Disability Pension.
(b) Widows drawing Family Pension.
(c) Spouse of pensioner.
(d) Unemployed sons below 25 years of age.
(e) Unemployed and/or unmarried daughters.
(f) Dependent parents whose income is less than Rs. 3500/- per month.
(g) Mentally / Physically challenged children for life.
(h) New born baby up to 03 months based on Birth Certificate.
Facilities
** Medical facilities are to be provided, through a network of ECHS Polyclinics spread across the Country. Basic Outdoor Services are provided at the Polyclinics.
In case further management is required, referral will be made from ECHS Polyclinics to Armed Forces Medical Services Hospitals, Empanelled Private Hospitals/ Dental and Diagnostic Centers, as applicable. These referrals can only be made by authorized staff of the Polyclinics.
** Empanelment of Hospitals/Nursing Homes and Diagnostic Centers are carried out after signing a Memorandum of Agreement (MOA) with ECHS.
Expenditure incurred on services provided by an Empanelled Hospital /Dental / Diagnostic Centre is paid directly to the empanelled facility concerned by ECHS as per approved rates
Authorisation
The authorization for payments to empanelled Hospitals, Nursing Homes, Diagnostic Centers and reimbursement of medical expenses to Ex-Servicemen is as per para-2(j) Govt of India letter No 22(1)/01/US(WE)/D(Res) dated 30 Dec 2002.
The free out patient treatment will be provided to the members at Augmented Armed Forces Clinics and Armed Forces Polyclinics.
Reimbursement will be provided to the patient or paid directly from where services are obtained from the Empanelled Diagnostic Centres/Nursing Homes/Hospitals for the following :
(a) Cost of medicines/drugs/consumables.
(b) Diagnostic tests.
(c) Consultation.
(d) Hospitalisation.
Implementation Instructions
(a) Central Organisation ECHS letter No B/49771/AG/ECHS/Empanelment dated 05th December 2003.
(b) Central Organisation ECHS letter No B/49773/AG/ECHS/CGHS dated 24th Aug 2010 (vide which MoD ID No 22A (48)/2007/US/WE/D(Res) dated 19th Aug 2010 was forwarded to all).
Package Rates
Package rates envisage payment for a duration of indoor treatment as per details given below :
(a) 12 days for Specialized (Super Specialties) treatment.
(b) Seven days for other Major Surgeries.
(c) Three days for Laparoscopic surgeries/normal deliveries.
(d) One day for day care/minor (OPD) surgeries.