Action to strengthen ECHS

Action to strengthen ECHS

Ministry of Defence

Measures to Improve ECHS

18 NOV 2019

An additional allotment of Rs.3,500/- crores have been sought to overcome the problem.

Following steps have been taken to check and curb the misuse of funds in ECHS and inflated bill being raised by empanelled hospitals:

Also check: VERIFICATION OF ONLINE APPLICATION FOR ECHS CARDS BY RECORD OFFICE

•     Strict monitoring of bills is done and they are restricted to CGHS rates. Disciplinary action is taken against defaulting hospitals which includes suspension of referrals/financial penalties/disempanelment.
•     A detailed SOP for taking action against empanelled hospitals has been issued on 10.10.2019 by Department of Ex Servicemen Welfare, Ministry of Defence.

This information was given by Raksha Rajya Mantri Shri Shripad Naik in a written reply to ShriRajeev Chandrasekharin Rajya Sabha today.

PIB

MoD- Payment and Reimbursement of Medical expenses under ECHS ; Processing of Online Bills by Bill Processing Agency (BPA)

MoD- Payment and Reimbursement of Medical expenses under ECHS ; Processing of Online Bills by Bill Processing Agency (BPA)

File No.25(01)/2018/WE/D(Res-I)
Government of India
Ministry of Defence
(Deptt. of Ex-Servicemen Welfare )
B wing, Room No.220
Sena Bhavan, New Delhi

Dated 09 July,2019

To,
The chief of Army Staff
The chief of Naval Staff
The chief of Air Staff

Payment and Reimbursement of Medical expenses under ECHS ; Processing of Online Bills by Bill Processing Agency (BPA).

Sir,
With reference to Govt. of India Ministry of Defence letter No.22A(10)/2010/US(WE)/ D(Res)- Vol-V dated 10th July 2014 on the subject, I am directed to convey sanction of the Competent to the following amendments:

Also check: Defence: RELAXATION OF RULES FOR CONSIDERATION OF REIMBURSEMENTS IN EXCESS OF THE APPROVED RATES PERTAINING TO MEDICINAL CLAIMS UNDER ECHS

For
Payment and Reimbursement of Medical Treatment (Online Billing)
(i) Director Regional Centre ECHS - Upto Rs.3,00,000/-
(ii) Dy MD, ECHS - Upto Rs.5,00,000/-
(iii) MD, ECHS - Upto Rs.10,00,000/-
(iv) Joint Secretary, ESW - Upto Rs.25,00,000/-
(v) Secretary ESW - Above Rs.25,00,000/-

Read
(i) Director Regional Centre ECHS - Upto Rs.4,00,000/-
(ii) Dy MD, ECHS - Upto Rs.8,00,000/-
(iii) MD, ECHS - Upto Rs.15,00,000/-
(iv) Joint Secretary, ESW - Upto Rs.40,00,000/-
(v) Secretary ESW - Above Rs.40,00,000/-

The powers delegated within the Ministry (bill above Rs.15 lakhs) will be exercised inconsultation with MoD (Finance/Pension).

Also check this: CGHS: Time limit for submission of final claims reimbursement of medical expenses

This issues with the concurrence of MoD (Finance/ Pension) vide U.0 No.32(14)/2018/ Fin/Pen dated 17-6-2019.

Ex-Servicemen Welfare - Payment and Re-imbursement of Medical expenses under ECHS

Ex-Servicemen Welfare - Payment and Re-imbursement of Medical expenses under ECHS; Processing of Online Bills by Bill Processing Agency (BPA)

File No.25(01)/2018/WE/D(Res-I)
Government of India
Ministry of Defence .
(Deptt. of Ex-Servicemen Welfare )
B wing, Room No.220
Sena Bhavan, New Delhi

Dated 09 July, 2019

To,
The chief of Army Staff .
The chief of Naval Staff
The chief of Air Staff

Subject: Payment and Re-imbursement of Medical expenses under ECHS; Processing of Online Bills by Bill Processing Agency (BPA).

Sir,
With reference to Govt. of India Ministry of Defence letter No.22A(10)/2010/US(WE)/D(Res)-Vol-V dated 10th July 2014 on the subject, I am directed to convey sanction of the Competent to the following amendments:

For

Payment and Re-imbursement for Medical Treatment (Online Billing)
(i) Director Regional Centre ECHS - Upto Rs.3,00,000/-
(ii) Dy MD, ECHS - Upto Rs.5,00,000/-
(iii) MD, ECHS - Upto Rs.10,00,000/-
(iv) Joint Secretary, ESW - Upto Rs.25,00,000/-
(v) Secretary, ESW - Above Rs.25,00,000/-

Read
(i) Director Regional Centre ECHS - Upto Rs.4,00,000/-
(ii) Dy MD, ECHS - Upto Rs.8,00,000/-
(iii) MD, ECHS - Upto Rs.15,00,000/-
(iv) Joint Secretary, ESW - Upto Rs.40,00,000/-
(v) Secretary, ESW - Above Rs.40,00.000/-

The powers delegated within the Ministry (bill above Rs.15 lakhs ) will be exercised in consultation with MoD (Finance/Pension).

This issues with the concurrence of MoD (Finance/Pension) vide U.O. No.32(14)/2018/Fin/Pen dated 17-6-2019.

Yours faithfully,
(A.K. Karn )
Under Secretary to Govt. of India

Source: DESW

Delay in handing over of ECHS Smart Card to ECHS Beneficiaries

Delay in handing over of ECHS Smart Card to ECHS Beneficiaries

Central Organisation, ECHS

Adjutant General’s Branch

Integrated HQ of MoD (Army)

Thimayya Marg,

Near Gopinath Circle

Delhi Cantt – 110010

B/49711-MoD/AG/ECHS/DBT

29 Jul 2019

IHQ of MoD (Air Force)
IHQ of MoD (Navy)
HQ South Comd (A/ECHS)
HQ East Comd(A/ECHS)
HQ Wesst Comd(A/ECHS)
HQ Central Comd(A/ECHS)
Northern Comd(A/ECHS)
South West Comd (A/ECHS)
All Regional Centres

DELAY IN HANDING OVER OF ECHS SMART CARD TO ECHS BENEFICIARIES

Please refer to Central Organisation, ECHS letter No B/49711-IT/AG/ECHS dated 13 Sep 2018. (Copy enclosed).

The procedure of dispatching the 64 Kb ECHS Cards by the Card making company and their distribution by respective station HQ’s was given vide a/m letter. As on 17 Jul 2019, the card making company has printed and dispatched 8,33,468 cards to various station HQ’s through respective Regional Centres. It is seen that only 4,11,948 cards have been physically handed over by the station HQ’s to the beneficiaries. This shows that the rate of distribution by most of the station HQ’s is very low. This has led to dissatisfaction amongst the ESM.

In view of the above, it is requested that suitable instruction be passed to Station HQ’s under your justification to handover cards on priority and clear the backlog.

Sd/-

(Rakesh Kakar)

Col (Retd)

Jt Dir (Stats & Automation)

for MD ECHS

Source: ECHS

ECHS Smart Card: DOCUMENTS REQUIRED AS PROOF OF INCOME TO CHECK ELIGIBILITY OF DEPENDANTS FOR ECHS MEMBERSHIP

ECHS Smart Card: DOCUMENTS REQUIRED AS PROOF OF INCOME TO CHECK ELIGIBILITY OF DEPENDANTS FOR ECHS MEMBERSHIP

Central Organisation ECHS
Adjutant General's Branch
Integrated Headquarters of MoD (Army),
Thimayya Marg, Near Gopinath Circle,
Delhi Cantt- 110 010

B/ 49711-NewSmartCard /AG/ ECHS

29 Apr 2019

IHQ of MoD (Air Force)
IHQ of MoD (Navy)
HQ South Comd (A/ ECHS)
HQ East Comd (A/ ECHS)
HQ West Comd (A/ ECHS)
HQ Central Comd (A/ ECHS)
Northern Comd (A/ ECHS)
South West Comd (A/ ECHS)
HQ ANC
Regional Centres ECHS

DOCUMENTS REQUIRED AS PROOF OF INCOME TO CHECK ELIGIBILITY OF DEPENDANTS FOR ECHS MEMBERSHIP

1. Refer to Central Organisation ECHS letter No B/ 49701-PR /AG/ ECHS/ 2017 dated 27 Sep 2017 and 8/49701-PR/ AG/ ECHS/ 2017 dt 16 Nov 2017(Not to all).

2. A policy on eligibility criteria for ECHS membership was promulgated vide letters under reference. The following documents are required to be produced by the ESM for all dependants above 18 years of age (except spouse) at the time of collection of their Cards:-

(a) Self attested copy of PAN Card.
(b) Self attested copy of Form 26AS for the last two financial years.

3. In case the documents given at Para 2(a) & (b) can not be produced by the ESM, then he will have to furnish a self attested certificate for dependant above 18 Years of age. Specimen proforma is attached as Appx 'A'.

4. In case of income of dependents above 18 years of age (except spouse) is more than Rs 9000/ - from all sources (excluding DA) per month, then the ECHS Cards for such dependants will not be handed over to the beneficiary/ ESM. Such Cards will be destroyed by a board of officers every month and record be maintained at the Station HQ's. Details of such destruction be forwarded to Regional Centre concerned, Central Organization, ECHS and M/ S Source Dot Com Private Limited. Cases will be intiated in such cases for cancellation of cards permanently.

5. It is further reiterated that the Cards of all dependants will be blocked automatically by the system on completion of one year. The ESM will have to submit an online self declaration certificate by using his login credentials. A specimen ECHS self attested certificate for dependant above 18 years of age is attached as Appx 'B'. The fields marked as 'A' will be auto populated and in the balance fields the beneficiary will have to upload the required certificate/ enter details. This renewal facility will be available one month in advance from completion of one year from the date of issue of Card/ last renewal.

(Rakesh Kakar)
Col Retd
Jt Dir (Stats & Automation)
for MD ECHS

Encls: (As above)

Copy to :-
The details of Cards destroyed by Regional Centres & fwd by Private Ltd board of officers should be blocked & removed from the system. However, data of such Cards should be maintained separately & fwd to Central Organization, ECHS on six monthly basis.

Internal
Medical Section
C & L Section
P & FC Section
S&A Section You are requested to upload the ECHS website and copy given to SourceDotcom.

Source: ECHS

One time contribution for ECHS membership and entitlement of Ward in empanelled Hospitals/ Medical facilities in respect of World War II veterans, ECOs, SSCOs and Pre-Mature Retires

One time contribution for ECHS membership and entitlement of Ward in empanelled Hospitals/ Medical facilities in respect of World War II veterans, ECOs, SSCOs and Pre-Mature Retires.

 

No.17(11)/2018/WE/D(Res-I)
GOVERNMENT OF INDIA
MINISTRY OF DEFENCE
(DEPARTMENT OF EX-SERVICEMEN WELFARE)
B WING, ROOM No.221
SENA BHAVAN, NEW DELHI

Dated 12th April, 2019

The Chief of Army Staff
The Chief of Naval Staff
The Chief of Air Staff

Subject : One time contribution for ECHS membership and entitlement of Ward in empanelled Hospitals/ Medical facilities in respect of World War II veterans, ECOs, SSCOs and Pre-Mature Retires.
Sir,
In continuation of MoD letter No.17(11)/2018ANE/D(Res-I) dated 7.3.2019, I am directed to convey the sanction of the Government prescribing one time contribution for ECHS membership and entitlement of ward in empanelled hospitals / medical facilities in respect of World War-II Veterans, Short Service Commissioned Officers (SSCOs), Emergency Commissioned Officers (ECOs) and Pre-mature Retirees (PMR) and their spouses as under :-

S.No.	Rank	One time contribution	Ward entitlement
a.	Recruit to Havildars of Army & equivalent Ranks in Navy & Air Force	Rs. 30,000/-	General
b.	Nb Sub/ Sub/ Sub Maj. and equivalent Ranks in Navy & Air Force (including Hony Nb Sub/MACP Nb Sub and Hony Lt/Capt)	Rs. 67,000/-	Semi Private
c.	All Officers	Rs. 1,20,000/-	Private

2. All other provisions of this Ministry’s letter referred above, unaffected by this order, will remain unchanged.

3. This issues with the concurrence of Ministry of Defence (Finance) vide their U.O. No.31(02)/2019/Fin/Pen dated 12.04.2019.

Yours faithfully,

(A.K. Karn)
Under Secretary to the Govt. of India
Tele Fax: 23014946

PCDA circular: FMA for Ex-Servicemen Pensioners/Family Pensioners who are members of ECHS and reside in a non - ECHS district.

PCDA circular: FMA for Ex-Servicemen Pensioners/Family Pensioners who are members of ECHS and reside in a non - ECHS district.

OFFICE OF THE PR. CONTROLLER.OF DEFENCE ACCOUNTS (PENSIONS)

DRAUPRADI GHAT, ALLAHABAD-211014

Circular No. 616

Dated: 31.01.2019

To,
The OI/C
Records/PAO(ORs)
--------------------
--------------------

    Subject:- Grant of Fixed Medical Allowance (FMA) to Ex-Servicemen Pensioners, and Ex-Servicemen Family Pensioners who are ECHS members and residing in Districts not covered by ECHS Polyclinic / Armed Forces Hospitals / MI Room upgraded to accommodate ESMs.

Reference:- This office Circular No. 451 dated 21.02.2011;Circular.No..544 dated 04.06.2015 & Circular No. 586 dated 25.09.2017.

 A copy of GoI, MoD letter No. 22(01)/2011.WE/D(Res-I):dated:01.11.2018 on the above subject, which is self-explanatory, is forwarded: herewith for information and necessary action.

2.. As per ibid Govt letter Fixed: Medical-Allowance (FMA) to Ex-Servicemen Pensioners and Ex-Servicemen Family Pensioners is also admissible to ECHS members who are residing in Districts not covered by ECHS Polyclinic/Armed Forces Hospitals / MI Room upgraded to accommodate ESMs.

3... Those pensioners who are covered under this. Govt order are-required to submit the necessary application in the prescribed format. to the nearest Stn HQ in triplicate. The Stn HQ will scrutinize the. residential address of the ECHS member and verify the applicability of District in the. address ‘for FMA. .and confirm the authorization of FMA on the application in the prescribed format.

4. A separate communication will follow for submission of LPC-cum-datasheet along with instructions in due course.

5. This circular. has been uploaded on this office website www.pcdapension.nic.in for dissemination to all concerned.

Gts/Tech/05/LXXI
Dated 31.01.2019

(S.K. Singh)

Addl.CDA(P)

Source: PDCA

ECHS: Cabinet approves grant of medical facilities under Ex-Servicemen Contributory Health Scheme

Cabinet

Cabinet approves grant of medical facilities under Ex-Servicemen Contributory Health Scheme (ECHS) to World War-II Veterans, Emergency Commissioned Officers (ECOs), Short Service Commissioned Officers (SSCOs) and pre-mature retirees

More than 40,000 individual to be benefitted

07 MAR 2019

The Cabinet Meeting Chaired by Prime Minister Narendra Modi today approved the grant of Ex- Servicemen Contributory Health Scheme (ECHS) facilities to World War-II Veterans, Emergency Commissioned Officers (ECOs), Short Service Commissioned Officers (SSCOs) and pre-mature retirees.

As a result, over 43,000 individuals not covered so far under ECHS will be able to avail the benefits of cashless medical treatment under ECHS facilities through a network of over 425 ECHS polyclinics, over 2500 empanelled private hospitals and all Government hospitals throughout the country, subject to certain conditions.

As a special dispensation, war-widows will be exempt from one-time contribution to join ECHS.
Launched by NDA Government in April 2003, ECHS provides quality medicare to 54 lakh ex-servicemen pensioners, their dependents and a few other categories.

Measures for welfare of Ex-Servicemen:
Today's decision is yet another landmark step in the pro-active policies of the Government since its very first days for welfare of our valiant ex-servicemen, who rendered valuable service to the country.
Implementation of 'One Rank One Pension' for ex-servicemen, a demand which had been pending for over four decades, has resulted in over 20 lakh ex-servicemen receiving more thanRs. 35,000 Crore under the scheme. Other welfare measures by the Government for ex-servicemen include increase in pension by 40%, disability pension for pre-mature retirees, applicability of battle causality compensation at Line of Actual Control, Line of Control and International Border, financial assistance to soldiers on their supreme sacrifice through newly created Army Battle Causalities Welfare Fund, enhancement of ex-gratia ad-hoc allowance, Special Pension to Ex-sailors and skill development training in 36 job roles to over 30,000 retiring soldiers so far.

PIB

Defence: RELAXATION OF RULES FOR CONSIDERATION OF REIMBURSEMENTS IN EXCESS OF THE APPROVED RATES PERTAINING TO MEDICINAL CLAIMS UNDER ECHS

Defence: RELAXATION OF RULES FOR CONSIDERATION OF REIMBURSEMENTS IN EXCESS OF THE APPROVED RATES PERTAINING TO MEDICINAL CLAIMS UNDER ECHS

File No.22 A(37)/2018/WE/D(Res-l)

Government of India
Ministry of Defence
(Department of Ex-Servicemen welfare)
Sena Bhavan, New Delhi

Dated- 15 January, 2019

To
The Chief of Army Staff
The Chief of Naval Staff
The Chief of Air Staff

Subject: RELAXATION OF RULES FOR CONSIDERATION OF REIMBURSEMENTS IN EXCESS OF THE APPROVED RATES PERTAINING TO MEDICINAL CLAIMS UNDER ECHS.

Sir,
With reference to Gol, MoD letter No 22(1)/01/US(WE)/D(Res) dated 30 Dec 2002 and Gol, MoD letter No. 24(8)/03/US(WE)/D(Res) dated 19 Dec 2003 and in light of M/o Health and Family Welfare order No. Z.15025/ 38/ 2018/ DIR/ CGHS/ EHS dated 22nd May 2018 and No. Z15025/ 51/ 2018/ DIR/ CGHS/ EHS dated 6-6-2018, partial amendments are hereby made to the procedure for payment and reimbursement of medical expenses under ECHS with relaxation of rules for consideration of reimbursement in excess of the approved rates as per the details given under the succeeding paragraphs.

2. The request for full reimbursement which fall under the defined criteria indicated in para 3 below and cases indicated in para 4 below shall be examined by a High Powered Committee whose constitution is indicated in para 5 below. After recommendation of HPC, the concurrence of MoD (Finance/Pension) and approval of Secretary, ESW will be required in all these cases.

3. The request for full reimbursement which fall under the following defined criteria would be considered by the High Powered Committee.

• Treatment was obtained in non empanelled hospital under emergency condition and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period.
• Treatment was obtained in non empanelled hospital under emergency and was admitted for prolonged period for treatment of head injury, coma, septicaemia, multiorgan failure etc.
• Treatment was obtained in non empanelled hospital under emergency and was admitted for prolonged period for treatment of head injury, coma, septicaemia, multiorgan failure etc.
• Treatment was obtained in a non empanelled hospital under emergency for treatment of advanced malignancy.
• Treatment was taken under emergency in a higher type of accommodation as rooms as per his/her entitlement were not available during that period.
• Treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections.
• Treatment was obtained in a non-empanelled hospital under emergency when there was a strike in Govt. Hospitals.

4. Cases falling in the following categories would also be considered by the High Powered Committee.

• Settlements of medical claims in relaxation of rules.
• Approval of air fare with or without attendant on the advice of the treating doctor, for treatment in another city even though he/she is not eligible for air travel/treatment facilities are available in city of residences.
• Representation from ECHS beneficiaries seeking full reimbursement under special circumstances, which are not covered under para 3 above

5. Composition of the High Powered Committee would be as follows :

• JS, ESW - Chairman
• Government Hospital Specialist Doctor (of concerned speciality) - Member
• Director/DS/US, DoESW - Member
• Director(Medical), CO, ECHS - Member-Secretary
• Representative of MoD(Fin/Pen) - Member

6.. The other terms and conditions mentioned in the procedure for payment and reimbursement of medical expenses under ECHS vide Gol, MoD letter No.24(8)/03/US(WE)/D(Res) dated 19 Dec. 2003 shall remain unchanged.

7. This has the concurrence of Ministry of Defence(Finance/Pension) vide their U.O. No32(23)/2018/Fin/Pen dated 3-1-2019.

Yours faithfully
(A.K. Karn )
Under Secretary to the Govt. of India

Source: CGDA

ECHS: Extension of validity of Temporary Slip to Six months

ECHS: Extension of validity of Temporary Slip to Six months

Central Organisation ECHS
Adjutant General's Branch
Integrated Headquarters of
MOD (Army), Maude Lines,
Delhi Cantt- 110 010

B/49711-IT/AG/ECHS

05 Nov 2018

IHQ of MOD (Air Force)
IHQ of MoD (Navy)
HQ South Comd (A/ECHS)
HQ East Comd (A/ ECHS)
HQ West Comd (A / ECHS)
HQ Central Comd (A/ ECHS)
Northern Comd (A / ECHS)
South West Comd (A/ ECHS)
All Area Headquarters
All Regional Centres

EXTENSION OF VALIDITY OF TEMPORARY SLIP TO SIX MONTHS

1. All Ex-Servicemen applying for new 64 Kb Cards fall in any one of the following category

(a) Future Retiree.
(b) Temp Slip Holder.
(c) 01 Jan 1996-31 Mar 2003 Pensioners.
(d) Pre 01 Jan 1996 Pensioners.
(e) Death case while in Service.
(f) Loss of 32 Kb 85 64 Kb Cards.
(g) Post Apr 2003 Retiree not a member yet.
(h) 16/32 Kb Card Holders.

2. All the above categories except 16/32 Kb Card holders are required to download online generated temporary slip. This Temporary Slip is required to be taken to the nearest polyclinic for activation alongwith all related service documents for ECHS membership. The Temporary Slip was earlier valid for three months and subsequently extended on monthly basis.

3. Now the competent authority has approved the following

(a) All system generated Temporary Slips will be abinitio valid for Six Months.
(b) The Temporary Slip can be further extended by three months at a time by Parent Polyclinics in case the ECHS beneficiary does not receive the Card.
(c) The ECHS beneficiary to collect his Card from Station Headquarters within 30 Days from receipt of OTP. These slips will be handed over to the Station HQ at the time of collection of Card.

4. All Regional Centres will forward copy of this document to all Station HQs & Polyclinics in their AOR.

(Rakesh Kakar)
Jt Dir (Stats & Automation)
for MD ECHS

Source: echs.gov.in

ELIGIBILITY OF PERMANENTLY DISABLED UNMARRIED SON OF A ECHS BENEFICIARY TO AVAIL ECHS FACILITY

ELIGIBILITY OF PERMANENTLY DISABLED UNMARRIED SON OF A ECHS BENEFICIARY TO AVAIL ECHS FACILITY 

Year of Disability in line of Duty - Eligibility for ECHS Beneficiaries

Tele : 011-25684847
ASCON : 36832
Fax : 011-25684946
Email : diropsechs-mod@nic.in

Central Organisation ECHS
Adjutant General's Branch
HQ of MoD (Army)
Maude Lines
Delhi Cantt - 110 010

26 Sep 2018

B/49701-PR/AG/ECHS/2018
IHQ of MoD (Navy)/Dir ECHS (N) Air HQ (VB)/DPS
All Comd HQs (A/ECHS)
AMA ECHS, Embassy of India, Nepal
Director General of Indian Coast Guard
Director General NCC
Director General SFF
ADG TA/TA-3
All Regional Centres, ECHS

ELIGIBILITY OF PERMANENTLY DISABLED UNMARRIED SON OF A ECHS BENEFICIARY TO AVAIL ECHS FACILITY

1. "The Rights of Persons with Disabilities Bill - 2016" has been revised, which will replace the existing PWD Act - 1995. The permanent disabilities have been increased from existing 7 to 21.
2. In consonance with spirit of Indian Army wherein the year 2018 has been declared "Year of Disability in line of Duty" MoD (DoESW) has approved applicability of PWD Act 2016 wef 18 Sep 2018 vide their ID No 18(77)/2017/WE/D(Res-I) dated 18 Sep 2018 wherein sons suffering from following disabilities :-

(a) Blindness.
(b) Low-vision.
(c) Leprosy Cured persons.
(d) Hearing Impairment (deaf and hard of hearing).
(e) Locomotor Disability.
(f) Dwarfism.
(g) Intellectual Disability.
(h) Mental Illness.
(j) Autism Spectrum Disorder.
(k) Cerebral Palsy.
(l) Muscular Dystrophy.
(m) Chronic Neurological conditions.
(n) Specific Learning Disabilities.
(o) Multiple Sclerosis
(p) Speech and Language Disability
(q) Thalassemia
(r) Hemophilia
(s) Sickle Cell Disease
(t) Multiple Disabilities including deaf, blindness
(u) Acid Attack Victim
(v) Parkinson's Disease

(BS Sisodia)
Col
Dir (Ops & Coord)
for MD ECHS

ECHS: PRIOR SANCTION FOR TREATMENT IN NON EMP HOSPITAL

ECHS: PRIOR SANCTION FOR TREATMENT IN NON EMP HOSPITAL

Tele: 25682870
Mil: 36833

Central Organisation, ECHS
Adjutant General’s Branch
Integrated Headquarters
Ministry of Defence (Army)
Maude Lines
Delhi Cantt-110010

B/49770/AG/ECHS

05 Oct 18

All Regional Centres

PRIOR SANCTION FOR TREATMENT IN NON EMP HOSP

1 Ref Para 18(a) of SOP on treatment Management in ECHS.

2. All prior sanctions for treatment in Non Empanelled Hospitals will be accorded by Dir RC except in the following cases:-

(a) Major cardiac surgery/ interventional cardiology.
(b) Oncology
(c) Organ transplant cases.
(d) Joint Replacement cases.
(e) Major Neurosurgical / Neurology cases.
(f) Bariatric surgery cases.
3. Format of prior sanction by Dir RC ECHS will be same as is being followed by CO ECHS.

4 Bills will be reimbursed at CGHS Rates only. No representation will be accepted for full reimbursement in such cases.

5. No TA is admissible in such cases.

6. Cases already received and dispatched by 10 Oct 18 will be processed by Central Org ECHS Org ECHS.

sd/-
(Ravi Pal Kapoor)
Lt Col
Jt Dir (Med)
for MD ECHS

Source: https://echs.gov.in

Procedure for ECHS Application - marital discord/ Parents of soldiers after Death

Procedure for ECHS Application - marital discord/ Parents of soldiers after Death

Tele : 011-25684847
ASCON : 36832
Fax : 011-25684946
Email : diropsechs-mod@nic.in

Central Organisation ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Maude Lines
Delhi Cantt - 110 010

B/49701 -PR/AG/ECHS/2018

26 Sep 2018

Air HQ PD (DAV)
PD (Navy)
All Comd HQ’s (NECHS)
AMA ECHS, Embassy of India, Nepal
Director General Indian Coast Guard
Director General NCC
Director General SFF
ADG TA/TA-3
All Regional Centres, ECHS

PROCEDURE FOR PROCESSING OF ECHS APPLICATION
IN CASE OF MARITAL DISCORD / FAMILY DISPUTE AND
PARENTS OF SOLDIERS AFTER DEATH IN HARNESS

1.A number of petitions are recd from spouses of veterans as a consequence of marital discord and parents of the serving soldiers who died in harness wherein the primary beneficiary does not apply for ECHS membership for the dependents. The extant rules do not permit anyone else to apply for ECHS membership except the primary member.

2. ECHS is akin to CGH’S in many regards and ECHS rules are similar too. Since the CGHS rules extend CGHS facilities to a judicially separated wife (CGHS Rule Book, Chapter 3, Page 25), it is axiomatic that since a judicially separated wife is auth CGHS facilities, a spouse during the period of marital discord will also be allowed CGHS facilities. Further, the meaning of ‘family’ as per Govt Rules are as under :-

(a) Husband/wife, including more than one wife and a judicially separated wife.
(b) Parents (excluding step parents), subject to the following:-

(i) In case of adoption, adoptive parents and not real parents.
(ii) If adoptive father has more than one wife, only the first wife: and.
(iii) In case of female employees, parents or parents-in-law, at her option, subject to the conditions of dependency and residence etc. being satisfied.

(c) Children, including step children, legally adopted children, children taken as wards by the Government servant under the Guardians and Ward Act, 1980, provided that such a ward lives with him, treated as a family member and is given the status of a natural born child through a special will executed by that Government servant :-

(i) Son is eligible till he starts earning or attains the age of 25 years or gets married, whichever is earlier.
(ii) Daughter is eligible till she starts earning, or gets married.

(d) Sons suffering from permanent disability either physically or mentally, without any age-limit.

(i) Disability means blindness, low vision, leprosy- cured, hearing  impairment, locomotor disability, mental illness (includes schizophrenia), autism, cerebral palsy or a combination of any two or more of such conditions and includes a person suffering from several multiple disability.
(ii)’Permanent disability’ means a person with 40% or more of one or more

(e) Dependent divorced/abandoned or separated from their husband/widowed daughters (irrespective of age).

3. The ECHS facilities will hence be extended to the spouse/her dependent children/  eligible parents/dependents, during the period of marital discord.

4. In so far as, the parents of ESM are concerned, there are cases where the spouse of ESM becomes the primary member after the demise of the ESM, but due to strained relations (family dispute) is reluctant to obtain ECHS membership for the parents, despite their meeting the dependent criteria including income criteria. Such cases will also be addressed under the meaning of the term ‘family’ and ECHS facility will be made applicable to eligible persons.

5. The procedure for processing of ECHS application in case of marital discord / family dispute cases will be as under :-

(a) Spouse/ dependent children and dependent parents will be eligible to apply for ECHS membership on production all supporting documents for eligibility of self and his / her children and similarly for dependent parents.

(b) On the basis of ibid provision, the spouse I dependent children / dependent parents should apply to DIAV for Army, DESA for Navy & DAV for Air Force who will facilitate in obtaining copy of PPO from respective Record offices. The application should be duly supported with an identity proof in the form of Aadhaar Card, PAN Card, Ration Card, Marriage Part II order & Dependent Card issued by District Soldier Board. DIAV/DESA/DAV will endorse a letter to the primary beneficiary to give him/her an opportunity to apply for cards himself/herself within 30 days for eligible family members. In case of non receipt of reply within 30 days / refusal to apply, obtaining copy of PPO will be facilitated for the applicant.

(c) Having obtained the copy of the PPO, the spouse / dependent children I dependent parents should apply through ‘Online Application’ portal of ECHS website for issue of ECHS Smart Card. Once the online application is successfully filled ‘up alongwith payment for the card (s), the indl will be able to generate ‘Temporary Slip’ for the affected persons. The same will be activated at dependent Polyclinics with a validity of three months at a time or till receipt of card whichever is earlier. The Temporary Slip will allow need treatment to the concerned persons till receipt of Smart Card.

(d) In marital discord cases, the ECHS membership granted will be for a limited period of one year or till resolution divorce whichever is earlier. The same will be renewed in case of status quo beyond a year.

(e) The membership of spouse will be discontinued once a divorce is granted & The responsibility of informing of divorce will be that of the primary beneficiary / ESM. If not informed and any treatment taken by the divorced lady post divorce recovery due will be on the primary beneficiary / ESM including for those children staying with him / her.

(f) It will be responsibility of dependent parents (in cases of serving soldiers died in harness) to give yearly affidavit for income criteria. Wife of deceased soldier should also inform if parents have more income which makes them ineligible. Responsibility of recovery will be on primary beneficiary.

(g) Membership of children will be based on the eligibility criteria as governed in terms of age, income and marriage criteria applicable as laid down vide CGHS letter No MH & FW No 4-24/96-C&P/CGHS/CGHS(P) dated 31 May 2007.

(h) The onus of informing of divorce for marital discord cases and income criteria for dependent parents will be of primary beneficiary.

6. This has approval of AG.

(Niranjan Kumar) Brig
Dy MD
for MD ECHS

Handing Over of ECHS Smart Card to ECHS Beneficiaries

Handing Over of ECHS Smart Card to ECHS Beneficiaries

Tele : 25684645
Telefax : 011-25684946
Email : jditechsl@echs gov.in

Central Organisation ECHS
Adjutant General's Branch
Integrated Headquarters of
MoD (Army), Maude Lines,
Delhi Cantt - 110 010

13 Sep 2018

B/49711-IT/AG/ECHS

IHQ of MoD (Air Force)
IHQ of MoD (Navy)
HQ South Comd (A/ECHS)
HQ East Comd (A/ECHS)
HQ West Comd(A/ECHS)
HQ Central Comd(A/ECHS)
Northern Comd(A/ECHS)
South West Comd(A/ECHS)

All Regional Centres

HANDING OVER OF ECHS SMART CARD TO ECHS BENEFICIARIES

1. 64 KB Smart Card is being filled 'online' followed by 'online' verification before the data goes to the Card making company to print & despatch the Cards. Contracting company despatches the Smart Cards to Regional Centres in Station Headquarter packets. Regional Centres despatch these Stn HQ packets to Stn HQs.

2. Once the Cards are received at Station Headquarters, these have to be accounted for. SMS is sent to the beneficiary alongwith OTP to come & collect Card at the Stn HQ. Once OTP is fed into the system, activated card is handed over to the beneficiary for use.

3. . Station Headquarters are currently responsible not only for issue of new Smart Cards but also to collect old cards/temp slips besides physical verification of all beneficiaries as this is the only stage when physical presence is being used for authentication.

4. A number of Ex-Servicemen have represented that they are finding it inconvenient to take all the beneficiaries to the dependent Station Headquarters for collection of ECHS Cards besides Station Headquarters being far off from their place of residence.

5. The competent authority has approved the following for collecting new 64 Kb Cards from respective Station Headquarters :-

(a) The primary beneficiary can collect his own card and the cards of his dependents from Station Headquarters.

(b) The primary beneficiary will be responsible to handover all the old
Cards/Temp Slip as applicable to Station Headquarters while collecting the Cards of self and dependents.

(c) The primary beneficiary will be responsible to produce required
documents to ‘establish that the dependents are entitled for the ECHS Card.

(d) The Station HQ can also distribute the Cards at Polyclinic on specified days /dates and any nominated location on a pre announced date, as per the procedure laid down for online endorsement & accounting of Cards & documents.

6. Option of video call based verification using mobile, if needed, could also be utilized.

7. Station Headquarters will continue to remain responsible for accounting.

8. Regional Centres to fwd a copy of this letter to all Station Headquarters covering their Polyclinics.

s/d
(Rakesh Kakar)
Col (Retd)
Jt Dir (Stats & Automation)
for MD ECHS

Extension of date of Validity of 16KB ECHS Cards

Extension of date of Validity of 16KB ECHS Cards

Tele :25684645
Telefax : 011-25684946
Email : jditechsl@echs.gov.in

Central Organisation ECHS
Adjutant General’s Branch
Integrated Headquarters of
MoD (Army), Maude Lines,
Delhi Cantt- 110 010

B/49711-NewSmartCard/AG/ECHS

31 Aug 2018

IHQ of MoD (Air Force)
IHQ of MoD (Navy)
HQ West Comd (A/ECHS)
HQ South Comd (A/ ECHS)
HQ East Comd (A/ ECHS)
HQ Central Comd (A/ECHS)
HQ North Comd (A/ECHS)
HQ South West Comd (A/ECHS)
All Regional Centres
…………………………

EXTENSION OF DATE OF VALIDITY OF 16 KB ECHS CARDS

1. Refer is made to the instructions issued for Online Smart Card Application.
2. Considering the feedback from the environment, competent authority extended the validity of old 16KB Cards upto 31 Dec 2018. This extension is final and no further extension will be provided.
3. This information may be disseminated to the environment for information of ECHS beneficiaries.

(Rakesh Kakar)
Col (Retd)
Jt Dir (Slats & Automation)
for MD ECHS
ECHS

Veteran Patient Care and Assistance (VPCA) Teams - A vigilance Mechanism in ECHS

Veteran Patient Care and Assistance (VPCA) Teams - A vigilance Mechanism in ECHS

DG (DC & W)
Adjutant General's Branch
Integrated HQ of MoD (Army)
South Block
New Delhi - 110 011

B/49717-C(VIG)/AG/ECHS

12 Jul 2018

VETERAN PATIENT CARE AND ASSISTANCE (VPCA) TEAMS -A VIGILANCE MECHANISM IN ECHS
Gen

1. Ex Servicemen Contributory Health Scheme (ECHS) is a welfare oriented scheme providing effective healthcare to Ex Servicemen and their dependents. Since in 2003, the scheme has expanded exponentially and has nearly 52 lakh beneficiaries today throughout the length and breadth of the country.

2. There is a need to institute a vigilance framework with a nominated nodal officer at each echelon of the scheme to introduce checks and balances in the system to ensure its efficient and effective functioning . The vigilance frame work so instituted will pay attention to the following aspects with a mechanism to detect, analyse and take corrective and preferably pre-emptive :-

(a) Ensure ECHS benefits are not availed by unauthorized persons.
(b) Check unethical practices I exploitation of ESMs by empanelled facilities.
(c) Monitor referral to empanelled facilities and carry out checks to negate unauthorized treatments/or claims.

Handling of ECHS Issues/Subject/Tasks

3. Tech issues relating to billing, claims and MoA with empanelled hospitals are dealt by Regional Centres of ECHS. All adm issues of Polyclinics are handled by Stn HQ.

4. Regional Centres (RC) ECHS. Comments/ assistance/inv/vigilance on following issues are carried out through RCs:-
(a) MoA with empanelled hospitals therefore complaints regarding empanelled hospitals/Harassment in empanelled hospitals.
(b) Claims/Billing issues of empanelled hospitals.
(c) Indl reimbursement claims received by RC from Polyclinics.

5. Stn HQs. Stn HQs handle the following issues:-
(a) Adm of Polyclinics.
(b) Card making of beneficiaries.
(c) Contractual employment.
(d) Medicine availability through SEMO.
(e) C of I / detailed inv in empanelled hosp or service hosp.

Vigilance Cells

6. A feedback on the satisfactory functioning of Pilot Project at three stations has been obtained. It is now planned to institute the vigilance framework in 14 other major ECHS stations, to include Ambala, Bareilly, Channai, Hyderabad, Jaipur, Jabalpur, Jammu,Kochi, Kolkata, Lucknow, Meerut, Patna, Pune and Ranchi.

7. Composition of Vigilance Cell. The ECHS Vigilance Cell will function under the Stn Cdr and will incorporate a contractual Doctor/serving AMC officer for On-Spot verification of cases of alleged medical negligence/ violation of MoA. It will be composed as under:-
(a) OIC Team. Medical Offr (when accompanying) CMP JCO/NCO.
(b) CMP Team. Two CMP pers (JCO/NCO) in a light vehicle/MC.
(c) Medical Team. One Medical Offr (serving/contractual from ECHS) to be co-opted for all investigations related to hospitals/having examination of medical aspects. Serving offr may be also co-opted under arngs of Stn Cdr.

8. Tasks of Vigilance Cell. While not exhaustive, some of the tasks will be:-

(a) At Polyclinics.
(i) Investigate irregularities I fraudulence by contractual staff.
(ii) Physical verification of ESM and dependents (card and self attested proforma)
(iii) Review adm functioning of Polyclinics when so detailed by Stn I Sub Area I Area HQs on specific instructions
(iv) Surprise physical check of Medicines I Dispensary.
(v) Surprise physical verification of ESM/dependents.
(vi) Check use of ambulance/equipment with Polyclinic.
(vii) Avlb of complaint/Grievance Book and redressal/Comments.

(b) At Regional Centres.
(i) Check BPA verifiers at Regional Centres and any wrong practices by Hospital reps.
(ii) Check process of receipt of bills.
(iii) Ensure process of First in First Out (FIFO) in billing/ as specified by Central Org.
(iv) Monitor hospital representatives visiting for empanelment process.
(v) Security procedure of Regional Centre premises.

(c) At Hospitals/Diagnostic Centres/Labs.
(i) Periodic/Surprise Checks of Empanelled Facilities and patients admitted.
(ii) Physical verification of patients at non-empanelled facilities when so directed.
(iii) Investigate individual cases of fraudulence by beneficiaries .
(iv) Carry out preliminary investigation wrt complaints received at Regional Centre, if so directed by Director Regional Centre. These will be fwd to Stn Cdr being the nodal agency for check.
(v) Assist in medical audits if ordered by Regional Centres / Higher Headquarters .

Investigations and Reporting

9. Investigations. All complaints/reports are to be forwarded to Stn HQ in confidence irrespective of the subject being dealt by any agency. The Stn Cdr will brief the team and allocate the task to them in confidence. No prior info will be made available to vigilance cell members for surprise checks to avoid confidentiality being compromised. Routine and planned checks can be pre-decided.

10. Reporting. Reports will be of two types, viz/Incident/Info Report and Monthly Report. Reports of Vigilance Cell will be forwarded through Stn HQ SO (ECHS) to Area/Sub Area HQ (Dir ECHS/Dir Veteran) to Command HQ (SO ECHS) to Central Org ECHS (Dir C & L). All cases of misuse, fraud and harassment will be reported.

(a) Incident/Info Report. This report will be initiated by the Stn HQ to imdt higher HQ in chain of command within seven days of investigation being completed, with copy to all echelons of Comd till Comd HQ and Central Organisation ECHS (Dir C & L) for prompt action. Report should be passed immediately on telephone depending on gravity of input, to all concerned and followed up by return report so that corrective measures are not delayed. The format is as per Appendix A (in cases where delinquency in respect of serving pers come to notice, it will also be info to HQ Comd (DV) and DV Dte/AG's Br by Comd (SO ECHS) and Central Organisation ECHS respectively.)

(b) Monthly Report. A monthly report on surprise checks carried out during the month by the Vigilance Team will be forwarded to Central Org ECHS as per format on Appendix B by 20th of next month by the Comd HQ (SO ECHS).

11. Report. The report by the Vigilance Team for various est will be rendered as per u/m formats:-
(a) Empanelled Hospital - Appendix C.
(b) Regional Centre - Appendix D.
(c) Polyclinic - Appendix E.

12. Check list. A suggested check list for the Vigilance Team is at Appendix F.

13. The Stn Cdr will compile the activities of the vigilance team and render a ground report after three months to Central Org ECHS through comd channel with recommendations/inputs to refine the vigilance mechanism.

(Yogendra Dimri)
Lt Gen
DG (DC&W)

Source: echs.gov.in

ECHS: Scrutiny of OPD/ IPD Claims at RC Level

ECHS: Scrutiny of OPD/ IPD Claims at RC Level

Central Organisation ECHS
Adjutant General's Branch
Integrated HQ of MoD (Army)
Maude Lines

Delhi Cantt- 110 010
B/ 49779-Outsourcing/ AG/ ECHS/ Policy
12 Jul 2018

All Regional Centres
...................................
...................................

SCRUTINY OF OPD/IPD CLAIMS AT RC LEVEL

1. Further to our letter No B/ 49779-Outsourcing/ AG/ ECHS/ Policy dated 10 Nov 2017, pursuant to the instructions received from DoESW vide letter No. 18(80) / 2017/WE/ D(Res-1) dated 12 Jul 2018 and proposal to formalize second tier check vide case file No B/ 49779- Outsourcing/ AG/ ECHS initiated on 06 Jul 2018.

2. It is directed that the process for online bill processing at RC level to be carried out as under:-

(a) Bills Amounting to Less than Rs 30,000/ -. For bills amounting to less than Rs. 30,000/ -, 2% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bill scan be checked as per discretion.

(b) Bills in the Range of Rs 30,000/ -to Rs 59,999/ -. For bills in the range of Rs 30,000/ - to 59,999/ -, 3% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bills can be checked as per discretion.

(c) Bills in the Range of Rs 60,000/ -to Rs 99,999/ -. For bills in the range of Rs 60,000/ - to 99,999/ -, 5% bills per day shall be checked by the JD (HS). The bills selected will be those having highest financial value. Additional bills can be checked as per discretion.

(d) Bills More than Rs1 Lakh. 100% Bills for amount more than Rs. 1 Lakh to be checked by JD(HS) at RC.

3. The process to be put in effect immediately and respective functionaries in the Online Bill Processing chain to ensure that the above is complied.

4. The modification incorporated in the system of the online bill processing application will be such that a basket of 100 claims is presented to the JD(HS), those 100 claims will be picked up in FIFO manner out of the claims processed by BPA. There will be separate baskets for OPD, IPD and individual re-imbursement claims. The 100 claims in each basket will be strictly presented in FIFO manner. The presentation of these baskets to JD(HS) and its subsequent manner of processing for all baskets (OPD, IPD and individual re-imbursement) is described below:- ,

(a) Claims less than Rs. 30,000/ -. These will be listed on top of the page and JD(HS) would have to compulsorily check 2% of such claims (number to be rounded off to the next round figure). These claims would be the one's with the highest recommended amount. The multi select option for the balance claim in this category would be available orally after atleast 2% claims have been checked. JD(HS) can check additional claims also as per his discretion.

(b) Claims between Rs. 30.000/ - to Rs. 59,999/-. A counter for the claims falling in this region would be created by BPA to reflect 3% of such claims ,(number to be rounded off to the next round figure) which would have to be compulsorily checked by the JD(HS). These claims would be the one's with the highest recommended amount. The JD(HS) would have the option to check any additional claim also should he choose to do so. The multi select option for the balance claim in this category would be available only after atleast 3% claims have been checked.

(c) Claims between Rs. 60,000/ - to Rs. 99,999 / -. A counter for the claims falling in this region would , be created by BPA to reflect 5% of such claims (number to be rounded off to the next round figure) which would have to be compulsorily checked by the JD(HS). These claims would be the one's with the highest recommended amount. The JD(HS) would have the option to check any additional claim also should he choose to do so. The multi select option for the balance claim in this category would be available only after atleast 5% claims have been checked.

(d) Claims above Rs. 1 Lakh/-. All claims above Rs. 1 Lakh will have to be compulsorily checked by JD(HS). No multi select option will be enable? in this window.

5. Next set of 100 claims in the concerned basket will be presented to the JD(HS) only after the claims in the respective basket has been completely cleared.

6.In addition, it is highlighted that in accordance with Para 2(d) of MoD letter No. 22(A)(10/ 10/ US(WE)(Res) dated 23 Feb 2012, "CFA will examine the bill and BPA's worksheet prior to according sanction,,." Hence, all CFAs must ensure that no violation to the above guidelines take place and 'the provisions brought out above are not compromise did any manner.

7. Please ensure speedy clearance of bills so that large tendencies can be reduced. Financial integrity of checks, will not be compromised.

8. These instructions are issued with approval of MD ECHS.1

(DM Anand)
Col
Dir (Stats & Automation)
for MD ECHS

Source: ECHS

EMPANELMENT OF MEDICAL FACILITIES WITH ECHS

EMPANELMENT OF MEDICAL FACILITIES WITH ECHS

Tele: 25683476
Army: 36833

Central Organisation, ECHS

Adjutant General's Branch

Integrated Headquarters

Ministry of Defence (Army)

Maude Lines

Delhi Cantt- 110010

 B/49771/AG/ECHS/Emp/Gen

20 Jun 18

(All Regional Centre ECHS)

EMPANELMENT OF MEDICAL FACILITIES WITH ECHS

1. Further to our letter No B/49771/AG/ECHS/Gen dated 20 Sep 17. Empanelment of medical facilities to recommence as per details in succeeding paras.

2. PI process the applications of hospitals with current procedure with immediate effect.

3. Only completed applications should be fwd.

4. NABH/NABL entities can apply directly to CO ECHS.

5. Applications from the areas having adequate No of empanelled hospitals need not be processed unless the hospital has specialised facility/needed by our ESM.

6. PI focus specifically in those areas where there are no/ltd empanelled facilities.

7. This has the approval of MD ECHS.

S/d,

(DK Dubey)

Gp Capt

Jt Dir (Med)

for MD ECHS

Delay in Payment to Empanelled Hospitals

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO: 4758
ANSWERED ON: 23.03.2018

Delay in Payment to Empanelled Hospitals

RAJIV PRATAP RUDY
Will the Minister of
HEALTH AND FAMILY WELFARE be pleased to state:-

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether there is a delay in the payment to empanelled hospitals under Government sponsored health programmes such as Central Government Health Scheme (CGHS) and Rashtriya Swasthya Bima Yojana (RSBY);

(b) if so, the details thereof and the reasons therefor;

(c) whether CGHS and RSBY has been effective in reducing the burden of out of pocket spending of poor households, if so, the details thereof; and

(d) the total number of beneficiaries and total funds allocated under CGHS and RSBY over the last four years, State/UT wise including Bihar?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b): Under CGHS there is some delay in payment to empanelled hospitals. Following are the reasons for delay in settlement of hospital bills under CGHS:-
i. Resource constraints particularly in the last quarter of Financial Year.
ii. Need for consultation with Specialists in some cases.
iii. Time taken in scrutinizing of Hospital bills.

Under RSBY, Insurance Companies make payment, as due and admissible, to the empanelled hospitals as per their claim. Details are not maintained at Central level.

(c): Under CGHS, the beneficiaries, who are primarily Central Government Employees and Pensioners, are provided health facilities including OPD, medicines, reimbursement of expenditure incurred on hospitalization etc. and they do not have to incur out of pocket expenditure. They have to bear additional expenditure only if they opt for specific brand of implants costing more than CGHS rates.

Under RSBY, claims amounting to Rs. 5012.17 Crore have been settled since 2011-12 to 2016-17, which may be construed as a reduction in out of pocket expenditure for the beneficiaries under RSBY, who have availed the hospitalization benefits.

(d): There are 32,53,219 number of CGHS beneficiaries as on 13.03.2018.
The total funds allocated under CGHS over the last four years is as under:-

Year Funds Allocated (Rupees in Crores)
2013-14 1772.75
2014-15 1734.02
2015-16 1872.29
2016-17 2026.91

Under RSBY no funds are allocated to States. Funds as central share of premium are released on receipt of proposals from State Governments. The State-wise list of beneficiaries under RSBY over the last four years including Bihar is at Annexure.

Source : LokSabha

Defence: Empanelment of Hospitals for ECHS Facilities

Ministry of Defence

Empanelment of Hospitals for ECHS Facilities

12 MAR 2018

Empanelment of private hospitals with ECHS depends on the willingness of the hospitals to accept CGHS Rates and to abide by the procedures and rules of ECHS. The Government is continuously empanelling private hospitals, which are applying for empanelment and are found eligible for empanelment as per ECHS rules. In the recent past 217, 189, 123, and 85 private hospitals have been empanelled on 10.11.2016, 2.06.2017, 05.12.2017 and 04.01.2018 respectively. A total of 2609 hospitals are empanelled with ECHS as on date.

This information was given by RakshaRajyaMantriDr. Subhash Bhamre in a written reply to Shri Rajeev Chandrasekhar in Rajya Sabha today.

PIB