Medical - Indian Army

CONTENT
(MEDICAL)
SNO SUBJECT
SECTION I : REVISION OF RATES
1. MOA and CGHS Rates
2. Policy : Revision of ECHS Rates 2010
3. Implementation instructions : Revised ECHs Rates
4. Super specialty status : Empanelled Hospitals
5. Clarification regarding revision of packages rates
6. Guidelines on oncology treatment Rates
SECTION II : REFERRAL
1. ECHS referral procedure (less NCR)
2. ECHS referral to service hospital
3. Referral to empanelled hospitals in different station
4. Referral to empanelled hospitals echs polyclinic Thane
5. ECHS referral policy for outstation patients
6. Medical care for echs beneficiaries in remote/hilly areas
7. Referral of echs patients to army hosp (R &R)
8. Referral to empanelled hospitals in delhi/NCR
9. Referral to empanelled hospitals in delhi/NCR

SECTION III : PRIOR APPROVAL
1. Prior approval : Unlisted procedures/tests/implants
SECTION IV : PROCESSING OF BILLS/ REIMBURSEMENT
1. Reimbursement medical expenses
2. Representations by hospital/diagnostic centres on payment
3. Submission of claim for reimbursement by outstation ECHS members
4. Re-imbursement of medical expenses after demise of ESM/members of ECHS
5. Re-imbursement of Medical bills of outstation ECHS members for treatment in Delhi
6. Diet charges for ECHS Patients admitted to Hospital.
7. Processing of claim for reimbursement : Non empanelled Hospital
8. Case study : Establishment of emergency psychiatric cases
9. Reimbursement of Vat on drug and consumables
10. Processing of bills from empanelled medical facility/individual claims
11. Procedure for payment and Reimbursement of medical expenses under ECHS
12. Processing of minor hospital bill and individual claims
13. Reconcilation of Hospital Bill Code Head : 365/00
14. Utilisation of provisions of Fin Regs towards speedy clearence of Medical Bill
15. Guidelines for Demiciliary Rehabilation Medicine Intervention for Reimbursement
to echs Beneficiaries
SECTION V : PROCEDURE OF EMPANELMENT
1. Empanelment of Govt Hospital
2. Memoranda of Agreement Empanelment of hospital/Nursing Homes, dental centres and
diagnostic centres
3. Empanelment of dialysis centres
4. Empanelment Of Hospitals At Other Stations-Not Under The Jurisdiction Of A Station
Cdr.
5. Empanelment of hospitals, nursing homes and diagnostic centres for ECHS
6. Referral Of Echs Patients To Medanta, The Mediciti Hospital, Gurgaon
7. Empanelment of hospitals: Ernest Money deposit and performance bank guarantee
8. Empanelment of hospitals, nursing homes and diagnostic centres under ECHS

9. Procedure for empanelment of hospital, Nursing Homes and diagnostic centres under ECHS
10. General instruction : empanelment of hospital/nursing homes/eye care centres/imaging
centres/diagnostic laboratories/imaging centres dental clinics and hospices
SECTION VI : DENTAL
1. Dental Treatment under ECHS
2. Dental Services at ECHS Polyclinics
SECTION VII : ISSUE OF MEDICINE / MED EQPT
1. Issue of medicines to ECHS beneficiaries
2. Advisory No : 13 Medicines for Veterans Travelling Abraod
3. Issue of anti cancer drugs to ECHS beneficiaries
4. Issuance of strips for Glucometer
5. Adherance of policy on indenting/ supply of medical stoes in respect of echs
polyclinics
6. Indenting of medical stores
7. Modification of ambulance at ECHS polyclinics
8. Issue of expendable medical stores to new raising ECHS polyclinics.
9. Issue of expendable medical stores to new raising ECHS polyclinics.
10. Forwarded of : Annual Equipment Census
11. Repair of ECHS Equipment
12. Issue of hearing aids prescribed for ECHS members
13. Issue of medical eqpt prescribed for ECHS members

SECTION VIII : TREATMENT
1. Policy on duration of hospitalization
2. Advisory No-09 : Emergency admissions in empanelled hospitals
3. Advisory note no-06 requirement of blood for ECHS patients admitted in
Empanelled/non –empanelled hospitals
4. Dependent status of new born baby
5. Examination of patients in ECHS polyclinics

MOA AND CGHS RATES
1. Reference our letter No B/49773/AG/ECHS/Rats/Policy dated 09 Sep 2009.
2. All clearance of bills, signing of MOA with hospitals will be as per pre revised
rates (2006) as per Govt of India letter No 24(8)/03/US(WE)/D(Res)/Pt I dated
22 Feb 2008 forwarded vide this Organisation letter No B/49773/AG/ECHS/CGHS dt
25 Mar 2008.
3. This organization letter under reference is hereby superseded.
Authority : B/49773/AG/ECHS/Rates/Policy 13 Jul 2010
Sd/- X X X
Jt Dir (Med)
for MD ECHS

POLICY : REVISION OF ECHS RATES 2010
1. Refer GOI MoD ID No 22A(48)/2007/US/WE/D(Res) dated 19 Aug 2010 (copy
enclosed).
2. Revised CGHS rates wef 01 S ep 2010 are available on w ebsite
http://www.mohfw.nic.in/cghs for Delhi, Kolkata, Chennai, Bengaluru and Hyderabad.
The same will be f ollowed by ECHS in these cities and linked areas wef 01 S ep
2010.
3. As and when the revised CGHS rates for other cities are put into effect, the
same will be followed accordingly by ECHS.
l
Authority: B/49773/AG/ECHS/CGHS 24 Aug 2010
Sd/- X X X
Jt Dir (Med)
for MD ECHS

Subject :- Revision of ECHS Rates
Ministry of Defence
(Deptt of Ex-Servicemen Welfare)
Reference Central Org ECHS ID No B/49773/AG/ECHS/CGHS dated 3 rd Jul
2009 on the above mentioned subject.
2. Pre revised CGHS rates being followed by ECHS as at present may continue
only for the time being until the second revision by CGHS comes into effect. Since
the second revision for the rates for Delhi has already been notified by Ministry of
Health and Family Welfare, it may be f ollowed by ECHS for Delhi with immediate
effect. As and when the second revision rates by CGHS for other cities is put into
effect, it may be accordingly followed by ECHS.
3. For the polyclinics located in cities/towns not covered under CGHS, the rates
of payment to the empanelled hospitals/diagnostic centres will be negotiated and
fixed by ECHS based on the facilities available and the prevailing market rates. The
rates so fixed will, in any circumstances, not exceed the CGHS rates applicable to
the nearest cities/towns covered under CGHS (As per Govt letter No 24(8)/03/US
(WE)/D(Res) dated 19 th December 2003), copy enclosed.
4. Due efforts to ascertain and disseminate information regarding the new rates
to all stake holders will be made by MD ECHS under intimation to MoD.
5. This issues with the approval of competent authority.
MD ECHS
MOD ID No 22A(48)/2007/US/WE/D(Res) dated 19 Aug 2010
Sd/- X X X
Under Secretary to the Govt of India
Tele No 23014946

IMPLEMENTATION INSTRUCTIONS : REVISED ECHS RATES
1. Reference :-
(a) Central Organisation ECHS letter No B/49771/AG/ECHS/Empanelment
dated 05 Dec 2003.
(b) Central Organisation ECHS letter No B/49773/AG/ECHS/CGHS dated
24 Aug 2010 (vide which MoD ID No 22A(48)/2007/US/WE/D(Res) dated
19 Aug 2010 was forwarded to all).
2. Rates for various empanelled hospitals have been revised for Delhi and five
other cities presently and differentiated for NABH Accredited Hospitals, Non NABH
Hospitals and Super Speciality Hospitals by CGHS.
Super Speciality Hospitals
3. Central Organisation of ECHS has received requests for clarification as to
which hospitals will be categorised as “super-speciality hospitals” and which hospitals
can charge rates fixed for Super-speciality hospitals. It has been clarified by the
Ministry of Health and Family Welfare vide their Office Memo No.
S.11011/23/2009-CGHS D.II/Hospital Cell (Part I) dated 13 Sep 2010 for Delhi that
the entitlement of hospitals to super-speciality rates will not be, because hospitals
perceive themselves to be super-speciality hospitals, but subject to their fulfilling the
eligibility conditions for being classified as super-speciality hospitals. These are :-
(a) Hospitals with 300 or more beds.
(b) Should be accredited by NABH or its equivalent such as Joint
Commission International (JCI) of USA, ACHS of Australia or by any other
accreditation body approved by International Society for Quality in Health
Care (ISQua).
(c) Should have ECHS empanelled treatment facilities in at least three of
following Super Specialities in addition to Cardiology, Cardiothoracic Surgery
and Specialised Orthopaedic Treatment facilities that include Joint
Replacement Surgery :-
(i) Nephrology and Urology (including Renal Transplantation).
(ii) Endocrinology.
(iii) Neuro Surgery.
(iv) Gastroenterology and GI-Surgery including Liver
Transplantation.
(v) Oncology-(Surgery Chemotherapy and Radiotherapy).

4. ECHS beneficiaries have, so far, been given the option to get themselves
treated in any empanelled hospital of their choice. However, in view of the increased
outgo on getting treatment in Super Speciality Hospitals, it has now been decided
that ECHS beneficiaries desirous of getting treated in Super Speciality hospitals, in
non emergency conditions, prior approval of the concerned Regional Centres would
have to be obtained.
5. List of hospitals which meet the above criteria at Delhi, Mumbai, Bangalore,
Hyderabad, Kolkata and Chennai and can be qualified as Super Speciality is at
Appendix ‘A’.
6. Further, Station Headquarters be instructed to obtain documentary proof from
the empanelled hospitals and submit the same for categorization of the hospitals as
NABH accredited hospitals and Superspeciality hospitals by 31 Jan 2011.
Zonal Jurisdiction of CGHS Rates
7. Zonal jurisdiction of CGHS rates for ECHS was laid down vide this
Organisation letter No B/49771/AG/ECHS/Empanelment dated 05 Dec 2003.
Revised Zonal Jurisdiction of rates is at Appendix ‘B’ to this letter. (Appendix ‘D’ of
this Organisation letter No B/49771/AG/ECHS/Empanelmentt dated 05 Dec 2003 is
hereby superseded).
Package Rates
8. Package rate shall mean and include lump sum cost of inpatient treatment/
day care/diagnostic procedure for which a ECHS beneficiary has been permitted by
the competent authority or for treatment under emergency from the time of
admission to the time of discharge including (but not limited to) the following :-
(a) Registration charges.
(b) Admission charges.
(c) Accommodation charges including patients diet.
(d) Operation charges.
(e) Injection charges.
(f) Dressing charges.
(g) Doctor/consultant visit charges.
(h) ICU/ICCU charges.
(j) Monitoring charges.
(k) Transfusion charges.

(l) Anesthesia charges.
(m) Operation Theatre charges.
(n) Procedure charges/Surgeon’s fee.
(o) Cost of surgical disposables and all sundries used during
hospitalization.
(p) Cost of medicines.
(q) Related routine and essential investigations.
(r) Physiotherapy charges etc.
(s) Nursing Care and charges for its services.
9. Cost of implants/stents/grafts is reimbursable in addition to package rates as
per ceiling rates of CGHS for Implants/stents/graft or as per actual, in case there is
no CGHS prescribed ceiling rates. The CGHS ceiling rates presently applicable are
given at Appendix ‘C’ (these rates will be valid till the same are revised by CGHS).
10. Treatment charges for new born baby are separately reimbursable in addition
to delivery charges for mother.
11. The hospitals empanelled under ECHS shall not charge more than the
package rates/rates negotiated in MOA whichever is lower.
12. Package rates envisage upto a maximum duration of indoor treatment as
follows :-
(a) 12 days for Specialised (Super Specialities) treatment.
(b) 7 days for other Major Surgeries.
(c) 3 days for Laparoscopic surgeries/normal deliveries.
(d) 1 day for day care/minor (OPD) surgeries.
13. However, if the beneficiary has to stay in the hospital for his/her recovery for
a period more that the period covered in package rate, in exceptional cases,
supported by relevant medical records and certified as such by hospital, the
additional reimbursement shall be limited to accommodation charges as per
entitlement, investigations charges at approved rates and doctors visit charges (not
more than 2 visit per day per visit by specialists/consultants and cost of medicines
for additional stay).

14. No additional charge on account of extended period of stay shall be allowed if
that extension is due to infection on the consequences of surgical procedure or due
to any improper procedure and is not justified.
15. The package rates are for semi-private ward.
16. The ECHS beneficiaries taking treatment in the empanelled hospitals will be
entitled for reimbursement/treatment on credit as per the package rates/rates as
per MOA whichever is lower. The package rates are for semi-private ward. If
the beneficiary is entitled for general ward there will be a decrease of 10% in the
rates. For private ward entitlement there will be an increase of 15%. However, the
rates shall be same for investigation irrespective of entitlement, whether the patient
is admitted or not and the test per se does not require admission to hospital.
17. A hospital empanelled under ECHS whose normal rates for treatment
procedure/test are lower than ECHS prescribed rates shall charge as per the rates
charged by them for that procedure/treatment from a non ECHS beneficiary and will
furnish a certificate to the effect that the rates charged from ECHS beneficiaries are
not more than the rates charged by them from non ECHS beneficiaries.
18. During in patient treatment of the ECHS beneficiary, the hospital will not ask
the beneficiary or his/her attendant to purchase separately the medicines/sundries/
equipment or accessories from outside and will provide the treatment within the
package rate, fixed by the ECHS which includes the cost of all the items.
19. In case of treatment taken in emergency in any non-empanelled private
hospitals, reimbursement shall be considered by competent authority at ECHS
prescribed packages/rates only.
20. If one or more minor procedures form part of a major treatment procedure,
then package charges would be permissible for major procedure and only at 50% of
charges for minor procedure.
21. Any legal liability arising out of such services, responsibility solely rests on the
hospital and shall be dealt with by the concerned empanelled hospital themselves.
Definition of Wards
22. Private Ward. Private ward is defined as a hospital room where single
patient is accommodated and which has an attached toilet (lavatory and bath).
The room should have furnishing like wardrobe, dressing table, bed-side table, sofa
set, carpet etc as well as a bed for attendant. The room has to be air-conditioned.
23. Semi Private Ward. Semi private ward is defined as a hospital room
where two to three patients are accommodated and which has attached toilet
facilities and necessary furnishings.
24. General Ward. General ward is defined as halls that accommodate four
to ten patients.

25. Normally treatment in higher category of accommodation than the entitled
category is not permissible. However, in case of an emergency when the entitled
category accommodation is not available, admission in the immediate higher
category may be allowed till the entitled category accommodation becomes
available. However, if a particular hospital does not have the ward as per
entitlement of beneficiary, then the hospital can only bill as per entitlement of the
beneficiary even though the treatment was given in higher type of ward.
Entitlement of Ward
26. ECHS beneficiaries are entitled to facilities of private, semi-private or general
ward depending on their Rank at the time retirement. The entitlement is as
follows :-
Ser Rank at the time or retirement Entitlement
(a) NCOs & below of Army & equivalent in Navy &
Air Force
General Ward
(b) JCOs in Army & equivalent in Navy & Air Force Semi Private Ward
(c) Officers of Army, Navy and Air Force Private Ward
MOA with Empanelled Hospitals
27. All Station Headquarters where rates have changed be instructed to sign fresh
MsOA with their respective empanelled hospitals with fresh negotiated rates as per
Appendix ‘B’ to this letter. Rates in no case shall exceed CGHS rates. This must be
done earliest but not later than two months from the date of issue of this letter. The
rates for NABH accredited hospitals will be supported by documentary proof. For
Station Headquarters where rates have not been changed/affected presently, it is
the responsibility of the concerned Station Headquarters to negotiate and sign
fresh MsOA within two months of the declaration of the revised CGHS
rates as applicable as per letters at para 1 above.
28. Kindly ensure speedy dissemination to all concerned in your AOR.
Authority:B/49773/AG/ECHS/Rates/Policy.10 Jan 2011
Sd/- X X X
Maj Gen
MD ECHS

Appendix ‘A’
(Refer to para 5 of Central Organisation
ECHS letter No B/49773/AG/ECHS/Rates/
Policy dated ___ Jan 2011)
LIST OF HOSPITALS MEETING CRITERIA FOR
SUPERSPECIALITY HOSPITAL
Ser Name of Hospitals Cities
1. Kailash Hospital Noida
2. Sir Gangaram Hospital Delhi
3. Indraprastha Apollo Hospital Delhi
4. Wockhard Hospital Mumbai
5. Manipal Hospital Bangalore
6. Narayana Hridayalaya Bangalore
7. Apollo Hospital Hyderabad
8. Medvin Hospital Hyderabad
9. Apollo Hospital Chennai
10. Sri Ramachandra Medical Centre Chennai
11. Apollo Gleaneagles Hospital Kolkata

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Appendix ‘B’
(Refer to para 8 of Central Organisation
ECHS letter No B/49773/AG/ECHS/Rates/
Policy dated ___ Jan 2011)
ZONAL JURISDICTION – RATES FOR REIMBURSEMENT/PAYMENT OF
MEDICAL EXPENSES
Ser State CGHS Rates Remarks
Applicable
States
1. Jammu & Kashmir Jammu Rates applicable for Chandigarh
till promulgation of CGHS
2. Himachal Pradesh Jammu
Jammu rates.
-do-
3. Punjab Chandigarh CGHS Delhi 2010 rates till
promulgation of second revision
CGHS Chandigarh rates
4. Haryana Chandigarh -do-
5. Delhi and NCR Delhi Delhi 2010 CGHS rates
Region
promulgated vide MOH &
FW/OM MOH & FW office
memorandum No S
11011/23/2009-CGHS D-II/
6. Uttar Pradesh Lucknow (except
Hospital Cell (Part I) dated 17 Aug
2010.
Pre 2006 rates applicable for
districts under Lucknow till promulgation of
Allahabad, second revision of Lucknow
Meerut,
Area)
Kanpur rates by CGHS.
Allahabad (except Pre 2006 rates applicable for
districts under Allahabad till promulgation of
Lucknow, Meerut, second revision of Allahabad
Kanpur)
rates by CGHS.
Meerut (except Pre 2006 rates applicable for
districts under Meerut till promulgation of
Lucknow, second revision of Meerut rates
Allahabad,
Kanpur)
by CGHS.
Kanpur (except Pre 2006 rates applicable for
districts under Kanpur till promulgation of
Lucknow, Meerut, second revision of Kanpur rates
Allahabad) by CGHS.
7. Uttaranchal Dehradun Rates applicable for Lucknow till
promulgation of second revision
of Dehradun rates by CGHS.

9
Ser State CGHS Rates Remarks
8. Bihar
Applicable
Patna Pre 2006 rates applicable for
Patna till promulgation of
9. Jharkhand Ranchi
second revision of Patna rates
by CGHS.
Pre 2006 rates applicable for
Ranchi till promulgation of
10. Orissa Bhubaneshwar
second revision of Ranchi rates
by CGHS.
Rates applicable for Ranchi till
promulgation of second revision
of Bhubaneshwar rates by
11. West Bengal Kolkata
CGHS.
Kolkata 2010 CGHS rates
promulgated vide MOH &
FW/OM MOH & FW office
memorandum No S
11011/23/2009-CGHS D-II/
12. Sikkim Kolkata
Hospital Cell (Part V) issued in Aug
2010.
Rates as applicable for Kolkata.
13. Assam Guwahati Kolkata 2010 CGHS rates till
promulgation of second revision
of Guwahati rates by CGHS.
14. Meghalaya Shillong Rates as applicable for
Guwahati till promulgation of
CGHS Shillong rates.
15. Mizoram Guwahati Rates as applicable for
Guwahati.
16. Tripura Guwahati -do-
17. Manipur Guwahati -do-
18. Nagaland Guwahati -do-
19. Arunachal
Pradesh
Guwahati -do-
20. Madhya Pradesh Bhopal Rates applicable for Jabalpur
till promulgation of second
Jabalpur
revision of Bhopal rates by
CGHS.
Pre 2006 rates applicable for
Jabalpur till promulgation of
second revision of Jabalpur.

10
Ser State CGHS Rates Remarks
21. Chattisgarh
Applicable
Jabalpur Pre 2006 rates applicable for
Jabalpur till promulgation of
second revision of Jabalpur
rates by CGHS.
22. Rajasthan Jaipur Pre 2006 rates applicable for
Jaipur till promulgation of
23. Gujarat Ahmedabad
second revision of Jaipur rates
by CGHS
Pre 2006 rates applicable for
Ahmedabad till promulgation of
second revision of Ahmedabad
by CGHS.
24. Maharashtra Mumbai & Thane Mumbai 2010 CGHS rates
(except districts promulgated vide MOH &
under Pune, FW/OM MOH & FW office
Nagpur Area) memorandum No S
11011/23/2009-CGHS D-II/
Pune (except
Hospital Cell (Part II) dated 17
Sep 2010.
Pre 2006 rates applicable for
districts under Pune till promulgation of
Mumbai, Thane second revision of Pune rates
and Nagpur by CGHS.
Nagpur (except Pre 2006 rates applicable for
districts under Nagpur till promulgation of
Mumbai, Thane second revision of Nagpur rates
and Pune) by CGHS.
25. Goa Pune Rates as applicable for Pune.
26. Karnataka Bangalore Bangalore 2010 CGHS rates
promulgated vide MOH &
FW/OM MOH & FW office
memorandum No S
11011/23/2009-CGHS D-II/
27. Kerala Trivandrum
Hospital Cell (Part III) issued in
Aug 2010.
Pre 2006 rates applicable for
Trivandrum till promulgation of
second revision of Trivandrum
rates by CGHS.

11
Ser State CGHS Rates Remarks
28. Tamil Nadu
Applicable
Chennai Chennai 2010 CGHS rates
promulgated vide MOH &
FW/OM MOH & FW office
memorandum No S
11011/23/2009-CGHS D-II/
29. Andhra Pradesh Hyderabad
Hospital Cell (Part VI) issued in
Aug 2010.
Hyderabad 2010 CGHS rates
promulgated vide MOH &
FW/OM MOH & FW office
memorandum No S
11011/23/2009-CGHS D-II/
Hospital Cell (Part IV) dated 16
Sep 2010.
Union Territory
30. Chandigarh Chandigarh Rates as applicable for
31. Andaman
Nicobar Islands
& Chennai
Chandigarh
Rates as applicable for Chennai.
32. Puducherry Chennai -do-
33. Lakhsadeep Trivandrum Rates as applicable for
Islands
Trivandrum.
34. Daman Diu Mumbai Rates as applicable for Mumbai
35. Dadra
Haveli
& Nagar Mumbai -do-

Cardiology Implantation Devices
12
Appendix ‘C’
(Refer to para 10 of Central Organisation
ECHS letter No B/49773/AG/ECHS/Rates/
Policy dated ___ Jan 2011)
CGHS CEILING RATES FOR IMPLANTS
1. The ceiling rates for Cardiology Implantation Devices are as under :-
Name of the item Maximum Ceiling Rate
(a) Coronary stent
(i) Cypher stent Rs.95,000/- + VAT
(ii) Taxus Stent Rs.67,300/- + VAT
(iii) Endeavor Rs.85,000/- + VAT
(iv) Xience VEECSS Rs.95,000/- + VAT
(v) Yukon Choice Rs.55,000/- + VAT
(vi) Bare Metal Stent Rs.50,000/- (inclusive all )
(b) Rotablator Rs.50,000/-
(c) Pacemaker ( Single Chamber)
(i) Without rate response Rs.37,000/-
(ii) With rate response Rs.65,000/-
(d) Pacemaker (Dual Chamber) Rs1,15,500/-
2. Prior approval to be obtained as per Central Org letter No B/49773/AG/ECHS
dated 12 May 2006. The reimbursement for implants will be as per ceiling rates
above or actual cost whichever is lesser.
3. A maximum of three Coronary stents shall be permitted of which not more
than two shall be of Drug Eluting Stents (DES). However, DES shall be permitted
only for patients where re-stenosis will involve high risk to patient’s life,. i.e
(a) Osteal/Proximal LAD lesions.
(b) Stenosis of a Coronary artery, which is giving collaterals to another
blocked artery, thus supplying a large area of myocardium.
(c) Stenting of restenotic lesions after previous angioplasty.
(d) Permission shall be granted as per laid down procedure.
4. If a beneficiary under ECHS has been implanted by any other non approved
drug coated stent or a drug eluting stent is implanted in conditions other than those
mentioned above, reimbursement shall be limited to the cost of Bare metal stent.

13
5. If a non-approved drug eluting stent (DES) is implanted or a drug eluting
stend (DES) is implanted in conditions other than those mentioned above in an
empanelled hospital and no written informed consent was obtained from the
beneficiary, that he/she would bear the difference in cost between the DES and Bare
Metal Stent and the hospital has charged this amount from the beneficiary. the
additional amount shall be deducted from the pending bills of hospitals and shall be
paid to the beneficiary.
6. It is essential for the empanelled hospital to quote the Batch number when a
coronary stent of any type ( Ordinary metal/Drug Eluting stent) is implanted in the
case of a beneficiary under ECHS. In addition to this the outer pouch of the stent
packet alongwith the sticker on it on which details of the stent are printed alongwith
invoice shall also be enclosed with the medical bills for claiming reimbursement from
the Govt. In case the private empanelled hospital has not given the batch number
and or outer pouch of the stent (s) in a particular case, the cost for stents will not be
reimbursed (for reimbursement claims). In case of empanelled hospitals, the bills
without supporting documents as above will NOT be accepted.
Neuro Implant
7. The ceiling rates for Neuro Implant are as under :-
Name of the item Ceiling Rate Cost of Battery
DBS Implants (Including MER) Rs. 3,60,000/- Rs. 2,50,000/-
Intra Thecal Pumps (Intra Thecal
Beclofen Pump, Intra Thecal
Morphine Pump)
Rs. 2,62,000/- Rs. 2,25,000/-
Spinal Cord Stimulator Rs. 2,62,000 Rs. 2,00,000
8. Prior approval to be obtained as per Central Org letter No dated
12 May 2006. Original Invoice alongwith the warranty/Implant stickers to be
submitted alongwith claims. The reimbursement/payments for implants will be as
per ceiling rates above or actual cost whichever is lesser.
9. Guidelines.
(a) DBS Implant. The patient should be a case of idiopathic
Parkinsonism resistant to conservative treatment. ECHS/patient shall be
informed in writing by treating specialist of the cost of implant and the efficacy
of the treatment.
(b) Intra Thecal Pumps (Intra Thecal Beclofen Pump, Intra Thecal
Morphine Pump)/Spinal Cord Stimulator. All conservative treatment
procedures have failed and the diagnosis was confirmed. Treating specialist
shall certify that there is reasonable chance of survival of terminally ill patient.
Therapeutic trials shall be conducted and recommendation should be based on
positive therapeutic trials. The treating specialist shall certify as such in writing.
ECHS/patient shall be informed in writing by treating specialist of the cost of
implant and the efficacy of the treatment.

14
10. Warranty. The company offers limited warranty for two yrs from date of
Implantation to provide free replacement in the case of battery failure or if
malfunctioning of the device is reported by the concerned Physician. The company
shall also supply all the implants with not more than 1/6 of the life of battery
exhausted.
11. Life/Replacement of Batteries
(a) Life of Battery is 3-5 years in case of DBS Implants and Spinal cord
stimulator depending on parameters selected for stimulation and usage and
up to 7 years in case of Intrathecal Infusion pump.
(b) Replacement of Battery before 4 years may be permitted in exceptional
cases on the basis of justification by the treating specialist and shall be
considered on a case to case basis by Central Organisation ECHS.
Hip Knee Implants
12. The ceiling rates for Hip Knee Implants are as under :-
Name of the item Maximum Ceiling Rate
Knee Implant Rs. 60,000/- + the cost of bone cement Rs.5,000/-
Hip Implant Rs.35,000/- + the cost of Bone cement Rs.5,000/-
13. The treating orthopaedic specialist shall issue a certificate to the effect that
the implant has been implanted successfully and is functioning satisfactorily.
14. Invoice alongwith the Implant stickers will be submitted alongwith bills/
claims. The reimbursement/payments for implants will be as per ceiling rates
above or actual cost whichever is lesser.
IOL
15. The ceiling rates for IOL are as under :-
Name of the item Maximum Ceiling Rate
Hydrophobic Foldable IOL Rs.5,000/-
Silicon Foldable IOL Rs.3,600/-
Hydrophilic Acrylic Lens Rs.5,800/-
PMMA IOL Rs. 490/-
16. The ceiling rates mentioned above for different types of IOL implants to be
used will be as per actual expenditure or the rates mentioned whichever is less and
will be reimbursable in addition to the package rates for cataract surgery procedure.

15
17. The reimbursement at the above mentioned ceiling rates will be done as per
the rates fixed for the various IOL mentioned above and the IOL actually used in the
surgery. It is mandatory for the operating surgeon of all private empanelled
hospital/ECHS beneficiaries to attach the empty IOL sticker, bearing the signature
and stamp of the operating surgeon on it, alongwith the bill in support of the type of
IOL used, containing its batch number. In the event of the private empanelled
hospital not giving the batch number and/or empty IOL sticker in a particular case,
the cost for IOL will not be reimbursed (for reimbursement claims). In case of
empanelled hospitals, the bills without supporting documents as above will NOT be
accepted.
Cochlear Implant Surgery
18. The ceiling rate for Cochlear Implant Surgery is Rs 5,35,000/- (Rupees five
lacs and thirty five thousands only).
19. The best results are achieved if cochlear implants take place between the age
of 1-5 years. Hence it is therefore proposed to permit reimbursement in a graded
manner. In the pre lingual deafness, total reimbursement of the ceiling rate or
actuals, whichever is less, for cochlear implant will be allowed in respect of implants
carried out on children aged between 1 and 5 years. For children between the
age of 5 and 10 yrs, 80% of the ceiling rate for implant will be reimbursed. For
children above the age of 10 years, but below 16 years of age, only 50% of the
ceiling rate for the implant will be reimbursed.
20. 50% of the cost of the wearable components, e.g. Speech Processor,
Microphone, etc. (excluding cords, batteries) for the purpose of up-gradation and /
or replacement due to wear and tear may be allowed, after a period of three years,
to be considered on the basis of advice of Sr Adv (ENT).
21. Only unilateral implantation will be allowed. As cochlear implant surgery is
a planned surgery, prior permission has to be obtained before the surgery is
undertaken i.e prior approval procedure will be followed.
22. Selection criteria for Cochlear Implant
(a) Pre-lingually deaf children (severe to profound B/L S.N.H. Loss)
(i) Age group between 1 to 16 yrs. However, children using
hearing aids and getting auditory training from age 1 yr of less may be
considered at higher age also on a case to case basis.
(ii) No appreciable benefit from hearing aids after 6 months of trial
with hearing aids. No speech formation seen.
(iii) No mental retardation.
(iv) No active middle ear cleft disease. Perforation of the TM should
be closed at least three months prior to implantation.

16
(v) No cochlear aplasia and/ or agenesis of cochlear nerve.
(vi) No retro cochlear lesion or central deafness, and
(vii) Good family support for post op rehabilitation
(b) Post- lingually deaf candidates (B/L profound S N H Loss).
(i) There should be no appreciable benefit from hearing aids (both
ears).
(ii) No active middle ear cleft disease.
(iii) Perforation of the TM should be repaired three months prior to
the implantation.
(iv) Deafness should be due to cochlear lesions, and
(v) Post meningitic labyrinthitis osscificans of the cochlea is a
contraindication. However cases like post inflammatory ossification of
cochlea, cochlear dystrophies and cochlear otosclerosis with visible
perilymphatic shadow in MRI are relative indications and can be done
on case to case basis.
23. Type of Implants. Only multi channel cochlear implant duly approved by
appropriate authority should be recommended.
24. Basic pre-op Investigations for Cochlear Implant :
(a) Audiological.
(i) OAE.
(ii) BERA/ASSR.
(iii) Impedence (in children).
(iv) Audiogram/Aided audiogram.
(b) Radiological.
(i) HRCT temporal bone for bony cochlea and middle ear cleft.
(ii) 3D MRI for membranous cochlea, Neural Bundle and brain
(c) IQ/Psychiatric evaluation in children with prelingual deafness.

LIST OF SUPERSPECIALITY HOSPITALS
Ser Name of Hospitals Recognized for
General Services Specialised Services
1. Kailash Hospital and General Medicine, ENT, Dental Surgery : Neuro Surgery, Plastic and
Research Centre, H-33, (Prosthetic, Periodontal & Reconstructive, Cardiothoracic
Sector-27, Noida- Orthodontics only), Orthopedics, Surgery, Vascular Surgery, Geneto
201301
Microbiology, General Surgery, Urinary Surgery, Pediatric Surgery,
Ophthalmology, Psychiatry, Oncology Surgery, Gastro Intestinal
Blood Bank, Obstetrics and Surgery, Traumatology, Joint
Gynecology, Pediatrics,
Replacement, Spinal, Prosthetic and
Dermatology, Pathology and Laparoscopic Surgery.
Radio Diagnosis.
Medicine : Neuro Medicine,
Cardiology, Respiratory Disease,
Gastroenterology, Endocrinology,
Nephrology, Clinical Haematology,
Oncology (Medical), Critical Care
Medicine and Interventional
Cardiology.
Radio-diagnosis/Imaging :
MRI
Paediatrics : Nenatology
2. Sir Gangaram Hospital, - Surgery : Heart, Cancer, Renal, Total
Sir Gangaram Hospital
Hip/Knee Joint Replacement and
Marg, Delhi
Prostate Surgery
3. Indraprastha Apollo Radio-Diagnosis Surgery : Cardiothoracic Surgery,
Hospital, Sarita Vihar,
Genito Urinary Surgery (Urology and
Delhi Mathura Road,
Lithotripsy), Joint Replacement,
New Delhi – 110044
Prosthetic and Laparoscopic Surgery.
Medicine : Cardiology, Nephrology
(Including Dialysis), Interventional
Cardiology, Radiotherapy and Nuclear
Medicine.
Radio-diagnosis/Imaging :
CT Scan and MRI
Others : Kidney Transplant.
4. Wockhard Hospital Ltd, General Medicine, ENT,
Surgery : Neuro Surgery,
Mulund Goregon Link Orthopedics, Microbiology, Cardiothoracic, Vascular Surgery,
Road, Mumbai – General Surgery,
Geneto Urinary Surgery, Paediatric
400078
Ophthalmology, Anesthesia, Surgery, Gastro Intestinal,
Blood Bank, Paediatrics, Traumatology, Joint Replacement,
Pathology, Radio-diagnosis and Spinal and Laproscopic Surgery.
Emergency
Medicine : Neuro Medicine,
Cardiology, Respiratory Diseases,
Gasto Enterology, Endocranology,
Rheumatology, Critical Care medicine
and Interventional Cardiology.
Radio-diagnosis/Imaging :
CT Scan and MRI.
5. Manipal Hospital, 98,
Rustan Bag Airport
Road, Bangalore
- Heart and Cancer
6. Narayana Hridayalaya, - Surgery : Cardiology and Cardiac
Bangalore
Surgery.

Ser Name of Hospitals Recognized for
General Services Specialised Services
7. Apollo Hospital, Deccan - Surgery : Heart, Cancer, Renal, Total
Hospital Ltd, Jubilee
Hip, Knee, Joint Replacement,
Hills, Phase 3,
Prosthetic Surgery (TCRP) and
Hyderabad
Lithotripsy
8. Medvin Hospital,
Raghava Ratana
Towers, Chirag, Ali
Lane, Hyderabad
- Heart, Cancer and Renal
9. Apollo Hospital, 21 - Surgery : Heart, Cancer, Renal and
Greams Land (Off
Total Hip, Knee, Joint Replacement
Greams Road), Chennai
and Prosthetic Surgery (TCRP)
10. Sri Ramachandra Gerneral Medicine, ENT, Dental, Surgery : Neuro Surgery, Plastic and
Medical Centre Orthopaedics, Microbiology, Reconstructive, cardiopthoracic
1. Ramachandra Nagar General Surgery,
Surgery, Vascular Surgery, Genito
Porur, Chennai – Ophthalmology, Psychiatry, urinary Surgery, Paediatric Surgery,
600116
Blood Bank, Obstetrics and Gastro intestinal Surgery,
Gynaecology, Paediatrics, Traumatology, Joint Replacement,
Dermatology, Pathology and Spinal Surgery and Laparascopic
11.
Radio Diagnosis
Surgery
Medicine : Neuro medicine,
Cardiology, Respiratory Disease,
Gastroenterology, Endocrinology,
Nephrology, Rheumatology, Oncology
(Medical), Critical Care Medicine and
Interventional Cardiology.
Radio-diagnosis/Imaging :
CT Scan and MRI.
Paediatrics : Neonatology
Cardiology, Haematology and
Nephrology
2

SUPER SPECIALITY STATUS : EMPANELLED HOSPITALS
1. Reference this Organisation letter No B/49773/AG/ECHS/Rates/Policy dated
10 Jan 2011.
2. Super speciality status of an empanelled hospitals will be determined :-
(a) For CGHS Cities. A s per list of super speciality hospitals notified by
CGHS.
(b) For Non CGHS Cities. H ospitals meeting CGHS criteria for super
speciality hospitals will apply for the status of super speciality hospital to
Regional Centre ECHS under whose area of responsibility the hospital is
located. R egional Centre ECHS will verify the facts provided by the applicant
hospital and f orward their recommendations to Central Organisation ECHS for
approval.
3. Para 6 of our letter under reference in Para 1 above is hereby deleted.
Authority : B/49773/AG/ECHS/Rates/Policy 15 Sep 2011
Sd/- X X X
Jt Dir (Med)
for MD ECHS

1. Reference :-
2010.
CLARIFICATION REGARDING REVISION OF PACKAGE RATES
(a) Govt of India, MoD ID No 22A(48)/2007/US/WE/D(Res) dated 19 A ug
(b) Our letter No B/49773/AG/ECHS/CGHS dated 24 Aug 2010.
(c) Our letter No B/49773/AG/ECHS/Rates/Policy dated 10 Jan 2011.
2. Govt of India, Ministry of Health and Family Welfare vide their Office
Memorandum No S.11011/23/2009-CGHS D.II/Hospital Cell (Part I) dated 11 Apr 2011
have issued clarification regarding CGHS package rates at different locations. Copy of
the same may be downloaded from CGHS website.
3. For further clarification regarding CGHS rates the concerned Station HQ be
directed to liaise with concerned CGHS city office of their area. It would be ensured
that the CGHS rates of the area are followed by ECHS.
Authority : B/49773/AG/ECHS/Rates/Policy. 09 May 2011
Sd/- X X X
Jt Dir (Med)
for MD ECHS

GUIDELINES ON ONCOLOGY TREATMENT RATES
1. Refer to Central Organisation ECHS following letter Nos :-
(a) B/49774/AG/ECHS/Referral dated 01 Dec 2009.
(b) B/49773/AG/ECHS/Rates/Policy dated 10 Jan 2011.
2. The guidelines for treatment of Oncology cases have been recently revised in
CGHS by Ministry of Health & Family Welfare vide their office memorandum No
REC-!/2008/JD(Gr.)/CGHS/CGHS(P) dated 23 Jun 2011. Accordingly following
guidelines for treatment of Oncology will be implemented in ECHS :-
(a) Cancer Surgical Procedures.
(i) Rates of Tata Memorial Hospital (TMH), Mumbai (2009) as
mentioned under ‘B’ category will be applicable for ECHS beneficiaries for
treatment in semi private ward with 10% decrease for general ward and
15% enhancement for private ward. Rates of TMH under ‘B’ category are
at Appendix ‘A’.
(ii) The categorization of surgeries shall be same as per the
categorization of TMH.
(iii) The duration of treatment for different categories of Surgery will
be as follows :-
(aa) Category – I - 1-2 days.
2
(ab) Category – II - 3-5 days (7-10 days in
respect of operations
involving Abdominal/thoracic
cavity).
(ac) Category – III, IV and V - 14 days.
(b) Cancer Radiotherapy. Super specialty rates of CGHS Delhi for cancer
radiotherapy shall be applicable. These rates for cancer radiotherapy are at
Appendix ‘B’.
(c) Chemotherapy. Super specialty rates of CGHS Delhi shall be
applicable for Chemotherapy. The hospitals, shall provide Chemotherapy
medicines to ECHS beneficiaries at a discount of 10% on MRP. Rates of
Chemotherapy are at Appendix ‘C’.

(d) Consultation. CGHS rates for NABH accredited hospitals will be
applicable for consultation for ECHS beneficiaries suffering from these diseases.
(e) Room Rent. Rates applicable for room rent (Accommodation
Charges) for different categories of wards will be as given below :-
(i) General Ward - Rs 1,000/- per day.
(ii) Semi-private Ward - Rs 2,000/- per day.
(iii) Private Ward - Rs 3,000/- per day.
3. A hospital empanelled under ECHS, whose normal rates for treatment procedure
/ test are lower than the CGHS prescribed rates shall change as per the rates charged
by them for that procedure / treatment from a non-ECHS beneficiary and will furnish a
certificate to the effect that the rates charged by them from non-ECHS beneficiaries.
4. You are requested to disseminate the information to all Station Headquarters for
wide publicity and to encourage more hospitals for empanelment with ECHS for
treating Oncology cases.
Dir (Med)
for
Authority : B/49773/AG/ECHS/Rates/Policy 06 Jul 2011MD ECHS

3
RATES FOR SURGICAL ONCOLOGY
Appendix ‘A’
(Refer to Para 2(a) (i) of Central
Organisation letter No
B/49773/AG/ECHS/Rates/Policy
dated ______ Jul 2011)
Ser Description Rates Remarks
1. First Consultation (Surgical Oncology) *400/- * Revision 1
(Apr 2010)
2. Cross Consultation (Surgical Oncology) 265/-
3. Follow-up
Oncology)
consultation (Surgical 275/-
4. Chemotherapy Consultation Full 3,310/-
5.
Protocol (Surgical Oncology)
Intravenous Bolus per Cycle (Surgical
Oncology)
550/-
6. Chemotherapy Indoor Charges per 3,310/-
7.
Cycle (Surgical Oncology)
Chemotherapy Daycare Charges per 1,105/-
Cycle (Surgical Oncology)
8. Trucut Biopsy of Breast Lesions (OPD) 1,050/-
Operation Theatre (Hospital Service Charges)
9. Minor OT – Service Charges 870/-
10. Major OT – Service Charges less than
2hrs
3,465/-
11. Major OT – Service Charges for 2 – 4hrs 5,775/-
12. Major OT – Service Charges for More
than 4hrs
8,455/-
13. Minor OT – Drugs/Consumables 325/-
14.
(without GA)
Minor OT – Drugs/Consumables (with 540/-
GA)
Surgery Charges
15. Minor OT – Surgery Charges 870/-
16. Grade I Surgery 2,755/-
17. Grade II Surgery 6,930/-
18. Grade III Surgery 9,660/-
19. Grade IV Surgery 15,095/-
20. Grade V Surgery 17,325/-
21. Vascular Surgery Cover (Outsourced) *25,000/- * Revision 1
(Apr 2010)

4
Appendix ‘B’
(Refer to Para 2(b) of Central Organisation
letter No B/49773/AG/ECHS/Rates/Policy
dated ______ Jul 2011)
RATES FOR CANCER RADIOTHERAPY
Ser Name of Treatment Procedure Rates Remarks
Cobalt 60 Therapy
1. Radical Therapy 70,000/-
2. Palliative Therapy 25,000/-
Linear Accelerator
3. Radical Therapy 95,000/-
4. Palliative Therapy 47,500/-
5. 3D Planning 8,910/-
6. 2D Planning 6,530/-
7. IMRT (Intensity Modulated 1,29,000/-
8.
Radiotherapy)
SRT (Stereotactric Radiotherapy) 78,000/-
9. SRS (Stereotactic Radio Surgery) 1,03,000/-
10. IGRT (Image Guided
Radiotherapy)
1,88,000/-
11. Respiratory Gating alongwith
Linear Accelerator Planning
1,25,000/-
12. Electron Beam with Linear
89,060/-
Accelerator
13. Tomotherapy
Brachytherapy – High Dose Radiation
14. Intracavitory 23,750/-
15. Interstitial 1,07,830/-
16. Intralumil 14,250/-
17. Surface Moul 4,750/-
18. GLIADAL WAFER 1,07,830/-

5
Appendix ‘C’
(Refer to Para 2(c) of Central Organisation
letter No B/49773/AG/ECHS/Rates/Policy
dated ______ Jul 2011)
RATES FOR CHEMOTHARAPY
(CGHS DELHI 2010 SUPER SPECIALITY RATES)
Ser CGHS 2010
ser No
Name of Treatment Procedure Rates Remarks
Chemotherapy
1. 1186 Neoadjuvant 1960/-
2. 1187 Adjuvant 1960/-
3. 1188 Concurrent-chemoadiation 1430/-
4. 1189 Single drug 590/-
5. 1190 Multiple drugs 1345/-
6. 1191 Targeted therapy 1310/-
7. 1192 Chemoport facility 3140/-
8. 1193 PICC line (Peripherally Inserted
Central Consultation)
2000/-

ECHS REFERRAL PROCEDURE (LESS NCR)
1. Reference Government of India, Ministry of Defence letter No 24(8)/03/US(WE) /
D (Res) dated 19 Dec 03.
2. A number of requests and representations have been received from exservicemen
organisation and environment to review the referral system in ECHS in view
of the following : -
(a) Inconvenience and hardships to the patients who have to shuttle between
Polyclinic and service hospital for consultation/referral for speciality/super
speciality. The problem gets compounded because of old age and medical
condition of the ECHS beneficiaries.
(b) The issue of hardships faced by veterans on account of present referral
system was brought out by the Army Commanders during the Army
Commanders Conference in Apr 09.
(c) DGAFMS/DGMS (Army) has highlighted that medicare of serving soldiers
and their dependents was suffering because of excessive load of ECHS
beneficiaries on Army/Base/Zonal hospitals.
(d) Deliberations during ECHS Seminar at Chandimandir on 16 J ul 09
substantiated above problems.
(e) A large number of policy letters on referral system / procedure have been
issued since inception of the scheme by this Organisation. A requirement has
been felt to amalgamate all the letters into one c omprehensive letter for
convenience of all ECHS functionaries and Veterans.
3. Review of ECHS referral system has accordingly been included as one of the
priority issues in the ‘Time Bound Action Plan’ to give momentum to ECHS as
directed by COAS.
4. Revised ‘Referral Policy’ for NCR as been issued vide our letter No
B/49774/AG/ECHS/Referral dated 10 A ug 09 ( Copy encl as Encl 1). Guidelines for
referrals to service / empanelled facilities by ECHS Polyclinics (less NCR) are laid down
in succeeding Paras.
Categorisation of Polyclinics for Referrals
5. The polyclinics are categorised as Military / Non – Military primarily based on
support they get from service hospitals. The initial listing however has included certain
Polyclinics located in military stations without service hospital as Military Polyclinics. A
case has been taken up with the Government (Ministry of Defence) for conversion of
these polyclinics to Non-Military Polyclinics. For the purpose of referrals for treatment
these polyclinics will follow the procedure applicable to Non-Military Polyclinics.
Treatment at Polyclinics
6. Referral from Polyclinics will only be m ade once all available facilities of the
Polyclinics are fully utilized. Those patients needing additional diagnostic
tests/consultation/hospitalisation should be referred beyond the ECHS Polyclinics.
Authority for Referral to Empanelled Facility
7. Referrals to empanelled facilities will be generated from ECHS Polyclinics. The
choice of empanelled facility will b e with the ECHS member. Authority to initiate
referrals will be as follows :-
(a) Referral for General Service Specialities. For General Service
Specialities, list at Appendix ‘A’ attached, Polyclinic Medical Officers, Specialists
and Dental Officers (for dental treatment) are authorised to initiate referrals.

(b) Referral for Specialised Services. Referral for specialized services,
list at Appendix ‘B’ attached, can only be made by a specialist at the polyclinic
or on adv ice of concerned specialist of service hospital, subject to load, or
concerned specialist of local Government Hospital or concerned specialist of
empanelled hospital (in the absence of service hospital).
(c) Emergency Referrals. In case of emergency / life threatening
conditions a patient is permitted to take treatment in any hospital. However, if
such an emergency occurs while at Polyclinic, a Medical Officer of Polyclinic may
directly refer a patient for specialized treatment / tests so that emergent medical
attention is not delayed. I n such cases, a certificate to this effect will be
endorsed by the referring Medical Officer.
(d) Authentication and Endorsement. All referrals from ECHS,
Polyclinic will be authenticated by OIC Polyclinic under his stamp. He will also
endorse non-availability of spare capacity in service hospitals. The endorsement
should state as under (a rubber stamp may be used for the purpose) :-
Procedure for Referrals
(i) Military Stations with Service Hospitals. “Verified that beds /
speciality / facility is Not Available in the local service hospital at present”.
(ii) Non – Military Stations / Military Stations without Service
Hospitals. “There is no service hospital located in the station”.
8. Referral from Military Polyclinics (with Service Hospitals).
(a) T he stipulation of referral to service hospital before referring a pat ient to
empanelled hospital is primarily to economize on t he meager resources
of the state. I ntention of initial referrals to service hospitals to the ‘extent
possible’ is to utilize the spare capacity, without causing harassment to the
veterans or overloading the service hospital.
(b) In order to avoid undue inconvenience to the patients, following guidelines
will be adhered to :-
(i) Patients must be r eferred directly to civil empanelled facilities by
Medical Officer / Medical Specialist (as applicable) at ECHS Polyclinics in
case of ‘overloading’ or non-existence of medical facilities at the service
hospital.
(ii) Patient will be referred to service hospitals only for those diseases
for which facilities exist in the service hospital. All OIC ECHS Polyclinics
must possess a list of such facilities.
(iii) At times the facilities for a disease may exist in a service hospital
but it may be ov erloaded / bed s pace may not be av ailable. S uch
information must be pr ovided by SEMO to the OIC ECHS Polyclinics
under their SEMO cover on a regular basis.
(iv) A list of specialties with a check box against each is attached as
Appendix ‘C’. The same is to be completed by SEMOs and forwarded to
the ECHS Polyclinics under their SEMO cover. O IC ECHS Polyclinic
should be in touch with the concerned Senior Registrar of Command /
Zonal Hospital and CO of smaller hospitals to regularly update the
information. I n this connection, also refer to DGMS (Army) letter Nos
B/75068/DGMS-5B/ECHS dt 27 D ec 2006 a nd B/75086/DGMS-5B/ESM
dt 31 Mar 08 (copies encl as Encls 2 and Encl 3).
(c) To the extent possible, a service hospital of the station should NOT refer
the patient to service hospital of a different station, unless in the opinion of
the c oncerned specialist, such a step is in the interest of the patient. Hence,
once a patient is referred to a service hospital, the patient will either be treated in
the service hospital or outsourced locally to a civil empanelled facility of patient’s
choice in that station through the ECHS Polyclinic.

9. Referral from Non - Military Polyclinics (Including Military Polyclinics
without Service Hospitals).
(a) For the purpose of referrals Military Polyclinics without service hospitals,
list attached at Appendix ‘D’, will follow the procedure applicable to Non Military
Polyclinics.
(b) ECHS patients will be r eferred to civil empanelled facility having valid
MOA with the Station Headquarters as per instructions contained in Para 7
above.
(c) In absence of local empanelled facilities, direct referrals by Non – Military
Polyclinics to service hospitals in nearby stations are permitted except to Army
Hospital (Research & Referral).
(d) A patient can be r eferred directly to empanelled facility in nearby city
provided the Station Commander of originating Polyclinic has a valid MOA with
the concerned hospital. S uch cross-empanelment is essential to widen the
network of referral facilities. The Station Commanders must proactively liaise
with empanelled facilities of nearby stations and sign MOA for commencement of
direct referral to such facilities. H eadquarters Commands must intervene and
facilitate this process of cross empanelment.
(e) Till the time instructions on cross-empanelment are implemented all
referrals to outstation empanelled facilities will be routed through the local ECHS
Polyclinic of that town / station. The outstation referral will be stamped and
authenticated by the OIC Polyclinic of the station where the empanelled facility
exists before treatment is started. e.g. if an ECHS member at Bhatinda required
to be referred outstation hospital for Cancer therapy because there is no facility
available in his town, the ECHS Polyclinic at Bhatinda will initiate a referral for
treatment at an em panelled facility at Ludhiana/Amritsar. E CHS Member will
register himself/herself with the Polyclinic at Ludhiana/Amritsar and get his/her
referral form duly stamped and c ountersigned by the OIC Polyclinic before the
patient takes treatment at the empanelled cancer hospital at Ludhiana/Amritsar.
Cross - empanelment of cancer hospital at Ludhiana/Amritsar by Station
Commander, Bhatinda would have clearly saved the bother of the patient going
through high pressure polyclinics of Ludhiana/Amritsar. Travel expenses in all
such cases will be regulated as per Para 12(a) of Govt of India, Ministry of
Defence letter No 24(8)/03/US(WE) D/Res dated 19 Dec 03.
10. Use of Referral Form. The referrals to empanelled facilities will be made by
the authorized Medical Officers/ Specialists in the Polyclinics on ECHS Referral Form
only. A format of the referral form is attached at Appendix ‘E’. The referral form will
be duly stamped with the seal of the Polyclinic and will clearly outline a brief history of
the case, the diagnosis, the hospital/diagnostic centre to which the ECHS beneficiary
has been referred, and the specific treatment procedure/investigation for which the
referral has been made. This procedure is required to be followed diligently so that the
empanelled hospitals do not undertake unauthorized treatment on the ECHS members.
The original referral form is to accompany bills subsequently presented by the
empanelled facility except in conditions mentioned in para 17. Referrals should clearly
indicate the requirement as follows :-
(a) If referral is desired for consultation only, then it should read- ‘Referred
for Consultation’.
(b) In case, the referral is for consultation and is to include investigations
which the consultant may order, the same should be endo rsed in the referral
form as - ‘Referred for Consultation/Investigations’.
(c) In the event a review is required for some treatment/procedure carried out
earlier, the referral may be endor sed as - ‘Referred for Review/Follow-up’
(Includes consultation and investigations).
11. The details in Para 8 and 10 above are given in a diagrammatic form at
Appendix ‘F’ attached.
Emergencies

12. In emergencies and life threatening conditions, when patients may not be able to
follow the normal referral procedure, they may be admitted to the nearest hospital.
13. In case of admission to an empanelled hospital, the member would be
required to produce his/her ECHS card as proof of ECHS membership. In such
circumstances the empanelled hospital is required to inform the nearest Polyclinic of
Station HQ having MOA with the empanelled hospital concerned, within a period of two
working days, regarding the particulars of the ECHS patient and t he nature of
emergency. The O I/C Polyclinic will make arrangements for verification of facts
and issue a f ormal ‘Emergency Referral’ (Referral form at Appendix ‘E’ with
‘Emergency’ stamped on it to be used). Payment of bills will be made by ECHS and the
member is not required to pay.
14. In case of admission to a non-empanelled hospital, the ECHS beneficiary or
his/her representative should inform nearest Polyclinic / Parent Polyclinic / nearest
ECHS Regional Centre / Central Organisation (e-mail ID mdechs@bol.net.in) within two
working days of such admission. OIC of nearest Polyclinic will make arrangements for
verification of facts and issue E mergency Information Report (EIR) as per format
attached as Appendix ‘G’ on receipt of information form representative of ECHS
beneficiary/OIC Parent Polyclinic / Regional Centre / Central Organisation. The
responsibility for clearing bills in such cases will rest with the ECHS member. He/she
may thereafter submit the bills alongwith summary of the case and other documents to
the concerned Polyclinic. The sanction for reimbursement of such bills has been
delegated to Competent Financial Authorities by the Central Organisation ECHS letter
No B/49778/AG/ECHS/Policy dt 19 A ug 2008 as amended vide letter No
B/49773/AG/ECHS/Policy dt 01 D ec 2008 (copies enclosed as Encl 4 and E ncl 5).
Such bills will be submitted within a period of one month from the date of discharge from
hospital.
15. While being treated in emergency, if another test/procedure is to be carried out
on account of new illness/complication, treatment of which cannot be deferred, the
same may be under taken in the hospital and fresh referral is not required. N eed for
additional procedure undertaken in emergency is to be elaborated in clinical summary
submitted with the bills.
16. Policy already exists for permitting Haemodialysis as an emergency in a nonempanelled
hospital (Central Org ECHS letter No B/49770/AG/ECHS dated
26 May 2009 : enclosed as Encl 6). T he requirement of obtaining Emergency
Certificate from the Hospital and subsequent EIR from the ECHS Polyclinic is therefore
dispensed with. Further, if Haemodialysis is undertaken on an OPD/Day Care basis
there will be no r equirement of attaching discharge summary/certificate signed by the
Medical Supdt/Hospital Signatory with the claim for reimbursement.
Follow-up Treatment/Reviews
17. In cases where regular follow-up/reviews are required, such follow-up treatment,
(OPD/Indoors) will be provided for periods of 1 month at a time. Referral form in such
cases should mention the same e.g., “Referred for follow-up treatment for a period
of one month.” Fresh referral has to be initiated on termination of the 1 month period.
18. The same provisions will apply for cases where treatment procedures are to be
repeated at regular intervals as an ongoing process, e.g., cases requiring dialysis or
regular long term physiotherapy. The referral should read as “Referred for
Haemodialysis, 3 sessions per week for a period of one month.”
19. In case of mil-Polyclinics referrals for follow up t reatment for the same ailment
should not be routed through the service hospitals.

20. The original referral form will be attached alongwith the first lot of bills in all such
cases. A photocopy of the referral form will be attached with subsequent bills for the
same referral, with an endorsement by the hospital linking the case to the original
referrals.
Oncology Referrals
21. In order to rationalize Oncology referrals, the following procedures will be
implemented :-
(a) All patients reporting initially to ECHS Polyclinic and suspected /
confirmed to be s uffering from cancer should first be referred to a O ncology
Centre of a s ervice hospital (if available locally) or in the absence of service
hospital with Oncology Dept, to an e mpanelled hospital recognized for
oncology where registration, work-up and treatment planning can be carried out.
(b) Patients requiring surgery as part of their multi-modality treatment will be
treated in the service hospital (subject to availability to spare capacity) or the
empanelled hospital (recognized for Onco surgery). I f facility is not available
locally, patient will be referred to the nearest service hospital/empanelled facility
where such a facility is available.
(c) Patient requiring Chemotherapy/Radiotherapy (RT) will be issued a
referral to local service hospital with Onco Dept (subject to load) or ECHS
empanelled Onco centres once only for the entire duration of treatment.
(d) The stipulation of one month validity for referral forms will not apply for
Oncology cases prescribed Chemotherapy/Radiotherapy.
End Stage Disease
22. In certain cases where the medical finality has been reached and active
treatment is over, the patient would require rehabilitative care/terminal care. S uch
patients should be transferred to an appropriate empanelled institution like a
Rehabilitation Centres or a H ospice. Hospitalisation in non-empanelled hospices /
terminal care centres has been permitted vide our letter No B/49771/AG/ECHS/Policy
dated 07 A ug 09, with a v iew to reduce expenditure on pr olonged hospitalisation of
such patients. Treatment in such an Institute is permitted for a maximum period of six
months.
Period of Hospitalisation
23. Where a patient is admitted for specific treatment, he will be hospitalized for such
period only as is necessary for completion of the treatment. For treatments, specialized
procedures or diagnostic tests for which Package rates are specified, the periods of
hospitalisation should not exceed the following limits, under ordinary circumstances :-
(a) Specialised procedures - 12 days.
(b) Other procedures - 07 days.
(c) Laparoscopic surgery - 03 days.
(d) Day care/minor procedures - 01 day.
24. In case the beneficiary has to stay in the hospital for his/her recovery for more
than the period covered under package rates, the additional payment will be limited to

oom rent as per entitlement, cost of the prescribed medicines and investigations,
doctors visits (not more than 2 times a day).
25. Referral for ECHS Members in Remote/Hilly Area.
(a) Representations have been received from the environment that ECHS
beneficiaries residing in remote/hill areas face great inconvenience for getting
referrals even for minor ailments from their nearest polyclinics due t o difficult
terrain/distance involved.
(b) ECHS beneficiaries are permitted to avail the facilities/services of nearest
Govt Health Care Centres/Primary Health Centre/Government Hospitals
(deemed empanelled) without prior referral from the Polyclinic as elucidated in
this HQ letter No B/49774-P/AG/ECHS/Referral dt 05 Apr 07 and letter No
B/49774-P/AG/ECHS/Referral dt 25 A pr 07 (copy enclosed as Encl 7 and
Encl 8).
(c) Regional Centre, ECHS and HQ Commands may as and when required
review areas to be dec lared remote for the above purpose and f orward their
recommendations for addition/delition to Central Organisation for approval.
26. Referral to Reputed Hospitals for planned Treatment.
(a) Presently, ECHS beneficiaries are referred from ECHS Polyclinic to
various empanelled hospitals/diagnostic centres/dental centres, to avail cashless
medical treatment. I n emergency, they can avail medical facilities at any
hospital. I n case of non-empanelled hospital, the individual has to make
payment and claim re-imbursement at ECHS rates.
(b) Certain private reputed hospitals, viz, Sir Ganga Ram Hospital, Rajiv
Gandhi Cancer Institute, Indraprastha Apollo Hospital and VIMHANS, had signed
MOA with ECHS but later terminated the MOA. P atients had to pay to get
treatment from such hospitals (deemed non-empanelled). Re-imbursement was
not permitted to individual and piecemeal sanctions were issued to tide over such
contingencies.
(c) ECHS members may be referred to such hospitals for planned procedures
on merits of the case. Approval for such referrals would be granted on case to
case basis by Central Organisation, ECHS based on recommendations by
Medical Officer/Specialist at the Polyclinic, OIC Polyclinic and concerned
Regional Centre.
(d) Ex-Post-Facto sanction is not permitted. There is no provision for waiver
to such a sanction.
(e) The cost of treatment would be borne by ECHS member. Reimbursement
would be limited to ECHS approved rates.
(f) TA/DA will NOT be entitled in such cases.
27. Treatment at Medical Institute of National Repute. Admission/treatment in the
Institutes of National repute listed below is permitted. In case ESM or their dependents
are referred by ECHS Medical Officer/Specialist to any of the Institutes mentioned
below, an advance in the form of a crossed cheque payable to the concerned hospital
will be drawn by the patient from the concerned Station Headquarters after submitting
the referral for by an ECHS Polyclinic and estimate from the concerned hospital. The
hospitals where such an arrangement is permitted are as follows :-
(a) All India Institute of Medical Science, New Delhi.
(b) Post Graduate Institute, Chandigarh.
(c) Sanjay Gandhi Post Graduate Institte, Lucknow.
(d) National Institute of Mental Health and Neurosciences, Bangalore.
(e) Tata Memorial Hospital, Mumbai (for Oncology).

(f) JIPMER, Pondicherry.
(g) Christain Medical College, Vellore.
(h) Shankar Nethralaya, Chennai.
(j) Medical College and Hospitals under the Central or State Government.
28. Our following letters are hereby superseded :-
(a) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated
01 Sep 04.
(b) Central Organisation ECHS letter No B/49774/AG/ECHS dated 03 Mar 05.
(c) Central Organisation ECHS letter No B/49774/AG/ECHS dated
27 May 05.
(d) Central Organisation ECHS letter No B/49764/AG/ECHS dated 05 Nov 05.
(f) Central Organisation ECHS letter No B/49774/AG/ECHS dated 23 Aug 06.
(g) Central Organisation ECHS letter No B/49770-P/AG/ECHS/Referral
dated 04 Apr 07.
(g) Central Organisation ECHS letter No B/49770-P/AG/ECHS/Referral
dated 05 Apr 07.
(h) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral
dated 27 Jun 07.
(j) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral
dated 13 Jul 07.
(k) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral
dated 17 Jul 07.
(m) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral
dated 22 Oct 07.
(o) Central Organisation ECHS letter No B/49774/AG/ECHS/Referral
dated 21 Aug 08.
(p) Central Organisation ECHS letter No B/49774/AG/ECHS dated 23 Apr 09.
Appendices :- ‘A’ - List of General Service Facilities.
‘B’ - List of Specialised Services.
‘C’ - List of Specialities with Check Box.
MD ECHS
‘D’ - List of Polyclinics without Service Hospitals.
‘E’ - Format of the Referral Form.
‘F’ - Diagrammatic Form of ECHS Referral Flow Chart.
‘G’ - Format of the Emergency Information Report.

Encls :-
1. Central Organisation ECHS letter No B/49774/AG/ECHS/Referral dated
10 Aug 2009.
2. DGMS (Army) letter No B/75068/DGMS-5B/ECHS dated 27 Dec 06.
3. DGMS (Army) letter No B/75086/DGMS-5B/ESM dated 31 Mar 08.
4. Central Organisation ECHS letter No B/49778/AG/ECHS/Policy dt 19 Aug 2008.
5. Central Organisation ECHS letter No B/49773/AG/ECHS/Policy dt 01 Dec 08.
6. Central Organisation ECHS letter No B/49774-P/AG/ECHS/Referral dt 05 Apr 07.
7. Central Organisation ECHS letter No B/49774-P/AG/ECHS/Referral dt 25 Apr 07.
8. Central Organisation ECHS letter No B/49770/AG/ECHS dt 26 May 09.
Authority: B/49774/AG/ECHS/Referra 01 Dec 09

LIST OF GENERAL SERVICE SPECIALITIES
Appendix ‘A’
(Refer to Para 7(a) of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
Type of Speciality Type of Speciality Type of Speciality
General Medicine General Surgery Obstetrics and
Gynaecology
ENT Ophthalmology Paediatrics
Emergency Services Psychiatry Dermatology
Dental Anaesthesia Pathology
Microbiology Blood Bank (Blood
Transfusion)
Radio diagnosis

LIST OF SPECIALIZED SERVICES
Appendix ‘B’
(Refer to Para 7(b) of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
Specialised Services Specialised Services Specialised Services
Surgery Medicine Obstetrics and
Gynaecology
Neuro Surgery Neuro Medicine Gynaecological Oncology
Plastic and R econstructive Cardiology Infertility and assisted
Surgery
reproduction
Cardio Thoracic Surgery Respiratory Diseases Gynaecological
Endocrinology
Vascular Surgery Gastro enterology Materno foetal Medicine
Genito Urinary Surgery Endocrinology
Paediatric Surgery Nephorology Paediatrics
Oncology (Surgery) Rhematologyy Neonatology
Gastro Intestinal Surgery Clinical Haematology Cardiology
Traumatology
Clinical Immunology Neurology
Joint Replacement Surgery Oncology (Medical) Haematology
Spinal Surgery Critical care medicine Nephrology
Prosthetic Surgery Interventional Cardiology Oncology
Laparascopic Surgery Medical Genetics
Endovascular Surgery Geriatric Medicine
Geriatric Surgery Radiotherapy Pathology
Onco Pathology
Radio Diagnosis & Imaging Molecular Pathology
CT Scan Transplant Pathology
MRI AIDS & Virology
Interventional and Vascular
Radiology
Molecular Immuno
Pathology
Genetic Pathology
Transfusion Medicine

FACILITGY AVAILABLITY IN SERVICE HOSPITALS
NAME OF POLYCLINIC : _________________________________
NAME OF HOSPITAL : ___________________________________
Appendix ‘C’
(Refer to Para 8(b) (iii) of letter
No B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
Type of Speciality
A. GENERAL SERVICES
Type of Speciality Type of Speciality
General Medicine General Surgery Obstetrics and
Gynaecology
ENT Opthalmology Paediatrics
Psychiatry Dermatology
Dental Pathology
Orthopaedics Blood Bank(Blood
transfusion)
Radio diagnosis
B. SPECIALIZED SERVICES
Specialised Services Specialised Services Specialised Services
Surgery Medicine Obstetrics &
Gynaecology
Neuro Surgery Neuro Medicine Gynaecology Oncology
Plastic and
Cardiology(consultation Infertility and assisted
Reconstructive Surgery
and diagnostics)
reproduction
Cardio Thoracic Surgery Interventional
Cardiology
Vascular Surgery Gastro enterology
Genito Urinary Surgery Endocrinology Paediatrics
Paediatric Surgery Nephrology Neonatology
Oncology ( Surgery) Rhematology
Gastro Intestinal Surgery Clinical Haematology
Traumatology Clinical Immunology
Joint Replacement
Surgery
Oncology (Medical)
Prosthetic Surgery Respiratory Diseases
Laparascopic Surgery Radiotherapy
Geriatric Surgery Nuclear Medicine Pathology
Radio Diagnosis & Imaging Dental Onco Pathology
Transfusion Medicine
CT Scan Orthodontia
MRI Prosthodontia
Interventional and
Oral Surgery
Vascular Radiology
Other
Other (Specify)
Dated: (Signature of CO/Comdt
Hospital/Designated Offr)
Note : PLEASE MARK AGAINST SPECIALITIES FOR WHICH ECHS PATIENTS CAN BE
REFERRED.
PLEASE MARK AGAINST SPECIALITIES FOR WHICH SPARE CAPACITY IS NOT
AVAILABLE.

Appendix ‘D’
(Refer to Para 9(a) of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
LIST OF MILITARY POLYCLINICS WITHOUT SERVICE HOSPITAL
Ser No Polyclinic
1. Janglot
2. Moga
3. Sangrur
4. Sirsa
5. Jaisalmer
6. Ajmer
7. Saharanpur (Sarsawa)
8. Bharatpur
9. Balasore
10. Nagpur
11. Yelahanka
12. Dimapur
13. Shajahanpur
14. Kotdwara
15. Haldwani
16. Mumbai (Upnagar) Powai

Appendix ‘E’
(Refer to Para 7(b) of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME
ECHS POLYCLINIC …………………(Station)
REFERRAL FORM
Part I
OPD Regn No ……………………………… date ……………………
ECHS Card No ……………………………..
Name of patient ………………………… Age ……. Relationship with ESM ………….
Service No ………………….. Rank ………….. Name of ESM ………………………….
Tele No …………………………………
Brief Clinical Notes
Provisional Diagnosis
Vide Referral Serial No ………………………………….. the above named is referred
for
(a) Admission ………………………………………………. (Specify)
(b) Investigation ………………………………………………. (Specify)
(c) Consultation for ………………………………………………. (Specify)
Referred to ……………………………………………………………………………………
(Specify Hospital, Nursing Home, Diagnostic Centre)
Place : Signature of Med Officer
(with stamp)
Dated :
* Travel reimbursement allowed (Yes/No).
OIC POLYCLINIC
* Attendant reimbursement allowed (Yes/No).
Place :
Dated :

Part II
SUMMARY OF THE CASE
(To be completed by the empanelled hospital, nursing home, diagnostic centre and
consultant)
Clinical Summary/Investigation Reports (for Diagnostic centres)
Final Diagnosis …………………………………….. ICD Code No …………………….
Treatment Summary
Place : (Signature and Stamp)
Date :
Part III
Final Disposal
(a) Admission to …………………………………………………………………………
(Specify Hospital, Nursing Home, Diagnostic Centre)
(b) To follow treatment as specified.
Place : Signature of Med Officer ECHS
with Stamp

ECHS REFERRAL FLOW CHART
VERIFICATION
OF ECHS
MEMBER
Appendix ‘F’
(Refer to Para 11 of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
Specialists Medical Dental
• Medical Officer Officer
• Gynaec
Further Diagnostic Tests / Treatment / Hospitalisation Required
E
On Advice of Concerned M
- Specialists Polyclinics E
- Specialists Service Hospitals R
- Specialists Govt Hospital G
- Specialist Empanelled Facility E
N
C
Y
General Service Specialised Service
Is facility
available
in Service
Hospital
Yes No
Choice of Patient
Spare
capacity
to
treat
ECHS
patient
Empanelled Facility
Yes No
Service Hospital
in Station
On Advice of :-
MO Polyclinics / Specialist
Polyclinic

Enclosure ‘1’
(Refer to Para 8(b)(iii) of letter No
B/49774/AG/ECHS/Referral
dt 01 Dec 2009)
Tele : 23094763 Dte General of Med Services (Army)
Adjutant General’s Branch
Army Headquarters
‘L’ Block, New Delhi – 110 001
B/75068/DGMS-5B/ECHS 27 Dec 2006
HQ Southern Command (Med)
HQ Eastern Command (Med)
HQ Western Command (Med)
HQ Central Command (Med)
HQ Northern Command (Med)
HQ South Western Command (Med)
BED AVAILABILITY AT SERVICE HOSPITAL FOR ECHS MEMBERS
1. Further to this HQ letter No B/75068/DGMS-5V dt 02 May 2006.
2. It has been observed that ECHS member on being referred to service hospital by
the ECHS polyclinics could not be treated at times in these hospitals due t o non
availability of concerned specialist facility/beds/specialist. This leads to an avaidable
inconvenience to the ECHS members. In order to overcome this communication gap,
all Senior Registrars/COs of the hospitals mentioned at appendix ‘A’ will keep
themselves updated daily on t he availability of all specialist officers/beds in their
respective hospitals. The same will also be communicated to the OIC polyclinic daily to
avoid referral to the specialist who is not available and also to avoid admitting a patient
when a bed is not available.
3. The OIC Polyclinic in turn will also confirm the availability of the concerned
specialist facility/bed from the Senior Registrar/CO of the hospitals before the ECHS
members are referred to the service hospitals. In hospitals where only one specialist is
available leave roster of the concerned specialists will be fwd to the OIC Polyclinic.
4. In case the concerned specialist facility/bed is not available in the Service
hospital, the ECHS member will be referred to the empanelled facility by the OIC
polyclinic directly.
Copy to :-
Cent Org ECHS
Maude Line
Near Old Base Hosp
Delhi Cantt
Sd/-x-x-x-x-x-x-x-x
JDMS (ESM Cell)
For DGMS (Army)

Appendix ‘A’
BED AVAILABILITY AT SERVICE HOSPITAL FOR ECHS MEMBER
Srl No NAME OF HOSPITAL COMMAND
1. CH (SC)
2. MH TRIVANDRUM SOUTHERN COMMAND
3. MH CHENNAI
4. MH SECUNDERABAD
5. CH(EC) EASTERN COMMAND
6. 151 BH
7. CH WC
8. AH (R&R)
9. BH DELHI CANTT WESTERN COMMAND
10. MH JALANDHAR
11. MH AMRITSAR
12. 166 MH
13. MH AMBALA
14. CH(CC) CENTRAL COMMAND

Enclosure ‘5’
(Refer to Para 25 (b) of letter No
B/49774/AG/ECHS/Referral
dt ____________ 2009)
Tele: 011-25684945 Central Organisation ECHS
Mil: 233 36833 Adjutant General’s Branch
Integrated HQ of MoD
Maude Lines
Delhi Cantt –10
B/49774-P/AG/ECHS/Referral 05 Apr 07
IHQ of MoD (Navy)/DGMS (N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC, CC, NC, SWC (A/Med)
HQs WNC, SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Representations have been received from the environment that ECHS
beneficiaries residing in remote/hilly areas face great inconvenience for getting referrals
even for minor ailments from their nearest polyclinics due to distance/terrain.
2. It has been decided that ECHS beneficiaries will henceforth be permitted to avail
the facilities/services or nearest Govt Health Care Centres/Primary Health Centre/Govt
Hospitals (deemed empanelled) without prior referral from the polyclinic subject to the
following conditions :-
(a) Distance from nearest polyclinic should be more than 50 Kms.
(b) Applicable for residents of following states only :-
(i) Jammu & Kashmir.
(ii) Himachal Pradesh.
(iii) Uttranchal.
(iv) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram,
Manipur, Tripura and Nagaland.
(v) West Bengal : District – Darjiling only.
(vi) Karnataka : District – Chikmagalur, Kodagu only.
(vii) Tamil Nadu : District – Nilgiris only.
(viii) Chattisgarh : Distt – Bastar and Dantewara only.
(ix) Orissa : District – Koraput only.
(c) Treatment permitted for maximum period of 07 days.
3. Parent Polyclinic will be not ified of such treatment undertaken at the earliest
(within two working days). Info can be sent by person/telephone/mail/fax/telegram.
Parent polyclinic will generate a r eferral immediately on receipt of information and
attach the same with the claim when received. Claims for reimbursement of
expenditure incurred should be submitted to Parent Polyclinic within one month of
completion of treatment. The claim will include the following :-

2
(a) Application of claim by the member. Summary of case including diagnosis
and outcome/further advise by treating doctor/hospital to be enclosed.
(b) Photocopy of ECHS Smart Card/Regn Slip.
(c) Prescription/Clinical notes of treating doctor.
(d) Bills of medicines/investigations/treatment procedure in original duly
authenticated by treating doctor/hospital, alongwith a ph otocopy. I n cases of
treatment in Govt Hospitals, consultation is normally free. Bills, therefore, would
pertain to medicines and treatment/investigation charges only, as applicable.
4. The bills will be processed by Parent Polyclinic as per procedure laid down vide
this HQ letter No B/49773/AG/ECHS dated 25 May 04 read in conjunction with this HQ
letter No B/49773/AG/ECHS/R dt 28 Oct 04 for treatment in Govt Hospital and payment
made through cash assignment of local Station Headquarters. S anction of Central
Organisation, ECHS is not required.
5. In cases of Emergency, patients can get admitted to any hospital. Emergency
bills will continue to be processed as per existing instructions. Similarly in cases where
further treatment is advised by local Govt Hosp, and/or major treatment procedure is
required, patient will be referred to suitable Service/Empanelled Hospital through Parent
Polyclinic as per existing procedure.
Copy to :-
DGAFMS/DG-3A
DGMS (Army)/DGMS 5(B) - for info please.
DGMS (Navy)
DGMS (Air Force
Sd/-x-x-x-x
MD ECHS
All HQ Area/Sub Area - Please disseminate the above contents to all
All Regional Centres polyclinics under jurisdiction.

Enclosure ‘6’
(Refer to Para 25 (b) of letter No
B/49774/AG/ECHS/Referral
dt ____________ 2009)
Tele: 011-25684945 Central Organisation ECHS
Mil: 233 36833 Adjutant General’s Branch
Integrated HQ of MoD
Maude Lines
Delhi Cantt –10
B/49774-P/AG/ECHS/Referral 25 Apr 07
IHQ of MoD (Navy)/DGMS (N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC, CC, NC, SWC (A/Med)
HQs WNC, SNC & ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Further to this Organisation letter No B/49774-P/AG/ECHS/Referral dt
05 Apr 2007.
2. Para 2(b) of this Org letter quoted in ref may please be d eleted and
reconstructed as under :-
Copy to :-
‘Applicable for residents of following stats only :-
(i) Himachal Pradesh.
(ii) Uttranchal.
(iii) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram,
Manipur, Tripura, Nagaland and Meghalaya (less district Shillong).
(iv) West Bengal : District – Darjiling only.
(v) Karnataka : District – Chikmagalur and Kodagu only.
(vi) Tamil Nadu : District – Nilgiris only.
(vii) Chattisgarh : Distt – Bastar and Dantewara only.
(viii) Orissa : District – Koraput and Mayurbhanj only.
DGAFMS/DG-3A
DGMS (Army)/DGMS 5(B) - for info please.
DGMS (Navy)
DGMS (Air Force
Sd/-x-x-x-x
Dir (Med)
For MD ECHS
All HQ Area/Sub Area - Please disseminate the above contents to all
All Regional Centres polyclinics under jurisdiction.
Tele/Fax : 011-25684945 Central Organisation, ECHS

ECHS REFERRAL TO SERVICE HOSPITAL
1. An incidence has occurred recently where-in an ECHS beneficiary was referred
by OIC of a polyclinic in NCR to Army Hospital (R&R) in moribund condition. The ICU
of the hospital did not have any vacant bed at that point of time, leading to great
inconvenience to the patient and her family.
2. The above incidence was avoidable, had OIC of the polyclinic ascertained bed
availability from the Service Hospital prior to transferring the patient.
3. You are requested to issue suitable instructions so that all polyclinics maintain an
updated status of availability of beds/facilities in the Service Hospitals on which they are
dependent. Referral to Service Hospital be made only for specialties/facilities available
at that point of time. In this connection, attention of all concerned may please be drawn
to this HQ letter of even reference dated 08 Jun 07.
Copy to :
sdxxxxxxx
Dir (Med)
For MD
-------------------------
All Regional Centers : For information and necessary action please.
Authority : B/49774-P/AG/ECHS/Referra 30 Jun 2007

REFERRAL TO EMPANELLED HOSPITALS IN DIFFERENT STATION
1. Representations are received from ECHS members residing in non-
Metro/smaller towns/cities or remote areas regarding problems and un due delay in
getting treatment, due t o complicated referral procedures. Patients from Non Mil Stn
with nil or inadequate empanelled facilities need to be referred to nearest other town/city
where such facility is available. I f that city happens to be a M il Stn with a S ervice
Hospital, patients are to use facilities available in that Service Hospital, and are allowed
to be referred out only if requisite facility is not available.
2. In many instances patients are referred for a facility which is not available in the
Service Hospital of the ‘other Stn where referred. As per existing ECHS procedure, the
patients have to first report to the ECHS Polyclinic of ‘other Stn then to the
service hospital of that Stn back to Polyclinic then referred to empanelled
hospital.
3. To reduce the avoidable inconvenience in such cases, it has been decided to
permit direct referral to empanelled facilities in another station which is under the AOR
of the same Stn Cdr. Such referral will be subject to fulfillment of following conditions:-
(a) Both Stations (i. e. Station from where referral is initiated and station
where referred to ) should be under the jurisdiction of same Stn Cdr.
(b) Existence of valid M oA between particular hospital where referred and
concerned Stn Cdr.
(c ) Facility/Specialty for which referred is not available at existing Service
Hospital (if any) of either station.
(d) Direct referral to empanelled hospital for specialty available in the Service
Hospital of the ‘other’ Station where referred will NOT be permitted even if bed
space is not available. Referrals in such cases must be routed through Polyclinic
of that ‘other’ Station.
(e) Empanelled hospital should agree to submit bills at Polyclinic of origin of
referral.
(f) Initial processing of bills will be by Polyclinic of origin of referral.
(g) All referrals to be endorsed with either of following two statements under
stamped signature of OIC Polyclinic originating referral :-
“Verified that Specialty/Facility is not available at present in
________________________________________________
(Name of Service Hospital of Station of origin of referral, if applicable)
AND IN _________________________________________
(Name of Service Hospital of Station where referred, if applicable)
OR
“There is no Service Hospital in _______________
(Station of origin of referral)
AND “Verified that Specialty/Facility is not available
In _____________________________________________
(Name of Service Hospital of Station where referred, if applicable)

4. The above provisions be disseminated to all concerned for implementation
please,
Authority : B/49774-P/AG/ECHS/Referral 18 Jul 2007
Sd xxxxxxx
Dir (Med)
For MD ECHS

CONDITIONS FOR DIRECT REFERRAL TO EMPANELLED HOSPITAL IN A
DIFFERENT TOWN/CITY
1. Both Station ( i.e. Station from where referral is initiated and station where
referred to) should be under the jurisdiction of same Stn Cdr.
2. Existence of valid MOA between particular hospital where referred and
concerned Stn Cdr.
3. Facility/Specialty for which referred not available at existing service Hospital (if
any) of either Station.
4. Submission of bills at Polyclinic of origin of referral to be agreed to by
empanelled hospital.
5. Initial processing of bills at Polyclinic of origin of referral.
6. All referrals to be endorsed with either of following two statements under
stamped signature of OIC Polyclinic:
“Verified that Specialty/Facility is not available at present in
________________________________________________
(Name of Service Hospital of Station of origin of referral, if applicable)
AND IN _________________________________________
(Name of Service Hospital of Station where referred, if applicable)
OR
“There is no Service Hospital in _______________
(Station of origin of referral)
AND “Verified that Speciality/Facility is not available
In _____________________________________________
(Name of Service Hospital of Station where referred, if applicable)

REFERRAL TO EMPANELLED HOSPITALS
ECHS POLYCLINIC THANE
1. The issue of referral from ECHS Polyclinic Thane has been considered. Since
the nearest Service hospital, INHS Aswini, is at a c onsiderable distance, it has been
decided that following referral procedure will be followed :
(a) Direct referral to local empanelled/Govt hospitals in Thane Distt and Navi
Mumbai will be permitted directly from ECHS polyclinic, Thane on the
recommendations of MO/Specialist of polyclinic.
(b ) Referral to hospitals in Mumbai will be routed through, ECHS polyclinic
INHS Aswini, Colaba.
2. Suitable instructions may be issued to all concerned accordingly.
Authority : B/49774-P/AG/ECHS/Referral 01 Oct 2007
Sd xxxxxx
Dir (Med)
For MD ECHS

ECHS REFERRAL POLICY FOR OUTSTATION PATIENTS
1. Presently all out Stations referral to Delhi have to be routed through Base
Hospital Delhi Cantt (BHDC) Polyclinic, which is resulting in undue rush at BHDC
Polyclinic and also causing inconvenience to the ECHS beneficiaries.
2. In order to resolve this problem, it has been decided that Lodhi Road Polyclinic
will also be made a nodal point where outstation cases of few Stations will be referred.
The patients from ECHS Polyclinics of the following states will be now first referred to
Lodhi Road Polyclinic for further referral to Service /Empanelled facilities :-
(a) Uttar Pradesh
(b) Uttarakhand
(c ) Bihar
(d) Orissa
(e) West Bengal
(f) North Eastern States.
3. The cases for outstation referral from rest states will continue to be routed
through BHDC Polyclinic as done hitherto fore.
4. You are requested to disseminate this information to all concerned.
Authority : B/49774-P/AG/ECHS/Referra18 Aug 2008
Sd xxxxx
Jt Dir (Med)
For MD

MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Further to this organization letter No. B/49774/AG/ECHS/Referral dated 25 Apr
2007.
2. Para 2 (b) of this Org letter quoted in reference may please be recommended as
under :-
Applicable for residents of following states only:-
(i) Himachal Pradesh
(ii) Uttaranchal
(iii) North Eastern States of Sikkim, Arunachal Pradesh, Mizoram, Manipur,
Tripura, Nagaland and Meghalaya (less district Shillong)
(iv) West Bengal : District Darjeeling only
(v) Karnataka : District Chikmagalur, Kodagu and Karwar (Uttar
Kannada only)
(vi) Tamil Nadu : District Nilgris only
(vii) Chhattisgarh : District - Bastar and Dantewara only
(viii) Orissa : District Koraput and Mayurbhanj only
Authority : B/49774-P/AG/ECHS/Referral 20 Aug 2008
sdxxxxxx
Jt Dir (Med)
For MD

REFERRAL OF ECHS PATIENTS TO ARMY HOSP (R &R)
1. Refer this Organisation letter No. B/49774/AG./ECHS/Referral dated 21 A ug
2008.
2. Consequent to a meeting with Comdt Army Hosp (R &R) and analysis of work –
load pattern the specialities for which this apex hosp has spare capacity has been
identified. Hence ECHS referral to Army Hosp (R&R) can be initiated for specialities as
brought out in succeeding paras and following guidelines in ibid letter.
3. The Cardiology cases requiring consultation and interventional procedures will be
referred to the Cardiology Center of Army Hospital (R &R). Besides the Speciality for
which patient can be referred is an follows:-
(a) General Services - ENT, Opthalmology
(b) Specialised Services
(i) Surgery - Neuro Surgery, Cardio Thoracic Surgery, Vascular
Surgery, Genito Urinary Surgery (Incl Renal Transplant Surgery),
Paediatric Surgery, Oncology (Surgery), Grastro Intestinal Surgery (Incl
Liver transplant Surgery), Traumatology-Joint Replacement Surgery,
Spinal Surgery, Laparoscopic Surgery.
(ii) Medicine - Neuro Medicine, Gastro Enterology, Endocrinology,
Nephrology, Rhematology, Clinical Haematology, Clinical Immunology,
Critical Care Medicine, Respiratory Dieseses, Nuclear Medicine.
(iii) Obstetries and Gynaecology - Gynaccology Oncology
(iv) Paediatrics - Cardiology, Neurology
(v) Pathology - Onco Pathology, Transplant Pathology.
4. All diagnostic investigations for ECHS inpatients will be c arried out at Army
Hospital (R7 R). However, following investigations when advised by specialists at the
Army Hosp (R &R) for outpatients will be outsourced by the referring ECHS Polyclinic :-
(i) CT Scan
(ii) MRI
5. Transfer of cases from empanelled Hosp to Army Hosp (R &R) should not be
encouraged where finality of treatment has been completed and pat ients needs only
terminal case. H owever, in exceptional cases requests for such trf will only be
entertained after ascertaining the bed availability.
6. The above may kindly be disseminated to all concerned.
Authority : B/49774/AG/ECHS/Referral 22 Aug 2008
Sdxxxxxx
Jt Dir (Med)
For MD

REFERRAL TO EMPANELLED HOSPITALS IN DELHI/NCR
1. A number of requests and representations had been recd from ex-servicemen
orgs and environment to review the referral system in ECHS in view of the following:-
(a) Inconvenience and hardships to the patients from ECHS Polyclinics (nonmil)
who have to shuttle between Polyclinic and MHs for consultation/referral for
speciality/super speciality. The problem gets compounded because of old age
and medical condition of the ECHS beneficiaries.
(b) The issue of hardships faced by our veterans on acct of present referral
system was brought out by the Army Cdrs during the Army Cdrs Conf in Apr 09.
(c ) DGAFMS/DGMS(Army) had h ighlighted that service to serving soldiers
and their dependents was suffering because of excessive load of ECHS
beneficiaries on Army/Base/Zonal hospital OPDs.
(d) Deliberations during ECHS Seminar at Chandimandir on 16 J ul 09
substantiated above problems.
2. Review of ECHS referral system had ac cordingly been included as one of the
priority issues in the ‘Time Bound Action Plan’ to give momentum to ECHS as directed
by COAS.
3. Earlier ECHS policy governing referrals had been f ormulated with the aim of
controlling excessive referrals to empanelled hospitals through evaluation of patient by
a Service Specialist as also to ensure that spare capacity of service hospitals is fully
utilized. This was necessary for a mega-medical scheme during its stabilization phase.
While the scheme is yet to see its final state, it has now become inescapable to review
and refine the referral system. The review primarily covers ECHS Polyclinics (non-Mil)
or those without service hospitals. Revised policy is contained in succeeding paras.
4. The revised referral policy in respect of Polyclinic s in Delhi/NCR will be as
follows:-
Ser NAME OF POLYCLINIC POLICY OF REFERRAL
(a) Delhi Cantt and Lodhi Road All referrals to empanelled hospitals in NCR
having MOA with Stn Cdr will be s ubject to
non availability of spare capacity with Base
Hospital/Army Hosp (R&R)
(b) Noida, Gurgaon & Faridabad (i) Direct referral to empanelled hospitals
in NCR having MOA with Stn Cdr.
(ii) C ases for Jt Replacement will be
referred to Army Hospital (R&R) for
evaluation.
(c ) Hindan (I) All referrals to empanelled hospitals in
NCR having MOA with Stn Cdr, will be
subject to non-availability of spare capacity
with 11 AFH.
(II) C ases for Jt Replacement will be
referred to Army Hospital (R &R) for
evaluation.
5. Referral will only be made once all available facilities of the Polyclinic are fully
utilized. C hoice of empanelled hospital/diagnostic centre will be with the ECHS
member.

6. ECHS Cells have been established at Army Hosp (R &R) and Base Hosp Delhi
Cantt. P rior written intimation by the ECHS Cells about non-availability of
Specialist/facilities/bed space for a particular duration will become an authority for OsIC
Polyclinics Delhi Cantt, Lodhi Road and Hindan to refer patients directly to empanelled
hospitals.
7. On remarks by the services spacialists of Army Hosp (R &R)/BHDC indicating
treatment from empanelled hospital, ECHS Cell at these hospitals will directly refer
patients to the empanelled hospital of patient’s choice. Photocopy/fax of such referral
form will be forwarded to the originating ECHS Polyclinic.
8. In case veteran desires to be treated at Service Hospital, referral will be made to
Army Hospital (R&R)/Base Hospital Delhi Cantt/11 AFH as per his choice.
9. The above policy will be implemented with effect from 01 Sep 09. Following
letters are hereby superseded :_
(a) B/49774/AG/ECHS dated 23 Aug 2006
(b) B/49774/AG/ECHS/Referral dated 18 May 2009
(c ) B/49774/AG/ECHS/Referral dated 01 Jul 2009
10. The policy shall be reviewed after six months.
Authority : B/49774/AG/ECHS/Referral 10 Aug 2008
sdxxxxxxxxxx
MD ECHS

1. References :-
REFERRAL TO EMPANELLED HOSPITALS IN DELHI/NCR
(a) This office letter No. B/49774/AG/ECHS/Referral dated 10 Aug 2009
(b) This office letter No B/49774/AG/ECHS/Referral dated 01 Dec 2009.
2. Referral by ECHS Polyclinic Lodhi Road to empanelled hosp of NCR was subject
to non availability of spare capacity with Base Hosp/Army Hosp (R &R) as per para 4 (a)
of Central Organisation letter No B/49774/AG/ECHS/Referral dated 10 A ug 2009.
Henceforth, ECHS Polyclinic Lodhi Road is permitted to make direct referral to
empanelled hosps in NCR having valid MsOA with Stn Cdr.
sdxxxxxxx
Dir (Med)
For MD ECHS
8. Necessary amendments to Govt letter will be carried out after the overall review
of ECHS.
Authority : B/49774/AG/ECHS/Referral 10 Dec 2010
sd/-xxxxxxx
Offg Dir (Med)
For Managing Director

Appx ‘A’
(Refer Para 5 of letter Central Org ECHS
Letter No. B/49778/AG/ECHS/Policy dt
19 Aug 08)
REVISED CHANNEL OF PROCESSING OF INDIVIDUAL REIMBURSEMENT BILLS
SUBMISSION OF BILLS BY INDIVIDUAL
POLYCLINIC
SEMO
STN HQ
CFA
Sanction
*
1. Claims above 2 lakhs will be sent to Regional Centre (Except RC,
Chandimandir and Regional Centre Delhi) as hithertofore.
2. Claims above 4 lakhs will be fwd to Central Org ECHS for further
processing.

Appx ‘B’
(Ref Para 7 of Central Org ECHS Letter
No. B/49778/AG/ECHS/Policy dt
19 Aug 2008)
SANCTION OF CFA FOR
EMERGENCY TREATMENT IN NON-EMPANELLED HOSPITAL
DEBITABLE TO MAJOR HEAD-2076, MINOR HEAD-107
SUB HEAD-F, CODE HEAD-365/00
1. Under the provisions of Government of India, Ministry of Defence letter No
24(8)/03/US/(WE)/D(Res) dated 19 December 2003, on ‘Procedure for Payment and
Reimbursement of Medical Expenses” under ECHS, read in conjuction with Serial 1 of
Appendix to Govt of India, Ministry of Defence letter No 24(3)/03/US/(WE)/D(Res)(i)
dated 08 September 2003 and Central Org ECHS letter No B/49778/AG/ECHS/Policy
DT 19 Aug 2008, sanction of CFA is hereby accorded for payment _____________
__________________________ (Retd) as per the following details:-
(a) ECHS card No/Regn No : ____________________________
(b) Name of Patient : ____________________________
(c ) Name of the Hospital : ____________________________
____________________________
____________________________
(d) Period of Hospitalisation : ____________________________
(e) Diagnosis : ____________________________
_____________________________
(f) Amount Santioned : Rs _________________________
(Rupees____________________________________________only)
File Ref : (Sanction of CFA)
Date

Tele : 011-25684945
Mil : 6833
B/49773/AG/ECHS/Policy 01 Dec 2008
IHQ of MoD (Navy)/DGMS/(N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC,CC,NC,SWC (A/Med)
HQs WNC, SNC &ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
1. Reference :-
Encl ‘5’
(Refer to Para 14 of letter No.
B/49774/AG/ECHS/Referral
Dt 01 Dec 2009)
Central Organisation, ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Madue Line, Delhi Cantt -10
PROCEDURE FOR PAYMENT AND REIMBURSEMENT
OF MEDICAL EXPENSES UNDER ECHS
(a) GOI, MOD letter No 24(8)/03/US(WE)/D(Res) DATED 19 Dec 2003.
(b) This HQ letter No B/49778/AG/ECHS/POLICY dated 16 May 2007.
(c ) This HQ letter No B/49778/AG/ECHS/Policy dated 19 Aug 2008.
2. Following paragraph may be added to this HQ letter at Para 1 (c ) for allowing
review and reconsideration of the claims being rejected :-
“In case any claim preferred by an ECHS member is not recommended, it will not
be rejected from any intermediate functionary due to any reason, whatsoever. C alim
will be f wd to Central Organisation, ECHS for review alongwith deatailed reasons for
rejection”.
Copy to :-
Sd/-xxxxxxxxxxx
Jt Dir (Med)
For Managing Director
____________________ - Please ensure dissemination of above
Contents to all
All Regional Centres ECHS Concerned under AOR
Kendiry Saink Board -For info please
Internal :-
Web JCO
P & FC Sec

Tele : 011-25684945
Mil : 6833
B/49773/AG/ECHS/Policy 26 May 2009
_______________
(All Regional Centres
Encl ‘6’
(Refer to Para 14 of letter No.
B/49774/AG/ECHS/Referral
Dt 01 Dec 2009)
Central Organisation, ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Madue Line, Delhi Cantt -10
RE-IMBURSEMENT OF DIAYYSIS CHARGES
1. In a S tn which does not have an empanelled facility for Haemodialysis, the
treatment can permitted in the non-empanelled hospital as a life saving treatment.
2. Haemodialysis can also be p ermitted in a non-empanelled hospital when the
facility in an empanelled hosp is not available to an ECHS member due to its limited
capacity.
3. The following are the guidelines :-
(a) EIR should be raised by OIC Polyclinic with an endorsement stating that
Haemodialysis is not available in a Service/Empanelled hospital in the Stn. Non
availability of Haemodialysis in empanelled hosp be examined with ref to provn of
Para 2 above.
(b) Bills are to be processed for a period of one month at a time.
(c ) The maximum amount admissible will be as per CGHS package
applicable in the area or the amount claimed, whichever is less.
4. This supersedes Central Organisation ECHS letter No B/49770/AG/ECHS dt 31
Oct 2007.
Copy to :-
All Comd HQs
Sd/xxxxxxxxxx
Offg Dir (Med)
For Offg MD

Tele : 011-25684945
Mil : 6833
B/49773/AG/ECHS/Policy 05 Apr 07
IHQ of MoD (Navy)/DGMS/(N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC,CC,NC,SWC (A/Med)
HQs WNC, SNC &ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
Encl ‘7’
(Refer to Para 25 (b) of letter No.
B/49774/AG/ECHS/Referral
Dt 01 Dec 2009)
Central Organisation, ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Madue Line, Delhi Cantt -10
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Representations have been received from the environment that ECHS
beneficiaries residing in remote/hilly areas face great inconvenience for getting referrals
even for minor allotment from their nearest Polyclinics due to distance/terrain.
2. It has been decided that ECHS beneficiaries will henceforth be permitted to avail
the facilities/services or nearest Govt Health Care Centres/Primary Health Centre/Govt
Hospitals (Deemed empanelled) without prior referral from the Polyclinic subject to the
following conditions :-
(a) Distance from nearest Polyclinic should be more than 50 Kms.
(b) Applicable for residents of following states only :-
(i) Jammu & Kashmir.
(ii) Himachal Pradesh
(iii) Uttranchal
(iv) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram,
Manipur, Tripura and Nagaland.
(v) West Bengal :District – Darjilliing only
(vi) Karnataka : District – Chikmagalur, Kodagu only.
(vii) Tamil Nadu : District – Nilgiris only.
(viii) Chattisgarh : District – Bastar and Dantewara only.
(ix) Orissa : District – Koraput only.
(c ) Treatment permitted for maximum period of 07 days.
3. Parent Polyclinic will be not ified of such treatment undertaken at the earliest
(within two working days). Info can be sent by person/telephone/mail/fax/telegram.
Parent Polyclinic will generate a r eferral immediately on receipt of information and
attach the same with the claim when received. Claims for reimbursement of
expenditure incurred should be submitted to Parent Polyclinc within one month of
completion of treatment. The claim will include the following:-

Tele : 011-25684945
Mil : 6833
B/49773/AG/ECHS/Policy 25 Apr 07
IHQ of MoD (Navy)/DGMS/(N) for OIC ECHS
Air HQ (VB)/AOA/DPS
HQs SC, EC, WC,CC,NC,SWC (A/Med)
HQs WNC, SNC &ENC
HQs WAC, CAC, EAC, TC, SWAC & MC IAF
Encl ‘8’
(Refer to Para 25 (b) of letter No.
B/49774/AG/ECHS/Referral
Dt 01 Dec 2009)
Central Organisation, ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Madue Line, Delhi Cantt -10
MEDICAL CARE FOR ECHS BENEFICIARIES IN REMOTE/HILLY AREAS
1. Further to this Organisation letter No B/49774-P/AG/ECHS/Referral dt 05 Apr
2007.
2. Para 2(b) of this Org letter quoted in ref may please be d eleted and
reconstructed as under :-
Copy to :-
Applicable for residents of following stats only :-
(i) Himachal Pradesh
(ii) Uttranchal
(iii) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram, Manipur,
Tripura, Nagaland and Meghalaya (less district Shillong).
(iv) West Bengal : District – Darjilling only
(v) Karnataka : District – Chikmagalur and Kodagu only.
(vi) Tamil Nadu : District – Nilgiris only
(vii) Chattisgarh : District – Bastar and Dantewara only.
(viii) Orissa : District – Koraput and Mayurbhanj only.
DGAFMS/DG-3A
DGMS(Army)/DGMS 5(B) - for info please
DGMS(Navy)
DGMS(Air Force)
Sd/-xxxxxx
Dir (Med)
For MD ECHS
All HQ Area/Sub Area - Please disseminate the above contents to all
All Regional Centres Polyclinics under jurisdication.

Reference
PRIOR APPROVAL : UNLISTED PROCEDURES/TESTS/IMPLANTS
1. Our letter No B/49773/AG/ECHS dt 12 May 06.
2. Our letter No B/49778/AG/ECHS dt 14 Dec 10.
Background
3. The prior approval procedure of ECHS as elaborated in our letter under reference at
Para 1 w as reviewed in light of experience gained thus far and recommendations on t he
subject received in response to our ibid letter at Para 2. A fter due deliberation revised
procedure has been formulated and the same is enumerated in succeeding paragraphs.
Prior Approval
4. Prior approval will be required only for those procedures, implants and tests
(diagnostic) which are not listed in CGHS rate list of procedures/investigations/ceiling rates of
implants. P rior approval for all such cases will be obtained by fastest means of
communication to include fax and e-mail from ECHS Polyclinic. Approving authorities for prior
approvals are as follows :-
Cost of procedure/test/implant Approving Authority
(a) Less than two lakhs SEMO/SMO/PMO/CMO
(b) Two to four lakhs Service Specialist in concerned
speciality
(c) Above four lakhs Concerned Senior Advisor/Consultant
at Zonal/Comd Hosp [(for NCR- BHDC/
AH (R&R)]

Channel for Seeking Prior Approval
2
5. The onus of obtaining prior approval is on the empanelled hospital. I t has been
experienced that the hospitals have not lived upto expectations in this regard and have
forced/coerced patients/their kin to run around with the prior approval documents from
hospital to approving authorities. T his shall not be ac cepted henceforth. T he hospitals
violating this procedure will invite disciplinary action for disempanelment/blacklisting. T he
documents will be sent by courier/ post/fax/e-mail and not by hand.
6. All prior approvals will be initiated by the Empanelled Hospital where the ECHS patient
is undergoing treatment. It will be initiated on the proforma attached as Appx ‘A’ to this letter,
before the proposed procedure/test is carried out. It is mandatory that the treating
Specialist/Consultant attaches a det ailed case summary justifying the proposed procedure/
test/implant with the Appx A.
7. The channel of seeking prior approval is represented diagrammatically at Appx B.
8. The Empanelled Hospital initiating the Appx A will adopt the fastest means to forward
the same to the concerned Polyclinic. The OIC Polyclinic will forward the documents to SEMO
without delay. SEMO will dispose off all cases upto Rs two lakhs. Cases upto four lakhs will
be forwarded to nearest service specialist and those beyond four lakhs will be forwarded
directly to Senior Advisor/Consultant.
9. The approving authority after endorsing remarks/approval will forward the proforma
back to the SEMO
10. If the SEMO/approving authority feels that the situation is emergent, he/she can
communicate his/her opinion directly to the concerned Empanelled Hospital by fax/telephone.
This has to be followed by sending the original ink signed hard copy to the concerned
Polyclinic.
Emergency Conditions
11. In certain emergency situations due to the urgency of the case or to save life or limb of
a patient, prior approval may not be pos sible. I n all such cases the proposed treatment
should continue. Emergent/life saving treatment will not be denied on the plea that
‘Prior Approval’ needs to be obtained. However, the concerned Empanelled Hospital will,
in discharge summary, give a detailed justification of the cause as to why the prior approval
was not obtained for that particular procedure/test. There is no provision, however, of an ex
post facto ‘Prior Approval’ and the Proforma (Appx A) will NOT be used in such cases.
Disposal
12. The ink signed copy of prior approval, duly approved by the competent authority, will
be attached in original along with the bills being submitted by the Empanelled Hospital for
payment.

Conclusion
3
13. With the simplification of prior approval procedure it is expected that patients and their
relatives will not be put to avoidable hardships. S tn HQ are requested to ensure that the
aforestated instructions are communicated to all the Empanelled Hospitals/Nursing
Homes/Diagnostic Centres in their AOR and that the Proforma for prior approval as per
Appx A to this letter is made available in sufficient quantity to them.
14. Our letter No B/49773/AG/ECHS dt 12 May 2006 is superseded.
.
Authority : B/49778/AG/ECHS/PA/Ruling 28 Jun 2011
Sd/- X X X
MD ECHS

ECHS Membership No …………………………
Appx A
(Refers to Para 6 of Central Organisation ECHS letter No
B/49778/AG/ECHS/PA/Ruling dt 28 Jun 11)
APPROVAL FOR UNLISTED PROCEDURE/IMPLANT/TEST AT ECHS EMPANELLED HOSPITAL
PART – I (To be filled by the Empanelled Hospital)
1. Name (Patient)………………………………………….2. Relationship with ECHS Member ……………………….
3. No …………………….. 4. Rank……………………. 5. Name (Member)…………………………………………...
6. Hospital…………………………………………………………………………………………………………………….
7. Diagnosis ………………………………………………………………………………………………………………….
8. Proposed Treatment Procedure/Test/Implants…………………………………………………………………………
9. Estimated Cost (Rs)……………………. (in words)…………………………………………………………………….
10. Case summary including investigation reports attached (Yes/No)…………. 11. Remarks ………………………
12. Date……………… 13. Signatures & Stamp of Treating Physician/Consultant ……………..
PART II – ENDORSEMENT BY OIC POLYCLINIC
14. Received on ____________(date) at _________(time) and forwarded to SEMO on _________ at ________.
(OIC Polyclinic)
PART II (To be filled by the SEMO/SMO/PMO/CMO)
15.* APPROVED/NOT APPROVED/FORWARDED FOR APPROVAL TO (competent approving authority)
…………………………………………………………………………………………………………………………………………
16. Date………………….. 17. Place……………………. 18. Signatures & Stamp of SEMO ………………………...
(*Strike out whichever is not applicable)
PART III (To be filled by approving authority other than SEMO/SMO/PMO/CMO if applicable)
19. Remarks…………………………………………………………………………………………………………………….
APPROVED/NOT APPROVED
20. Date …………….21. Place ……………………. 22. Signature with Stamp………………………………………
Note
1. Empanelled Hospitals will forward this form directly to the OIC Polyclinic. Necessary case summary
alongwith investigation reports will be enclosed by the Hospital.
2. SEMO will fwd the case summary & documents directly to the approving authority (if required) with
recommendations.

3. In emergencies, the hospital may proceed with the treatment/test/procedure and justify the cause in
discharge summary.
Appx B
(Refers to Para 7 of Central Organisation ECHS letter No
B/49778/AG/ECHS/PA/Ruling dt 28 Jun 11)
Notes
See Note 2
PRIOR APPROVALS : UNLISTED PROCEDURES/TESTS/IMPLANTS
(CHANNEL OF APPROVAL)
Upto Four Lakhs
Nearest Service Specialist
EMPANELLED HOSPITAL
POLYCLINIC
SEMO
See Note 2
Above Four Lakhs
Senior Advisor/Consultant at
nearest Zonal/Comd Hospital
1. Movement of the Proforma for Prior Approval should be by fastest possible means.
2. Sanction be faxed/e-mailed to empanelled hospital to avoid delays. Ink signed hard copies may
follow as per channel indicated above.
3. In case of Prior Approvals above four lakhs the OIC ECHS will endorse a copy of approval to
Regional Centre, ECHS for record.
4. It is mandatory to attach the original approved copy with the bills being submitted.

Appx B
(Refers to Para 8 of Central Organisation ECHS letter No
B/49778/AG/ECHS/PA/Ruling dt Jun 11)
PRIOR APPROVALS : UNLISTED PROCEDURES/TESTS/IMPLANTS
(CHANNEL OF APPROVAL)
EMPANELLED
HOSPITAL
POLYCLINIC
(upto two lakhs)
SEMO
(upto four lakhs)
SERVICE SPECIALIST
(Above four lakhs)
SR ADV/CONS AT
ZONAL/COMD HOSP
[IN CASE OF DELHI
AND NCR SR ADV/CONS
AT BHDC/AH(R&R)]
Note 1. Movement of the Proforma for Prior Approval should be by fastest possible means.
- Fax/e.mail
2. Sanction be faxed/e-mailed to empanelled hospital to avoid delays. Ink signed hard copies
may follow as per channel indicated above.
3. In case of Prior Approvals above four lakhs the OIC ECHS will endorse a copy of approval to
Regional Centre, ECHS for record.
4. It is mandatory to attach the original approved copy with the bills being submitted.

REIMBURSEMENT MEDICAL EXPENSES
1. A number of cases have been fwd to Central Organisation ECHS for obtaining
sanction where treatment has been undertaken by ECHS members in Institute of
National Repute/Govt Hospitals e.g. AIIMS or PGIMER.
2. In this connection please refer to Para 12 of this office letter No
B/49773/AG/ECHS dated 25 May 2004 and GOI and MOD letter No 24(8)/03/US(WE)/D
(Res) dt 19 Dec 03. When ECHS members are referred by Polyclinic to these Institute
of treatment the expenses will be processed as per normal procedure and payments
make after approval of CFA. Sanction of Central Organisation ECHS is not required in
these cases.
3. Similarly a number of cases for reimbursement of drugs have been referred to
Central Organisation ECHS. It is reiterated that reimbursement for medicine for OPD is
only entitled under provision of Para 6 of GOI MOD letter No 24(8)/03/US(WE)/D (Res)
dated 19 Dec 2003 on P ayment and R eimbursements of Medical Expenses. Where
expenditure is not covered under the provisions of GOI/MOD letter, the expenses will
have to be borne by the ECHS member themselves. These cases may be disposed at
the Stn HQ itself since reference to Central Orgnisation will not serve any purpose.
4. HQ Western Command Only : Cases listed in Appendis to this letter are
returned herewith for processing and disposal at your end.
Authority : B/49773/AG/ECHS/R 31 Aug 2004
Sd/- x x x
Jt Dir (Med)
for MD

REPRESENTATIONS BY HOSPITAL/DIAGNOSTIC
CENTRES ON PAYMENT
1. A number of representations are being received in Central Organisation ECHS
regarding short payment/under payment of bills raised by hospitals for treatment of
ECHS beneficiaries.
2. In order ensure transparency in the whole process in line with CVC guidelines,
the Hospital/Diagnostic Centres on request will be s hown the reason (s) for
disallowance. I f the empanelled facility desires to contest the disallowance, a
representation can be made to the next higher CFA through the concerned Station
Headquarters. T he representation in such cases will be f orwarded to the concerned
Regional Centre ECHS. The Regional Centre ECHS will call for the documents from
the Stn HQs, carry out an anasysis and forward to the appropriate authority along with
their observation/recommendations.
3. The appropriate authority will forward the decision to the Stn HQ and Regional
Centre concerned. The decision will be conveyed to the Empanelled Medical facility by
the Stn HQ.
4. The Regiona Centre will NOT communicate their recommendations or the final
decision of th appropriate authority to the Empanelled Medical facility. This function will
be performed only by the Stn HQs.
Authority :B/49773/AG/ECHS/ 01 Apr 2005
SD/- x x x
MD ECHS

SUBMISSION OF CLAIM FOR REIMBURESEMENT BY
OUTSTATION ECHS MEMBERS
1. Ref this Organisation letter No B/49773/AG/ECHS dated 05 Feb 2005.
2. As per present policy issued vide this Organisation letter under reference, ECHS
members can submit claims pertaining to emergency treatment in non-empanelled
hospitals either at Parent Polyclinic of Stn where treatment occurred.
3. The Policy has since been reviewed and it has been decided that all claims for
reimbursement of med expenses incurred for Emergency Treatment in Non-empanelled
Hospitals will henceforth will be submitted at the Parent Polyclinic only.
4. Emergency treatment will be permissible in any stn where the emergency occurs.
Emergency Info Report (EIR) will be generated from there. Subsequently, claims will be
submitted to Parent Polyclinic for processing.
5. In case where it is not possible for ECHS member to submit claim at his Parent
Polyclinic due to exceptional circumstances, the claim may be accepted at the Polyclinic
of Stn where treated, subject to approval of the Stn Cdr of that Stn.
(Auth : B/49773/AG/ECHS dt 31 Aug 2006).
Authority : B/49773/AG/ECHS/ 09 Aug 2006
Sd/- x x x
Dir (Med)
For MD

RE-IMBURSEMENT OF MEDICAL EXPENSES
AFTER DEMISE OF ESM/ MEMBERS OF ECHS
1. A few cases have come to light where both members of the ECHS (ESM as well
as the spouse) have expired and sanctioned amount of re-imbursement could not be
credited to their account. Subsequently, other family members, who were neither ECHS
members nor dependent beneficiary of the Scheme, approached ECHS Organisation
for payment of the Bills.
2. Based on t he procedure in vogue in CGHS, the following guidelines may be
followed by ECHS :-
(a) In case of death of members of ECHS, claimant is to submit an Affidavit
on Stamp Paper of value not less than Rs 10/- duly attested by Public Notary.
Specimen copy of the affidavit is placed at Appx `A’.
(b) A “No Objection” Certificate from other legal heirs, if any, is also required
to be given on a similar Stamp Paper stating that they have not objection in case
the amount of Bills was paid to Claimant. Details of other family members may
be verified from Original Application Form submitted at the time of taking ECHS
membership or from the Affidavit submitted along with above application Form.
Specimen copy of the affidavit is placed at Appx `B’
(c) A copy of Death Certificate & smart cards of the ECHS members are to be
attached along with above documents.
3. The above mentioned documents are required to be submitted by the Claimant to
Stn HQ. S tn HQ will verify the documents for their completeness and authenticity
before effecting the payment to claimant to avoid any litigation at a later date. Smart
cards will be def aced/destroyed to prevent misuse & annotation to this effect will be
made in the records held at Stn HQs/RC.
4. You are requested to issue suitable instructions to all concerned and ensure
compliance.
Authority :B/49773/AG/ECHS/ 24 Nov 06
Sd/- x x x
Dir (P&FC)
For MD

Appendix ‘A’ to leeter No B/49773/AG/ECHS dt Oct 2006
Draft for Affidavit on Stamp Paper for claiming medical reimbursement
1. _______________ Wife/Son/Daughter of Late _______________________ and
resident of __________________ hereby submit the medical claim papers pertaining to
treatment of my father/mother/________ Late Shri/Smt _____________ who has
expired on ________ (Copy of death certificate is enclosed).
Late Shri/Smt __________ has left behind the following other legal heirs none of
whom have any objection if the entire amount reimbursable is paid to me.
___________________________
___________________________
No objection certificate signed by the legal heirs on Stamp paper is enclosed herewith.
Attested by Notary Public Deponent
Appendix ‘B’ to letter No B/49773/AG/ECHS dated Oct 2006
Draft for No objection certificate on Stamp Paper
We ______________________ S/o/D/o Late Shri _______________________
Being the legal heirs of Late Shri ______________ have no objection if the entire
amount reimbursable pertaining to the treatment of our father is paid to our brother Shri
________________________
( ) ( )
Sons/
Dauthers W/O
Address Address
Verified by Notary Public

CENTRAL GOVERNMENT HEALTH SCHEME
CHECK LIST FOR REIMBURSEMENT OF MEDICAL CLAIMS
1. CGHS Taken No and place of issue :
2. Validity of CGHS Card (for pensioners) from ________ to ________
3. Full Name of Card Holder (Block letters) :
4. Status (Govt Servant/Pensioner/Others) :
5. The following documents are submitted :
(Please tick(-/) the relevant column) :
(a) Medical 97 Form : Yes/No
(b) Photocopy of CGHS Card : Yes/No
(c) Essentiality Certificate : Yes/No
(d) No of Original Bills/Vouchers : _______
(e) Whether original bills/vouchers : Yes/No
Have been verified
(f) Copy of Discharge Summary : Yes/No
(g) Copy of Permission letter : Yes/No
(h) Whether the hospital has given break : Yes/No
Lab investigations
(j) Original papers have been lost the : Yes/No
Following documents are submitted
i) Photo Copies of Claim papers : Yes/No
ii) Affidavit on Stamp Paper : Yes/No
(j) Incase of Death of Card Holder, the
The following documents are submitted :
i) Affidavit on Stamp Paper by claimant: Yes/No
ii) No Objection from other legal heirs on: Yes/No
Stamp Paper
iii) Copy of Death Certificate : Yes/No
Dated : _____
Signature of CGHS Card Holder
Tele No :

INFORMATION
a) Kindly write correct postal address in block letters
b) Obtain Break up of investigation from the hospital (death and rates of individual
tests and the card number of Sugar tests, X-ray films, Etc) as the reimbursable amount
is calculated as per approval rates only.
c) Draft against column (i) of check list-in case of loss of Original Papers
Draft for Affidavit for Duplicate Claim Papers/bills on Stamp Paper
1. ___________ Son/Wife/Daughter of __________ and resident of
_______________ submit duplicate papers for consideration as original bills are
lost/misplaced/not traceable. I hereby give an undertaking that I have not received any
payment against original bills/claim papers from any source and t hat if the original
papers are traced I shall not stake claim against original bills in future and that in the
event I receive any cheque against original bills in future I shall return the same to
competent authority.
Verified by Notary Public
Deponent
d) Draft against column (j) of check list – in case of Death of Card holder.
Draft for Affidavit on Stamp Paper for claiming medical reimbursement
I,…………………………. Wife/ son/daughter of Late ……………………. And resident of
……………… hereby submit the medical claim papers pertaining to treatment of my
father/mother/… Late Shri/Smt ……………. Who has expired on ……………. (Copy of
Death Certificate enclosed)
Late Shri /Smt ……………. Has left behind the following other legal heirs none of
whom have any objection if the entire amount reimbursable is paid to me.
………………………………….
………………………………….
No Objection Certificate signed by other legal heirs on Stamp Paper is enclosed
herewith.
Attested by Notary Public
Draft for No Objection certificate on Stamp Paper
Deponent
We ……………………. s/o d/o Late Shri …………………………………
…………………………. s/o d/o Late Shri ………………………………..
Being the legal heirs of Late Shri …………………… have no obj ection if the entire
amount reimbursable pertaining to the treatment of our father is paid to our brother
Shri ……………………………………..
( ) ( )
Address : W/o
Verified by Notary Public
Address

CENTRAL GOVERNMENT HEALTH SCHEME
CHECK LIST FOR REIMBURSEMENT OF MEDICAL CLAIMS
1. CGHS Token No and place of issue :
2. Validity of CGH Card (For pensioners) &: from ………….. to ……………
Entitlement. Pvt / Semi Pvt/General
3. Full name of Card Holder (Block Letters):
4. Status (Govt,Servant/Pensioner/Other) :
5. The following documents are submitted :
(Please tick (-/) the relevant column)
(a) Medical 2004 Form : Yes/No
(b) Photocopy of CGHS card : Yes/No
(c) Essentiality Certificate : Yes/No
(d) No, of Original Bills : _____
(e) Whether original bills/vouchers : Yes/No
Have been verified
(f) Copy of discharge summary : Yes/No
(g) Copy of Permission letter : Yes/No
(h) Whether the hospital has given breakup: Yes/No
For lab investigations
I. Photocopies of claim papers : Yes/No
II. Affidavit on Stamp Paper : Yes/No
(j) Incase of death of card holder the
Following documents are submitted __
I. Affidavit on Stamp paper by : Yes/No
Claimant
II. No objection from other legal : Yes/No
Heirs on Stamp papers
III. Copy of death certificate : Yes/No
Dated : _____________ Signature of CGHS card holder
Tele No (O)
(R)
e-mail Address
Name of the Bank ___________ Branch ___________ SB A/C No
Branch MICR Code __________ Tel. No. of Bank Branch.

Computer NO
CENTRAL GOVERNMENT HEALTH SCHEME
MEDICAL 2004 FORM FOR REIMBURSEMENT OF
MEDICAL CLAIM OF CGHS BENEFICIARIES
(To be filled by the claimant)
1. CGHS Token No and Place of issue :
2. Validity of CGHS Token Card : From ____ to _____
and entitlement : Pvt/Semi Pvt/General
3. Full name of the card holder (Block letters):
4. Full address :
5. Telephone no. (O) ________ (R) _________
6. E-mail address if, any.
7. Name of the Bank _________ Branch _________ SB A/C
Branch MICR Code ________ Tele. No. of Bank Branch ________
8. Name of the patient & relationship
With the card holder
9. Status tick (-/) (Govt-Servant/Pensioner/Serving employee or pensioner of
autonomous body/Member of Parliament/Ex-MP/Ex-Governor/Former Judge of
Supreme Court/Former Judge of High Court/Freedom Fighter/Legal Heir/others)
10. Basic Pay/Basic Pension.
11. Name of the Hospital with Address :
(a) OPD treatment and investigations
(b) Indoor Treatment.
12. Date of admission ___________ date of discharge _________(In case of Indoor
Treatment only)
13. Total amount Claimed
(a) OPD Treatment.
(b) Indoor Treatment.
14. Details of Permission :
15. Details of Medical advance if, any :
DECLARATION
I hereby declare that the statements made in the application are true to the best
of my knowledge and belief and the person for whom medical expenses were incurred
is wholly dependant on me. I am a CGHS beneficiary and the CGHS card was valid at
the time of treatment. I agree for the reimbursement as is admissible under the rules.
Date : Signature of CGHS card holder
Note : Misuse of CGHS facilities is a criminal offence. Suitable action including
cancellation of CGHS card shall be taken in case of willful suppression of facts or
submission of false statements. Suitable disciplinary action shall be taken in case of
serving employees.

INFORMATION
a) Kindly write correct postal address in block letters
b) Obtain Breack up of Investigations from the hospital (details and rates of
individual tests and the exact number of Sugar tests, X-ray films, etc,) as the
reimbursable amount is calculated as per approved rates only.
c) Draft against column (I) of check list-in case of loss pf Original Papers.
Draft for Affidavit for Duplicate Claim Papers/bills on Stamp Paper
I, ____________ son/wife/daughter of __________ and resident of lost/misplaced/not
traceable. I hereby given and undertaking that I have not received any payment against
original bills/claim papers from any source and that if the original papers are traced I
shall not stake claim against original bills in future and that in the event I receive any
cheque against original bills in future I shall return the same to competent authority.
Deponent
Verified by Notary Public
d) Draft against column (I) of check list in case of Death of Card holder
I,…………………………. Wife/ son/daughter of Late ……………………. and resident of
……………… hereby submit the medical claim papers pertaining to treatment of my
father/mother/… Late Shri/Smt ……………. Who has expired on ……………. (Copy of
Death Certificate enclosed)
Late Shri /Smt ……………. has left behind the following other legal heirs none of
whom have any objection if the entire amount reimbursable is paid to me.
………………………………….
………………………………….
No Objection Certificate signed by other legal heirs on Stamp Paper is enclosed
herewith.
Deponent
Attested by Notary Public
Draft for No Objection certificate on Stamp Paper
We ……………………. s/o d/o Late Shri …………………………………
…………………………. s/o d/o Late Shri ………………………………..
being the legal heirs of Late Shri …………………… have no objection if the entire
amount reimbursable pertaining to the treatment of our father is paid to our brother
Shri ……………………………………..
( ) ( )
Address : W/o
Verified by Notary Public
Address

(ii) Charges for :
a) O.T _________ _________
b) O.T. Consumables _________ _________
c) Anethesia _________ _________
d) Procedure _________ _________
(iii) Medicines _________ _________
iv) Implants like pacemaker joint replace-
ment, Coronary
Slent etc (details) _________ _________
(v) Artificial devices _________ _________
(details)
(vi) Lab charges _________ _________
(Break-up given in
Annexure).
(vii) Spl. Nurse/Aya if any ________ _________
(viii) Miscellaneous ________ _________
Total ________ _________
Signature of Claimant
Name in Block Letters
Address & Telephone No. if any:
1. Certificate that the relevant bills/vouchers have been v erified by me and t he
expenditure shown above is correct and the treatment services provided are essential
and minimum that required for the recovery of the patient.
2. Certified that the services of special Nurse/Ary were required from ______ t o
________ that were absolutely essential for the recovery of the patient.
3. Specific procedure/Operation performed
Was ______________________
Signature of the Treating Specialist With official seal.
Countersigned by Medical Superintendent
Of the Hospital with seal (For Indoor treatment only)

REIMBURSEMENT OF MEDICAL BILLS OF OUTSTATION ECHS
MEMBERS FOR TREATMENT IN DELHI
1. A large number of outstation members come to Delhi to avail medical treatment
as good facilities are available here. All such outstation patients as required to report to
ECHS Polyclinic at Base Hospital, Delhi Cantt for further referral to Service/Empanelled
Hospital. This has resulted in increased work load on t he Polyclinic at Base Hospital
SEMO Base Hospital and Stn HQ, Delhi Cantt.
2. Apart from processing the medical treatment requirements, the Polyclinics,
SEMO and S tn HQ have also the additional load of processing the bills for these
outstation patients. These bills can be categorized as under :-
(a) Bills of Empanelled Hospital.
(b) Bills for Emergency treatment in non Empanelled Hospitals.
(c) Bills for treatment in AIIMS/other Govt Hospitals.
(d) Bills for reimbursement of cost of medicines for specified diseases.
3. Out of categories listed above, bills for empanelled hospitals have to be
processed in Delhi as MOA with hospitals have been signed with Stn Cdr, Delhi.
Regarding individual reimbursement claims for treatment in non empanelled hospitals,
instructions have already been issued that respective parent polyclinics are to process
the claims.
4. With an aim to case out additional load from the Polyclinic/SEMO/Stn HQ, Delhi
Cantt for outstation ECHS beneficiaries, it has been decided that bills listed at Para (c)
and (d) above be also processed by concerned parent polyclinics. However, in cases,
where advance is granted from Stn HQ Delhi, the bills will have to be processed by the
same Stn HQ.
5. You are requested to disseminate this to all concerned for compliance.
Authority : B/49773/AG/ECHS/ 23 Feb 07
Sd/xxxxxxx
Offg Dir (Med)
For MD

DIET CHARGES FOR ECHS PATIENTS ADMITTED TO HOSPITAL
1. ECHS patients admitted to hospitals are entitled to free diet subject to their basic
pension not exceeding specified amounts as laid down vide Govt of India, Min of
Defence letter No 22 (08)/06/US(WE)/D(Res) dt 05 Dec 2006.
2. Several queries have been received from the environment regarding methology
for implementing the provision. The following clarifications are made :-
(a) Treatment in Empanelled Hospitals. Diet charges are included in the
package mrates’ for various procedures which are negotiated with hospitals. For
treatment procedures with no prescribed package rate, ‘diet’ is included in ‘Room
Rent’ charges. Hence att treatment in Empanelled hospital is inclusive of diet and
no additional charges are to be levied for the same.
(b) Treatment in Service Hospital Diet is not charged separately for
treatment in Service Hospitals. However Hospital Stoppage’ at prescribed rates
for ESM/dependents is charged from patients which is not reimbursable.
(c) Treatment in Govt Hospitals. Diet charges are payable by ECHS
beneficiaries. Reimbursement of the same is admissible as per actual, subject to
entitlement as per basic pension scale laid down vide Govt letter referred in Para
1 bove. In all such cases, where diet charges are admissible, reimbursement will
be from code head 365/00 (medical treatment related expenditure).
(d) Treatment in Emergency in Non Empanelled Hospital.
Reimbursement i s admissible at CGHS rates. Hence CGHS stipulations as
outlined at Para 1 (a) above are applicable, and diet charges’ cannot be admitted
separately.
Authority : B/49773/AG/ECHS/ 14 May 07
Sd/xxxxxxx
Dir (Med)
For Managing Director

PROCESSING OF CLAIM FOR REIMBURSEMENT :
NON EMPANELLED HOSPITAL
1. Reference our letter No B/49773/AG/ECHS/Policy dt 16 May 2007.
2. All high cost hospital bills are required to be processed through concerned
Regional Centres vide our letter under reference.
3. Please ensure the following while forwarding such bills to Central Org ECHS :-
(a) Every bill should have a check list as per Appdix A attached which should
be duly completed, checked and attached.
(b) Documents attached with the bills should be flagged as indicated in the
check list (Appx A).
(c) The processing of bills should be carried out in the format enclosed as
Appx B (4 pages) duly signed by all concerned.
(d) All bills/documents should be placed in a folder neatly marked on top as
per Appx C.
4. The above instructions be implemented with imdt effect.
Authority : B/49773/AG/ECHS/ 06 Sep 07
Sd/xxxxxx
Dir (Med)
For Managing Director

Appx ‘A’
(Refer to Para 3 (a) of Central
Org ECHS letter No
B/49778/AG/ECHS/Policy
Dt 06 Sep 2007)
CHECK LIST OF MEDICAL DOCUMENTS : BILL ABOVE 4 LAKHS CASES
Name of Hospital ______________________ Date of Empanelement __________
Name of ECHS Member ______________________________________________
Ser Description Availability Flag
No
Yes/No/NA
1. Proof of membership(Photocopy of Smart
Card/ Regn receipt
A
2 Referral Form B
3 Discharge/Case Summary C
4 Bills on Original D
5 Cover Note E
6 Work sheet and Recommendation of Regionl
Centre
F
7 Emergency Certificate (If applicable) G
8 “Emergency Treatment in Empanelled
Hospital” superscribed in RED on all bills (If
applicable)
H
9 Sanction letter of Medical Advance drawn (if
applicable)
J
10 Prior Approval (Appx ‘A’) K
11 Justification if Prior Approval not obtained (if
applicable)
L

CHECK LIST (Dealing Clk)
Appx ‘B’(Page 1 of 4)
(Refer to Para 3 (c) of Central
Org ECHS letter No
B/49778/AG/ECHS/Policy
Dt 06 Sep 2007)
Name of Regional Centre _________________________
CLAIM DOCUMENTS ON RECEIPT
Name of Hospital ______________________ Date of Empanelement __________
Name of Patient ___________________ Name of Member __________________
ECHS No_________________ dt ____________________
Date claim received at Regional Centre __________________________________
Ser
No
Required Information/Doc
1. Date of membership
2 Proof of membership (Photocopy of Smart
card/Receipt
3 Referral form
4 Emergency Certificate (If applicable)
5 Original bills and Photocopy authenticated by
OIC Polyclinic
6 Emergency bills super scribed in Red
7 Prior Approval
8 Breakdown of charges by Hospital/OIC
Polyclinic
9 Receipt/Proof of payment of Hospital
10 Endorsement by OIC Polyclinic regarding
Beds/Speciality/Facility NA in Service Hospital
11 Discharge/Case Summary/Patient record by
treating Hospital
12 Cover Note has endorsement of :-
(a) OIC Polyclinic
(b) SEMO
(c) Stn Cdr
Remarks :
Date : Initial of Dealing Clk
Verified by Jt Dir (Accts & Assets)
Date : (Signature)
Remarks
Available Not
Available

Appx ‘A’ (Page 2 of 4)
Refer to Para 3(c) of Central
Org, ECHS letter No
B/49778/AG/ECHS/Policy
dt 06 Sep 07)
2
REVISED WORK SHEET AND ASSESMENT
Amount Entitled (Details Listed below) :-
ECHS Name of Tests/Procedures Amount
Ref No
Claimed
PACKAGE DEAL
Major Procedure : Name of Procedure
Amount
Entitled
Remarks
Minor Procedure : Name of Procedure 50% of
authorized
rate
HOSPITAL CHARGES (Where Package deal rates are not specified)
Accommodation – Type of Ward –
Private/Semi
Private/General/ICU/CCU/Day Care
Dietary charges
Procedure/Treatment/Surgery/Physiotherapy
or Dental Procedure
Pathology
Radiology
Specialised Investigations
Medicines
Chemotherapy Administration Charges
(Oncology)
Radiotherapy Charges (Oncology)
Consultation Charges OPD/Indoor
Ordinary Nursing
Special Nursing
Ambulance Charges
Other Charges
Total
Remarks/Comments
Recommendation
(a) Recommended sanction for an amount of Rs__________________________
(b) Not Recommended
Date : (Signature of Med Offr)
= Rate for
type of ward
x Duration of
stay
Auth/Not
auth
= Rate for
type of ward
x Duration
= Rate for
type of ward
x Duration
Not auth

1. Reference
2. ECHS Member ID
(a) Name of Member
(b) Name of Patient
(c) ECHS No
(d) Diagnosis :
Appx ‘A’ (Page 3 of 4)
Refer to Para 3(c) of Central
Org, ECHS letter No
B/49778/AG/ECHS/Policy
dt 06 Sep 07)
3
WORK SHEET AND ASEMENT
4. Hospital/Diagnostic Centre :
(For Emergency Treatment/Urgent Investigation
5. (a) Date of Admission _____________ (b) date of Discharge ________
6. Type of Claim (a) Empanelled Bill (b) Reimbursement Emergency/Urgernt
7. Clinical Notes
8. Bill Details
(a) Amt billed :
(b) Amt Admissible :
(c) Amt Disallowed :
9. Reasons for Disallowance
10. Recommendations :-
Rs ___________ may be approved/sanction.
Date : (Signature of Med Offr)

REMARKS OF DIR REGIONAL CENTRE
1. Membership Established : Yes/No
2. Date of Hospital admission after membership : Yes/No
3. Facilities NA at Service Hospital : Yes/No
4. Referral Verified : Yes/No
5. Prior Approval obtained/Condoned/NA : Yes/No
6. Remarks/Recommendations :
Station :
Appx ‘A’ (Page 4 of 4)
Refer to Para 3(c) of Central
Org, ECHS letter No
B/49778/AG/ECHS/Policy
dt 06 Sep 07)
Date : 9Signature of Director)

CASE STUDY : ESTABLISHMENT OF EMERGENCY –PSYCHIATRIC CASES
1. A case has come to light where a patient with suicidal tendencies was admitted
to a no n empanelled hospital by his family members and t he polyclinic was also
informed as per protocol. However, the claim was not admitted by the polyclinic on the
grounds that it was not a listed emergency.
2. It is clarified that an acute manifestation of a psychiatric disorder where is a treat
to life of the patient and/or to persons in contract with him/her is to be a i nterpreted as
an emergency and processed accordingly.
3. EIR (Emergency Information Report)/Emergency referral will be issued in such
cases with clear notes endorsed bringing out circumstances of the case.
4. Re-imbursement of expenses incurred by the ECHS beneficiary on this account
will be re-imbursed at admissible rates for emergency in a non-empanelled hospital.
Authority : B/49778/AG/ECHS/Policy 13 Nov 07
Sd/xxxxxxxx
Dir (Med)
For Managing Director

REIMBURSEMENT OF VAT ON DRUG AND CONSUMABLES
1. A representation has been r eceived from an e mpanelled hospital against
deduction of VAT charged on drugs and consumables. The following are clarified
(a) VAT charges are not admissible on package rates specified for various
procedure/diagnostic tests or on c harges for consultation, accommodation
nursing and other hospital/OPD procedures.
(b) Cost of drugs and consumables are payable as per ACTUALS subject to
the ceiling limit of MRP. Since MRP includes VAT, the same is admissible except
for certain consumable, rates in respect of which are specified separately.
2. The above may please be disseminated to all concerned.
Authority :B/497783AG/ECHS/Re-imb 10 Dec 07
Sd/xxxxxx
Offg Dir (Med)
For Managing Director

1. Ref :-
PROCESSING OF BILLS FROM EMPANELLED MEDICAL
FACILITY/INDIVIDUAL CLAIMS
(a) Govt of India, Min of Def letter No 24(8)/03/US(WE)/D(Res) dated
19 Dec 2003.
(b) Central Org ECHS letter No B/49773/AG/ECHS dated 25 May 2004.
(c) Central Org ECHS letter No B/49773/AG/ECHS dated 05 Feb 2005.
(d) Central Org ECHS letter NO B/49778/AG/ECHS/Policy dated 01 Sep 07.
2. Detailed instr have been passed vide our letter as ref in para 1 above regarding
correct processing of indl/empanelled hospital reimbursement bills. In cases of bills
where the recommended/admitted amount is less than the amount claimed the reasons
for such deductions are clear from the remarks column of the worksheet (which is
attached to the Cover note). However cases have come to notice in the receipt past
wherein reimbursement bills submitted by individuals and empanelled hospitals have
been forwarded “NOT RECOMMENDED” by intermediary authorities without assigning
any reasons for the same. Similarly requests for condition of delay in intimating
emergency by ECHS beneficiaries have been disallowed without elucidation of reasons.
This is contrary to the sprit of instr passed vide para 6 of letter referred in para 1 (c)
above.
3. Therefore in future all recommending/approving authorities will endorse detailed
reasons for Not Recommending/Rejecting claims (on a s eparate sheet, if necessary).
The final auth to reject a c laim is only CFA in all hospital reimbursement bills and
Central Org ECHS for indl reimbursement bills. This will ensure transparency as well as
avoid unnecessary correspondence at a later stage should the claimant wish to
represent.
Authority :B/497783AG/ECHS/Policy 09 Jan 2008
Sd/xxxxxxxx
Offg Dir (Med)
For Managing Director

PROCEDURE FOR PAYMENT AND REIMBURSEMENT OF
MEDICAL EXPENSES UNDER ECHS
1. Govt of India, Min of Def letter No 24(8)/03/US(WE)/D(Res) dated 19 Dec 2003
and this HQ letter No B/49778/AG/ECHS/Policy dated 16 May 2007.
2. Presently, all individual medical bills are being processed through this HQ. It has
been decided that the time taken for processing of these bills needs to be reduced
without compromising on the efficiency of scrutiny.
3. Over five years of experience, the following problems have been noticed in the
above procedure :-
(a) The procedure is time consuming.
(b) Virtually no value additional after SEMO/Stn HQ level.
(c) Avoidable paper work and addl effort.
(d) Results in dissatisfaction amongst the veterans.
4. 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 l oss to the State.
Therefore, the individual medical claims will also be pr ocessed and s anctioned like
claims for reimbursement to empanelled hospitals, by the appropriate CFA.
5. Diagrammatic representation of the revised system is att as per Appx ‘A’. For
bills below Rs 2 Lakh, Regional Centre have been kept out of this loop to save time.
6. This procedure will be implemented with immediate effect. Bill already dispatched
to Regional Centre/Central Org ECHS will be processed as done hithertofore.
7. Sanction by the CFA on behalf of Central Org, ECHS will be granted. A sample
of the sanction is attached as Appx ‘B’.
8. Necessary amendments to Govt letter will be carried out after the overall review
of ECHS.
9. In case any claim preferred by an ECHS member is not recommended, it will not
be rejected from any intermediate functionary due to any reason, whatsoever. Claim
will be fwd to Central Organisation, ECHS for review alongwith detailed reasons for
rejection. (Auth B/49773/AG/ECHS/Policy dt 01 Dec 2008)
r
Authority : B/497783AG/ECHS/Policy 19 Jan 2008
Sd/xxxxx
Offg Dir (Med)
For Managing Director

Payment
Appx ‘A’
(Refer para 5 of Central Org ECHS letter
No B/49778/AG/ECHS/Policy dt 19 Aug 08)
REVISED CHANNEL OF PROCESSING OF
INDIVIDUAL REIMBURSEMENT BILLS
SUBMISSION OF BILLS BY INDIVIDUAL
POLYCLINIC
SEMO
STN HQ*
CFA
Sanction
*
1. Claims above 2 lakhs will be sent to Regional centre (except RC, Chandimandir
and Regional Centre Delhi) as hithertofore.
2. Claims above 4 lakhs will be fwd to central Org ECHS for further processing.

Appx ‘B’
(Ref para 7 of Central Org ECHS letter
No B/49778/AG/ECHS/Policy dt 19 Aug 08)
SANCTION OF CFA FOR
EMERGENCY TREATMENT IN NON-EMPANELLED HOSPITAL
DEBITABLE TO MAJOR HEAD 2076, MINOR HEAD 107
SUB HEAD-F, CODE HEAD 365/00
1. Under the provisions of Government of India, Ministry of Defence letter No
24(8)/03/US(WE)/D(Res) dated 19 December 2003, on “ Procedure for Payment and
Reimbursement of Medical Expenses” under ECHS, read in conjunction with Serial 1 of
Appendix to Govt of India, Ministry of Defence letter No 24 (3)/US (WE)/D(Res) (i) dated
08 September 2003 and Central Org ECHS letter No B/49778/AG/ECHS/Policy dt 09
Aug 2008, sanction of CFA is hereby accorded for payment to __________________
(Retd) as per the following details :-
(a) ECHS Card No/Regn No :
(b) Name of Patient :
(c) Name of the Hospital :
(d) Period of Hospitalisation :
(e) Diagnosis :
(f) Amount sanctioned : Rs _________
(Rupees _______________________________________________ only)
File Ref : (Signature of CFA)
Date :

PROCESSING OF MINOR HOSPITAL BILL AND INDIVIDUAL CLAIMS
1. References :-
(a) Govt of India letter No 24 (8)/03/US(WE)/D(Res) dated 19 Dec 2003.
(b) Central Organisation letter No B/49773/AG/ECHS dated 25 May 2004.
2. ECHS members are referred to different empanelled hospitals/diagnostic
centres/dental clinics for various treatment/procedures. They can avail treatment in any
hospital including non empanelled medical facility when faced with emergency involving
threat to life or limb. In case of undertaking treatment in a non empanelled hospital, the
bills are cleared by the member and subsequently reimbursement is claimed. The bills
from empanelled hospital and individual claims are paid out of cash assignment of Stn
HQ after processing and working out the entitled amount.
3. On many occasions ECHS members and t heir dependents are referred to
Empanelled hospital/diagnostic centres as outpatients for consultations and
investigations. Many a times the cost of consultations/investigations or routine medical
procedures is quite low. There is no value additional in scrutiny by the SEMO as
package rates are applicable. Processing of such minor Medical bills when submitted by
hospitals/diagnostic centres or claimed by ECHS member is time consuming and
causes avoidable inconvenience and paper work. The problem is getting more acute in
high pressure stations.
4. In view of the above, it has been decided to lay down guidelines and procedures
to be followed while processing low cost emergency claims and hospital bills including
allowances (up to Rs 5000/-) to be reimbursed from the Cash Assignment of Stn HQs
without involving the SEMO at high pressure Stns as per Appx att. This will avoid delay
in bill processing and inconvenience to the ECHS members.
PROCEDURE FOR PROCESSING MINOR REIMBURSEMENT BILLS
5. Bills/claims of following type will be considered to be of minor nature :-
(a) OPD Consultation including re-visit and subsequent visit(s).
(b) Orthopedic and plaster work.
(c) Physiotherapy.
(d) Dental procedures.
(e) All X-Ray procedures including CT & MRI.
(f) Ultrasound Investigation.
(g) Clinical Pathology, Hemathology, Biochemistry, Histopathology,
Bacteriology and Serology.
(h) Dialysis.
(i) Travelling allowances.
6. The ECHS empanelled facilities/member will be required to submit the bill duly
signed and authenticated by Hosp authorities to the OIC Polyclinic. Following
documents will be attached in duplicate alongwith the bill/claim :-
(a) Referral slip from Polyclinic and Photocopy of ECHS Card.
2
(b) Copy of prescription slip and/or investigation report.
(c) In TA Claims Only – Case summary prepared by Medical Specialist/MO
of Polyclinic in case patient reqd referral to outstation medical facility, for which
TA has been claimed.
(d) Receipt for payment.

7. The bills will be examined by the medical specialist/medical officer in Polyclinic
and OIC Polyclinic will do authentication and verification of rates charged/claimed which
will be c ompared with approved CGHS/AIMMS rates and t he entitled amount worked
out.
8. Medical specialist of ECHS Polyclinic will be considered as SEMO for processing
such minor bills. His recommendations as SEMO will be endorsed on the bill/claim. In
case, there is no m edical specialist in the Polyclinic, the medical specialist of local
Service hospital will endorse his recommendation after processing by MO of Polyclinic.
9. Thereafter, the bill will be fwd to Station Headquarter for the approval of Station
Commander and payment.
10. In case of any ambiguity in validating treatment modality offered, procedure
undertaken or pathology investigations the bills/claim will be referred to the SEMO (CO,
Military Hospital) by Stn Cdr for authentication, before making payment from cash
assignment.
11. In respect of minor bills upto Rs 5000/- OIC, ECHS may sign the bills on behalf of
Station Commander. It is further clarified that the stn cdr will remain the sanctioning
authority and after he has sanctioned the bills on note on file, the communication
regarding sanction may be signed by the OIC ECHS. (Amendement be made in Para 11
of vide out letter No B/49778/AG/ECHS/Policy dated 21 Oct 2010).
Authority :B/497783AG/ECHS/Policy 04 Mar 2009
Sd/xxxxxx
Offg Dir (Med)
For Managing Director

RECONCILIATION OF HOSPITAL BILLS CODE HEAD : 365/00
1. Further to this Organisation letter of even reference dated 06 Mar 09 (Para 07).
2. Policy for Reconciliation of Hospital bills was to be implemented with effect from 31 Mar
09. By now the teething problems of monthly reconciliation would have been resolved and the
reconciliation process would be firmly in place.
3. MoD has been insisting on various data regarding medical bills, hospital wise, polyclinic
wise and Stn HQ wise. This HQ does not have the requisite data. The same can be obtained from
the Reconciliation Statements being generated by the polyclinics functioning under the Stn HQ.
Thus a ‘Reconciliation Return’ is being instituted at this stage. ‘Reconciliation return’ is to be sent
to this HQ once in three months (quarterly). The return will have all data month wise pertaining to
the previous three months. The return should be submitted as per the format attached at Appx ‘A’.
The return is to be forwarded by respective Stn HQ to concerned Regional Centres and HQ
Commands. The hard copy of the return should be accompanied by a soft copy on a CD.
4. Regional Centres are to compile all data pertaining to their AOR and forward the same to
this HQ in form of a CD along with a hard copy of Appx ‘B’. Copy of the same should also be
forwarded to respective HQ Command. This CD should contain all data as received from Stn HQ
plus the compiled data as per Appx ‘B’.
5. The first such Return for the month of Jul, Aug and Sep 09 should be compiled and
forwarded so as to reach this HQ and HQ Command by 15 Nov 09. Subsequently this
Reconciliation return should reach on or before 15 Jan, 15 Apr, 15 Jul and 15 Oct for the
respective quarters.
6. All Command HQ are requested to issue instructions to Stn HQ under their AOR for strict
compliance.
Sd/--
Authority : B/49779/AG/ECHS 06 Nov 09
Dy MD
For MD ECHS

UTILISATION OF PROVISIONS OF FIN REGS TOWARDS SPEEDY CLEARANCE
OF MEDICAL BILLS
1. It has been experienced that there have been inordinate delays in payment of individual /
hospital bills at various levels of sanction leading to non-achievement of the stipulated targets and
dis-satisfaction amongst empanelled facilities / individuals.
2. Registration of Claims at Polyclinics. The Polyclinic is the nodal agency to reconcile
the outstanding bills in respect of hospital as each of the hospital bills received at the Polyclinics
has to be first registered in a register maintained hospital wise for the purpose. On receipt of copy
of the covering letter of payment made by the Cash Assignment Officer, the register is to be
updated for payment made and the net outstanding liability towards payment to a hospital needs to
be worked out on a monthly basis. This reconciliation will enable the Polyclinic to know the amount
outstanding for payment (net liability) to a particular hospital at any given time.
3. Huge Workload of Sanctioning each Claim by the CFA. It has been observed that
the CFAs (Stn Cdr / Sub Area / Cdr / GOC Area / GOC-in-C) are getting hugely loaded towards
signing of each and every bill / claim. The provisions of FR Part-I Rule 65 permit a CFA to
authorize a staff Officer to sign communication of sanction and also to countersign on his behalf.
The signature of the Officer so authorized by the CFA needs to be communicated to the concerned
PCDA / CDA. Thus, it would be desirable that an Officer may be designated by the CFA,
preferably the OIC ECHS, to convey his sanction and to countersign claims / bills on his behalf. A
specimen of letter of authority is placed as Appendix A.
4. Procedure for Sanction. A note on file is required to be raised by the OIC ECHS in the
specimen format placed as Appendix B. On approval by the CFA, the Officer designated to sign
communication on behalf of the CFA can issue sanction as per specimen format placed at
Appendix C. An ink signed copy of the sanction by the designated Officer should be forwarded
under a covering letter along with the vouchers / accounting documents to the PCDA / CDA at
close of the month and photocopy of the sanction should be enclosed with each bill / claim.

5. At the appropriate place on the covering Note of the bill / claim, the designated Officer
should countersign on behalf of CFA. Thus, the CFAs are required to approve the payment on the
file only and the designated Officers are required to issue sanction and countersign claim on the
CFA’s behalf.
6. Forwarding of Bills / Claims to Higher CFAs /Formations. After a bill has been
scrutinized by the Polyclinic and the SEMO and is established that it would require sanction of the
higher CFA / formation, the claim can be recommended for approval by the OIC ECHS on behalf of
the lower CFA (Stn Cdr). It may not be essential that the Stn Cdr himself recommends approval of
the claim / bill by the higher CFA / formation.
7. The above procedure will enable speedy processing of the medical bills / claims and will not
overburden the CFAs towards signing routine communications. Considering the requirement of
reducing the load and unnecessary repetitive work by the CFAs who have a larger role to play,
provisions have been made in Rule 65, FR Part-I which needs to be extensively utilized. Part-I,
Para 17 of the ECHS policy letter issued vide GOI MoD letter No. 24(3)/03/US(WE)/D(Res)
(ii) dated 09 Sep 03 is also referred in this regard.
8. This may be circulated to all concerned under your AOR for immediate implementation.
Authority : B/49779/AG/ECHS 09 Sep 2009
Sd/---
Dy MD
For MD ECHS

Tele :
SPECIMEN COPY
Appendix A
(Refer Para 3 of
B/49779/AG/ECHS
dated 09 Sep 2009]
File Reference Date
PCDA (WC)
Chandigarh
Station HQ
Delhi Area
New Delhi- 10
AUTHORISATION TO COUNTERSIGN CLAIMS AND SIGN COMMUNICATION
AND DOCUMENTS OF A FINANCIAL CHARACTER
1. Under the provisions of Rule 65, Financial Regulations Part-I, Vol-I and
financial powers delegated vide GOI MoD letter No. 24(3)/03 /US(WE)/D(Res) (i) dated 08
Sep 2003, I hereby authorize ………………………………………….. (Name & Appointment) with
effect from…………….. (date) to countersign claims and sign communications and documents of a
financial character on my behalf after financial sanction has been accorded by me.
2. The specimen signatures of the Officer are appended below:-
----------------------- ----------------------- -----------------------
(ABC)
Brig
Stn Cdr

SPECIMEN COPY
(Note to CFA)
Appendix B
(Refer Para 4 of
B/49779/AG/ECHS
dated 09 Sep 2009]
File Reference…………………. Sheet No…………
SANCTION OF THE COMPETENT FINANCIAL AUTHORITY
FOR INDIVIDUAL / HOSPITAL CLAIM DEBITABLE TO
MAJOR HEAD 2076 MINOR HEAD 107 SUB HEAD E, CODE HEAD 365/00
1
1. Enclosed with this file, please find the following individual / hospital claims as per the
details given below for your sanction under the powers vested vide GOI MoD letter No.
24(3)/03/US(WE)/D(Res) (i) dated 08 Sep 2003.
Sl
No. ECHS
Card No.
1.
2.
3.
4.
40.
KC00057
KC01152
Name of
the ESM /
Member
Sub K
Singh
Nk D
Kumar
Name of
Patient with
Relation
Mamta Devi
(Mother)
Name &
Place of
the
Hospital
Appollo
Hospital,
Delhi
Self Fortis
Hospital,
Mohalli
Period of
Hospitalisation
From To
01/01/
09
15/06/
09
15/01
/09
21/06
/09
Diagnosis Amount
Recomme
nded
liver
disease
RTA
injury
(In Rs)
9,514/-
10,154/-
2. The claim has been vetted by the concerned authorities as per the procedure stipulated
vide GOI MoD letter No. 24(8)/03/US(WE)/D(Res) dated 19 Dec 2003 and found to be in order.
3. Put up for your approval please.
VCOAS
MD ECHS
Nov 2009

Sl
No.
SPECIMEN COPY
SANCTION OF THE COMPETENT FINANCIAL AUTHORITY
FOR INDIVIDUAL / HOSPITAL CLAIM DEBITABLE TO
MAJOR HEAD 2076 MINOR HEAD 107 SUB HEAD E, CODE HEAD 365/00
Appendix C
(Refer Para 4 of
B/49779/AG/ECHS
dated 09 Sep 2009]
Under the provisions of Rule 65, FR Part-I, the undersigned has been directed to convey the sanction accorded by
…………………………………………. (CFA) vide File Reference ……………………………………… dated………………., in exercise of
powers delegated vide GOI MoD letter No. 24(3)/03/US(WE)/D(Res) (i) dated 08 Sep 2003 in respect of the following claims:-
ECHS Card
No.
Name of the ESM /
Member
Name of Patient
with Relation
Name & Place of
the Hospital
1. KC00057 Sub K Singh Mamta Devi Apollo Hospital,
(Mother) Delhi
2. KC01152 Nk D Kumar Self Fortis Hospital,
Mohalli
40.
File Reference:
Period of Hospitalization Diagnosis Amount
From To
Sanctioned
(In Rs)
01/01/09 15/01/09 Decompensate liver disease with
complication
9,514/-
15/06/09 21/06/09 RTA Chest injury 10,154/-
Station / Sub Area / Area/ Command (XYZ)
Rank
Appointment of Officer Designated
Date:

EMPANELMENT OF GOVT HOSPITALS
1. Issues regarding treatment of ECHS beneficiaries of Institutions of National
Repute/Govt Hospitals and empanelment of these facilities are clarified as under :-
(a) Institutions of National Repute as listed in Para 5(c) of Govt of India, Min of
Defence letter No 24(8)/03/US(WE)/D(Res) dt 19 Dec 2003 (Para 5(c) as well as
Govt Hospitals stand automatically recognized for treatment of ECHS beneficiaries,
and signing of MOA is not mandatory.
(b) Patient on referral from ECHS Polyclinics can be treated at these Hospitals
on payment, which is re-imbursable by ECHS as per approved rates.
(c) ECHS beneficiaries also have the option of asking for advance for treatment
at these hospitals. Upto 80% of estimate (to be obtained from treating hospital) may
be sanctioned as advance. F inal bills in these cases are to be submitted for
settlement by the ECHS member, within one month of discharge from hospital.
(d) These hospitals may not, by and large, submit applications forms for
empanelment. However, wherever they are willing to apply formally/sign MOA, we
should go ahead and empanel them, as it will enable post-payment of bills by ECHS
and thus be beneficial to the scheme.
2. Regional Centre ECHS, Pune. This disposes your letter No
1027/Empanel/ECHS/192 dated 09 Aug 2004.
Authority : B/49771/AG/ECHS 23 Aug 2004
Sd/-x-x-x-
Dir (Med)

MEMORANDA OF AGREEMENT
EMPANELMENT OF HOSPITALS/NURSING HOMES, DENTAL CENTRES AND
DIAGNOSTIC CENTRES
1. The modifications as listed in subsequent paragraphs will be made to the MOA for
empanelment of Hospitals/Nursing Homes, Dental Centres and Diagnostic Centres under
ECHS.
2. Para 1
For – “------------------------ (name of Hospital/Nursing home) is recognized under
ECHS for treatment of the ECHS members and their dependent beneficiaries subject
to the conditions hereinafter mentioned.”
Read – “------------------------ (name of Hospital/Nursing home) is recognized under
ECHS for treatment of the ECHS members and their dependent
beneficiaries for Services attached at Annexure I subject to the conditions
hereinafter mentioned.”
3. Para 3
For – “The services would be extended on billing system to referred cases for agreed
upon period. Charges would be charged as per approved list provided by the
Hospital and approved by ECHS”.
Read – “The services would be extended on billing system to be referred cases for
agreed upon period. Charges would be levied as per rates negotiated with the
Hospital and approved by ECHS (Annexure II attached). Under no circumstances
will CGHS rates be exceeded. Where CGHS rates are not available AIIMS rates
will be applicable.”
4. Para 9 of MOA (Hospitals/Nursing Homes) and Para 8 of MOA (Diagnostic
Centres/Pathological Laboratory/Dental Clinic/Dental Laboratory)
For – “The schedule of approved charges are at Annexure I, attached hereto.”
Read – “The schedule of approved charges are at Annexure II, attached hereto.”
5. Para 14
For – “During in-patient treatment of the ECHS beneficiaries, the Hospital shall not
ask the members to purchase separately the medicines from outside but bear the
cost on its own, as the package deal rate fixed for the ECHS at Annexure-I includes
the cost of drugs, surgical instruments and other medicines etc.
Read – “During in-patient treatment of the ECHS beneficiaries, the hospital shall not
ask the members to purchase separately the medicines from outside but bear the
cost on its own, as the package deal rate fixed for the ECHS at Annexure II includes
the cost of drugs, surgical instruments and other medicines etc.”
6. A copy of the Memorandum of Agreement for Hospitals/Nursing Homes (Appendix
‘A’) and Dental Centres/Laboratories and Diagnostic Centres (Appendix ‘B’) is enclosed.
Sd/-x-x-x-x-x
Jt Dir (Med)
for MD ECHS
Authority : B/49771/AG/ECHS/Empanelment 11 Mar 2005

MEMORANDUM OF AGREEMENT
(Format for Hospital/Nursing Home)
Appendix ‘A’
An agreement made and entered into this ______________ day of ___________
(month and year) between the President of India, acting through Station Commander
_____________________ (Place), for Ex-Servicemen Contributory Health Scheme
(hereinafter called ‘ECHS’ which expression, unless excluded by or repugnant to the subject
or context, shall include its successors-in-office and assigns) of the One Part and Shri/Smt/
Ku __________________, S/o, D/o, W/o _________________________ owner or the
authorized signatory of the ____________________ Hospital/Nursing Home (hereinafter
called Hospital which expression unless excluded by or repugnant to the subject or context,
shall mean to include its legal representatives, successors and permitted assigns) of the
Other Part.
---------------------------------------------------------------------------------------------------------------------------
WHEREAS _________________________ (name of corporate body/firm/trust/owner
of Hospital/Nursing Home), had applied for recognition under ECHS for treatment of the
members of ECHS and their dependant beneficiaries, and ECHS proposes to extend
recognition to __________________ (name of Hospital/Nursing Home) for treatment of
ECHS members and their dependant beneficiaries.

2
Appendix ‘A’ (Contd)
NOW, THEREFORE, THE PARTIES HERETO HEREBY AGREE AS FOLLOWS :-
1. ________________________ (Name of Hospital/Nursing Home) is recognized under
ECHS for treatment of the ECHS members and their dependent beneficiaries for services
attached at Annexure I subject to the conditions hereinafter mentioned.
2. The Hospital shall provide the agreed upon services to referred cases only. These
cases would be referred by doctors from ECHS Polyclinics. The referred cases would be
issued referral slip duly signed by doctors under his seal and signature bearing name also.
3. The services would be extended on billing system to referred cases for agreed upon
period. The services would be extended on billing system to referred cases for agreed upon
period. Charges would be levied as per rates negotiated with the Hospital and approved by
ECHS (Annexure II attached). Under no circumstances will CGHS rates be exceeded.
Where CGHS rates are not available AIIMS rates will be applicable.
4. The Hospital is not at liberty to revise the rate suo moto.
5. The bills would be scrutinized by the ECHS authorities and would contain the
following :-
(a) Bills to be submitted on hospital performa.
(b) Medical advance drawn, if any.
(c) Referral slip from Polyclinic & photocopy of ECHS card.
(d) Summary of the case, including outcome.
(e) Consultation charges/Diagnostic/Package charges as applicable.
(f) Other charges if any, not included above (to be specified).
6. In grave emergency, patient shall be admitted and life saving treatment be given on
production of ECHS card by the members, even in the absence of referral slip. The referral
slip be allowed to be submitted within 48 hours from admission in such cases.
7. The Hospital would not refer the ECHS cases further to other institute, and if it does
so, it will be at their own arrangements, and ECHS would not be responsible to the other

3
Appendix ‘A’ (Contd)
institute for any liability. Payment in such cases would also be restricted to approved rates
only.
8. The Hospital would not refuse admission to referred case on flimsy ground.
9. The schedule of approved charges are at Annexure II, attached hereto.
10. The conditions of emergency are as under :-
(a) Acute Cardiac Conditions/Syndromes including Myocardial Infarction,
Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supraventricular Tachycardia,
Cardiac Tamponade, Acute Left Ventricular Failure/Severe Congestive Cardiac
Failure, Accelerated Hypertension, Complete dissection.
(b) Vascular Catastrophies including Acute limb ischaemia, Rupture of
aneurisms, medical and surgical shock and peripheral circulatory failure.
(c) Cerebro-Vascular Accidents including Stroke, Neurological Emergencies
including coma, cerebro meningeal infections, convulsions, acute paralysis, acute
visual loss.
(d) Acute Respiratory Emergencies including Respiratory faiulure and
decompensated lung disease.
(e) Acute abdomen including acute obstetrical and gynaecological emergencies.
(f) Life threatening Injuries including Road traffic accidents, Head Injuries,
Multiple Injuries, Crush Injuries and thermal injuries.
(g) Acute poisoning and snake bite.
(h) Acute endocrine emergencies including diabetic Ketoacidosis.
(j) Heat stroke and cold injuries of life threatening nature.
(k) Acute Renal Failure.
(l) Severe infections leading to life threatening sequelae including Septicaemia,
disseminated/military tuberculosis.
11. The Hospital shall provide access to the financial and medical records for
assessment and review by medical and financial auditors of the ECHS, as and when
required and the decision of ECHS on necessity or requirement shall be final.

4
Appendix ‘A’ (Contd)
12. The Hospital shall provide access to the financial and medical records for
assessment and review by medical and financial auditors of the ECHS, as and when
required and the decision of ECHS on necessity or requirement shall be final.
13. Any liability arising out of or due to any default or negligence in provision or
performance of the medical services shall be borne exclusively by the Hospital, who shall
alone be responsible for the defect ion rendering such services.
14. During In-patient treatment of the ECSH beneficiaries, the Hospital shall not ask the
members to purchase separately the medicines from outside but bear the cost on its own, as
the package deal rate fixed for the ECHS at Annexure – II includes the cost of drugs,
surgical instruments and other medicines etc.
15. This Agreement contains the entire agreement between both the parties and nothing
outside this Agreement shall be valid and binding. This Agreement may be modified or
altered only on written agreement signed by both the parties.
16. This Agreement shall remain in force for a period of two years from the date of its
execution, extendable on mutual agreement.
17. The Agreement may be terminated by either party serving on calendar month’s
notice in writing, upon the other party and the notice given by the ECHS shall be valid if
given and signed by the competent authority on behalf of the ECHS.
18. Should the Hospital get would up or partnership is dissolved, the ECHS shall have
the power to terminate or relieve the Hospital or their heirs and legal representatives from
the legal liability in respect of the services provided by the hospital during the period when
the Agreement was in force.
19. The ECHS shall have a lien and also reserves the right to retain and set off against
any sum which may, from time to time be due to and payable to the Hospital hereunder, any
claim which the ECHS may have against the Hospital under this or any other agreement.
20. The ECHS shall be at liberty at any time to terminate this agreement on giving 24
hours notice in writing to the Hospital for breach of any of the terms and conditions of this
Agreement and the decision of ECHS in this regard shall be final.

5
Appendix (Contd)
21. In the event of any bribes, commission, gifts or advantage being given, promised or
offered by or on behalf of the Hospital or any of them for their agent or any one else on their
behalf to any member, the family of any member or representative of the ECHS in relation to
the obtaining or execution of this or any other Agreement with the ECHS, then the ECHS
shall without prejudice to their other rights and remedies be entitled notwithstanding any
criminal liability which the Hospital may incur, cancel and/or terminate this Agreement and/or
any other agreement entered in by the ECHS holding the Hospital liable for any loss or
damage resulting from any such cancellation. Any question or dispute as to the commission
of any offence under this clause shall be decided by the ECHS in such manner and in such
evidence of information as it shall think fit and sufficient and its decision shall be final,
conclusive and binding upon the Hospital.
22. Subject as otherwise, provided in this contract, all notice may be given or taken by
the ECHS or by any officer for the time being entrusted with the functions of ECHS.
23. The administrative cost of the Hospital and all other expenses required by the
Hospital for the purpose of this Agreement shall be borne by the Hospital.
24. Any dispute or difference whatsoever arising between the parties to this agreement
out of our relating to the construction, meaning, scope, operation or effect of this agreement
or the validity of the breach thereof shall be referred to an arbitrator to be appointed by
mutual consent of both parties herein. If the parties cannot agree on the appointment of the
Arbitrator shall be nominated by the Secretary, Department of Legal affairs, Ministry of Law
and Justice. The provisions of the arbitration and conciliation Act, 1996 will be applicable
and the award made there under shall be final and binding upon the parties hereto, subject
to legal remedies available under the law. Such differences shall be deemed to be a
submission to arbitration under the Indian Arbitration and Conciliations Act, 1996, or of any
modifications, Rules or reenactments thereof. The Arbitration proceedings will be held at
New Delhi.
25. The Hospital shall pay all expenses incidental to the preparation and stamping of this
agreement.

6
Appendix (Contd)
26. All notice and reference hereunder shall be deemed to have been duly served and
given to the Hospital if delivered to the Hospital or their authorized agent or sent by
registered post to the address of the Hospital stated hereinbefore and to the ECHS if
delivered to the Station Commander ________________ or sent by registered post or left at
his office during office hours on any working day.
27. The originals copy of this Agreement shall be kept at the office of Station
Commander _____________ and a true copy shall be retained in the office of the Hospital.
In witness whereof, Station Commander ______________ for and on behalf of the
President of India and the above named Hospital have hereunto set their respective hands
and seal the date and year first above written.
________________________________________
Signature of Station Commander for and on behalf of
the President
________________________________________
Witness to the signature of Station Commander
________________________________________
Signature of Hospital/Nursing Home
________________________________________
Witness to the Hospital/Nursing Home

7
Appendix ‘B’
MEMORANDUM OF AGREEMENT
(Format for Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental
Laboratory)
An agreement made and entered into this ______________ day of ___________
(month and year) between the President of India, acting through Station Commander
_____________________ (Place), for Ex-Servicemen Contributory Health Scheme
(hereinafter called ‘ECHS’ which expression, unless excluded by or repugnant to the subject
or context, shall include its successors-in-office and assigns) of the One Part and Shri/Smt/
Ku __________________, S/o, D/o, W/o _________________________ owner or the
authorized signatory of the ____________________ Diagnostic Centre/Pathological
Laboratories/Dental Clinic/Dental Laboratory (hereinafter called Hospital which expression
unless excluded by or repugnant to the subject or context, shall mean to include its legal
representatives, successors and permitted assigns) of the Other Part.
---------------------------------------------------------------------------------------------------------------------------
WHEREAS _________________________ (name of corporate body/firm/trust/owner
of Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory), had applied
for recognition under ECHS for treatment of the members of ECHS and their dependant
beneficiaries, and ECHS proposes to extend recognition to __________________ (name of
Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory) for treatment of
ECHS members and their dependant beneficiaries.

8
Appendix ‘B’ (Contd)
NOW, THEREFORE, THE PARTIES HERETO HEREBY AGREE AS FOLLOWS :-
1. ________________________ (Name of Diagnostic Centre/Pathological
Laboratories/Dental Clinic/Dental Laboratory) is recognized under ECHS for treatment of the
ECHS members and their dependent beneficiaries for services attached at Annexure I
subject to the conditions hereinafter mentioned.
2. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
shall provide the agreed upon services to referred cases only. T hese cases would be
referred by doctors from ECHS Polyclinics. The referred cases would be issued referral slip
duly signed by doctors under his seal and signature bearing name also.
3. The services would be extended on billing system to referred cases for agreed upon
period. Charges would be levied as per rates negotiated with the Diagnostic
Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory and approved by ECHS
(Annexure II attached). Under no circumstances will CGHS rates be exceeded. Where
CGHS rates are not available AIIMS rates will be applicable.
4. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory is
not at liberty to revise the rate suo moto.
5. The bills would be scrutinized by the ECHS authorities and would contain the
following :-
(a) Bills to be submitted on Diagnostic Centre performa.
(b) Referral slip from Polyclinic & photocopy of ECHS card.
(c) Diagnostic/Package Charges as applicable.
(d) Other charges if any, not included above (to be specified).
6. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
would not refer the ECHS cases further to other institute, and if it does so, it will be at their
own arrangements, and ECHS would not be responsible to the other institute for any liability.
Payment in such cases would also be restricted to approved rates only.

9
Appendix ‘B’ (Contd)
7. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
shall not refuse for tests to referred case on flimsy ground.
8. The schedule of approved charges are at Annexure II, attached hereto.
9. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
shall provide access to the financial and medical records for assessment and review by
medical and financial auditors of the ECHS, as and when required and the decision of ECHS
on necessity or requirement shall be final.
10. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
shall raise bills in the prescribed format to the ECHS Polyclinic in respect of the ECHS
members treated within 10 days of the completion of laboratory investigations / diagnostic
tests.
11. In the case, the investigations/tests carried out by the Diagnostic Centre/Pathological
Laboratory are found to be meeting the standards of quality as per norms in medical practice
the Diagnostic Centre/Pathology Laboratory will bear any liability towards cost for
retesting/repair investigations and ECSH will not have any liability, financial or legal for the
same.
12. In the case, the treatment provided by the Dental Clinic/denture work of the Dental
Laboratory is found to be below desired standard of the expected norm the Dental Clinic/
Dental Laboratory will bear any liability towards cost for repeat treatment/repeat manufacture
of denture and ECHS will not have any liability, financial or legal for the same.
13. Any liability arising out of or due to any default or negligence in provision or
performance of the medical services shall be borne exclusively by the Diagnostic
Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory, who shall alone be
responsible for the defect in rendering such services.
14. While carrying out tests / diagnostic procedures/dental treatment/denture work of the
ECHS beneficiaries, the Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental
Laboratory shall not ask the members to purchase separately the medicines from outside but
bear the cost on its own, as the package deal rate fixed for the ECHS at Annexure – II

10
Appendix ‘B’ (Contd)
includes the cost of drugs, dyes, contrast media, surgical instruments and other medicines
etc.
15. This Agreement contains the entire agreement between both the parties and nothing
outside this Agreement shall be valid and binding. This Agreement may be modified or
altered only on written agreement signed by both the parties.
16. This Agreement shall remain in force for a period of two years from the date of its
execution, extendable on mutual agreement.
17. The Agreement may be terminated by either party serving on calendar month’s
notice in writing, upon the other party and the notice given by the ECHS shall be valid if
given and signed by the competent authority on behalf of the ECHS.
18. Should the Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental
Laboratory get wound up or partnership is dissolved, the ECHS shall have the power to
terminate or relieve the Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental
Laboratory or their heirs and legal representatives from the legal liability in respect of the
services provided by the Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental
Laboratory during the period when the Agreement was in force.
19. The ECHS shall have a lien and also reserves the right to retain and set off against
any sum which may, from time to time be due to and payable to the Diagnostic
Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory hereunder, any claim
which the ECHS may have against the Diagnostic Centre/Pathological Laboratories/Dental
Clinic/Dental Laboratory under this or any other agreement.
20. The ECHS shall be at liberty at any time to terminate this agreement on giving 24
hours notice in writing to the Diagnostic Centre/Pathological Laboratories/Dental
Clinic/Dental Laboratory for breach of any of the terms and conditions of this Agreement and
the decision of ECHS in this regard shall be final.
21. In the event of any bribes, commission, gifts or advantage being given, promised or
offered by or on be half of the Diagnostic Centre/Pathological Laboratories/Dental
Clinic/Dental Laboratory or any of them for their agent or any one else on their behalf to any

11
Appendix ‘B’ (Contd)
member, the family of any member or representative of the ECHS in relation to the obtaining
or execution of this or any other Agreement with the ECHS, then the ECHS shall without
prejudice to their other rights and remedies be entitled notwithstanding any criminal liability
which the Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory may
incur, cancel and/or terminate this Agreement and/or any other agreement entered into by
the ECHS holding the Diagnostic Centre liable for any loss or damage resulting from any
such cancellation. Any question or dispute as to the commission of any offence under this
clause shall be decided by the ECHS in such manner and in such evidence of information as
it shall think fit and sufficient and its decision shall be final, conclusive and binding upon the
Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory.
22. Subject as otherwise, provided in this contract, all notice may be given or taken by
the ECHS or by any officer for the time being entrusted with the functions of ECHS.
23. The administrative cost of the Diagnostic Centre/Pathological Laboratories/Dental
Clinic/Dental Laboratory and all other expenses required by the Diagnostic
Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory for the purpose of this
Agreement shall be borne by the Diagnostic Centre/Pathological Laboratories/Dental
Clinic/Dental Laboratory.
24. Any dispute or difference whatsoever arising between the parties to this agreement
out of our relating to the construction, meaning, scope, operation or effect of this agreement
or the validity of the breach thereof shall be referred to an arbitrator to be appointed by
mutual consent of both parties herein. If the parties cannot agree on the appointment of the
Arbitrator within a period of one month from the notification by one party to other of existence
of such dispute, then the Arbitrator shall be nominated by the Secretary, Department of
Legal affairs, Ministry of Law and Justice. The provisions of the arbitration and conciliation
Act, 1996 will be applicable and the award made there under shall be final and binding upon
the parties hereto, subject to legal remedies available under the law. Such differences shall
be deemed to be a submission to arbitration under the Indian Arbitration and Conciliations

12
Appendix ‘B’ (Contd)
Act, 1996, or of any modifications, Rules or reenactments thereof. T he Arbitration
proceedings will be held at New Delhi.
25. The Diagnostic Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory
shall pay all expenses incidental to the preparation and stamping of this agreement.
26. All notice and reference hereunder shall be deemed to have been duly served and
given to the Diagnostic Centre if delivered to the Diagnostic Centre/Pathological
Laboratories/Dental Clinic/Dental Laboratory or their authorized agent or left at consent by
registered post to the address stated hereinbefore and to the ECHS if delivered to the
Station Commander ________________ or sent by registered post or left at his office during
office hours on any working day.
27. The originals copy of this Agreement shall be kept at the office of Station
Commander _____________ and a true copy shall be retained in the office of the Diagnostic
Centre/Pathological Laboratories/Dental Clinic/Dental Laboratory.
In witness whereof, Station Commander ______________ or and on behalf of the
President of the Union of India and the above named Diagnostic Centre/Pathological
Laboratories/Dental Clinic/Dental Laboratory have hereinto set their respective hands and
the date and year first above written.
________________________________________
Signature of Station Commander for and on behalf of
the President of the Union of India
________________________________________
Witness to the signature of Station Commander
________________________________________
Signature of Diagnostic Centre/Pathological Laboratories/
Dental Clinic/Dental Laboratory
________________________________________
Witness to the Diagnostic Centre/Pathological Laboratories/
Dental Clinic/Dental Laboratory

EMPANELMENT OF DIALYSIS CENTRES
1. With the introduction of ECHS, the Army Group Insurance Fuund – Medical Benefit
Scheme (AGIF-MBS) is proposed to close down by 31 Mar 2006. Under the AGIF-MBS,
Heamodialysis is one of the approved treatment packages. F or this purpose, several
„Dialysis Centers“ were established to provide quality dialysis at cheaper rates to Ex
Servicemen who were members of AGIF. These ’Dialysis Centers’ exists at the following
hospitals :-
(a) Command Hospital, Pune.
(b) Command Hospital, Kolkata.
(c) Command Hospital, Chandimandir.
(d) Command Hospital, Lucknow.
(e) Base Hospital, Delhi Cantt.
(f) Military Hospital, Jalandhar.
2. To establish the Dialysis Centers, a corpus was created at each of the Hospitals,
which was shared by AG’s Welfare Fund and the AGIF, to cater for expenditure on
establishment of these centers incl purchase of equipment, and for maintenance to make
these Dialysis Centers full functional. A GIF members are required to pay Rs 400/- per
dialysis (which is reimbursed to patient by AGIF). This amount, alongwith interest on corpus
enables these centres to function on a self sustaining basis.
3. A large amount of welfare funds have been spent in creating these state of the art
’Dialysis Centres’. It has been decided to maintain these ’Dialysis Centres’ in perpetuity even
after withdrawal of the AGIF-MBS. To guarantee financial support to meet the expenditure
of pay and allowances of staff, maintenance/replacement cost of dialysis machines/reverse
OSMOSIS plant and such other expenditure the following have been decided :-
(a) Corpus held with Army Dialysis Centres will NOT be withdrawn.
(b) Each ’Dialysis Centre’ will apply for empanelment with ECHS in prescribed
aopplication form.
(c) Every ECHS member referred for dialysis to these Centres will be provided
dialysis free of cost. ECHS will be billed for each dialysis at the rate of Rs 1000/-
per session. Bill will be fwd for payment to ECHS Polyclinic which referred the case.
(d) Additional drugs (viz Erythropoietin) or investigations, if required, will be
carried out through the Service Hospital to which the concerned dialysis centre is
affiliated. Addl expenditure for the same, if required will be paid by the concerned
hospital out of ECHS funds allotted for DGLP.
4. In view of the above, you are requested to initiate empanelment action in respect of
the Army Dialysis Centres listed at Para 1 above at the earliest. Completed application
forms, duly endorsed with recommendations of BOO be fwd through the laid down channel
to reach us by 03 Oct 2005, so that sanction of MOD can be expeditiously obtained.
n (Retd)
Authority :B/49770/AG/ECHS/Dialysis 12 Sep 2005
Sd/-x-x-x-x-x-x
MD ECHS

EMPANELMENT OF HOSPITALS AT OTHER STATIONS-NOT UNDER THE
JURISDICTION OF A STATION CDR
1. Empanelment of civil medical facilities are approved by the empowered Committee.
After the Govt letter is issued the concerned Stn Cdr is required to enter into a
Memorandum of Agreement (MoA) with the hospitals/Dental Centres/Diagnostic Centres
based on the agreed upon rates for all treatment/procedures.
2. It has been noticed that there is heavy rush at few polyclinics where better medical
facilities are available. Floating population of neighbouring Stations also increase this rush.
All outstation patients presently are required to first report to the designated ECHS polyclinic
and referral to civil empanelled facility is then carried out depending upon the requirement
and similar facility not being available in the Service Hospital. T his causes avoidable
inconvenience to the beneficiaries as apart from delay, accommodation for over night stay
also has to be catered by them.
3. In order to overcome the difficulties as mentioned in para 2 above more than one
Stn Cdr of neighboring station can also sign such MOA with the approved civil medical
facility subject to their willingness. This will facilitate direct referral to these empanelled
facilities and will also ease the load of bill processing by only one station.
4. The detailed instructions for referring a patient to civil empanelled facility as
mentioned in Govt letter No 24(9)/03/US(WE)/D(Res) dated 16 Jul 2004 will still comply.
Authority : B/49771/AG/ECHS/Ruling 12 Aug 2008
Sd/-x-x-x
Jt Dir (Med)
For MD ECHS

EMPANELMENT OF HOSPITALS, NURSING HOMES AND
DIAGNOSTIC CENTRES FOR ECHS
1. Further to this Organisation letter No B/49771/AG/ECHS/Ruling dated 12 Aug 2008.
2. The above mentioned letter may please be amended at Para 4.
l
(a) For. Min of Def letter No 24(9)/03/US(WE)/D(Res) dated 16 Jul 04.
(b) Read. Min of Def letter No 24(9)/03/US(WE)/D(Res) dated 16 Jun 04.
Authority : B/49771/AG/ECHS/Ruling 05 Nov 2008
Sd/-x-x-x-x-x
Dir (Med)
for MD ECHS

REFERRAL OF ECHS PATIENTS TO MEDANTA, THE MEDICITI HOSPITAL, GURGAON
1. The Mediciti hospital, Gurgaon has submitted an application for empanelment with
ECHS. The same will be considered in next Empowered Committee meeting.
2. The hospital has offered super speciality Medicare facilities to ECHS members on
reimbursement at ECHS rates in the interim period pending their empanelment with ECHS.
3. After due deliberation, It has been decided that ECHS beneficiaries, who desire to
undergo treatment in the hospital, be referred by PCs of NCR to the hospital subj0ect to
following conditions:-
(a) ECHS members desirous of undertaking elective planned treatment in this
hospital would apply in writing to OI/C, Polyclinic requesting for the same.
(b) The AFV will pay the hospital bills, cashless facility will not be available.
(c) Claim will be pr ocessed in similar manner as reimbursement of bills for
treatment in non empanelled hospital with prior approval of MD, ECHS as per the
provision of Central Organisation letter No. B/49773/AG/ECHS dated 12 May 06.
(d) Sanction of MD ECHS will not be required for treatment in this hospital, Os
I/C PC may refer patients to the hospital on their choice on reimbursement basis as
per ECHS rates.
Authority : B/49771/AG/ECHS/WC 14 Sep 2010
Sd/-x-x-x-x
Jt Dir (Med)
for MD ECHS

EMPANELMENT OF HOSPITALS:
EARNEST MONEY DEPOSIT AND PERFORMANCE BANK GUARANTEE
1. Reference GOI MoD letter No.22B/(04)/2010/US/(WE)/D (Res) GOI of MoD dated
18 Feb 2011. A number of queries on the subject are being received at this HQ.
2. The detailed guidelines on Earnest Money Deposit (EMD), and Performance Bank
Guarantee (PBG) are as formulated.
Earnest Money Deposit.
3. The EMD of Rs.1.00 lac will be obtained by the Regional Centres from the hospitals
/ diagnostic laboratory in the form of Demand Draft in favour of respective Regional Centre.
The EMD is a surety to sign the MOA and will be refunded at the time of signing of MOA
subject to following:-
(a) In case the application is rejected on technical grounds, EMD would be
refunded.
(b) In case the application is rejected after inspection on the grounds of
submitting incorrect information, then 50 % of the EMD would be forfeited and the
balance would be refunded in due course.
(c) In case the applicant hospital / diagnostic centre refuse to sign the MOA,
50 % of the EMD would be forfeited.
Performance Bank Guarantee
4. The format of the PBG to be rendered by the nationalised bank is as enclosed. The
PBG will forfeit and the hospitals / diagnostic laboratory removed from the list of empanelled
institutions in case of the following.
(a) In case of any violation of the provisions of MOA by the hospitals /
diagnostic laboratory such as :-
(i) Refusal of service.
(ii) Undertaking unnecessary procedures.
(iii) Prescribing unnecessary drugs / tests.
(iv) Over billing.
(v) Reduction in staff / infrastructure / equipment etc. after the hospitals /
diagnostic laboratory has been empanelled.
(vi) Non submission of the report, habitual late submission or
submission incorrect data in the report.
(vii) Refusal of credit to eligible beneficiaries and direct charging from
them.
(viii) If recommended by NABH / NABL at any stage.
(ix) Discrimination against ECHS beneficiaries’ vis-à-vis general patients.

(b) The Bank Guarantee shall be forfeited and the ECHS shall have the right
to de-recognize the hospitals / diagnostic laboratory as the case may be. Such
action could be initiated on the basis of a complaint, medical audit or inspections
carried out by ECHS teams at random.
(c) The decision of the Ministry of Defence (ESW) in this regard shall be final.
5. Liquidated Damages.
(a) The hospitals / diagnostic laboratory shall provide the services as per the
requirements specified by the ECHS in terms of the provisions of the MOA. In
case of initial violation of the provisions of the MOA by the Hospital / Diagnostic
Laboratories such as refusal of service or refusal of credit to eligible categories of
ECHS Beneficiaries or defective service and negligence, the amount equivalent to
15% of the amount of Performance Bank Guarantee shall be charged as agreed
Liquidated Damages by the ECHS, however, the total amount of the
Performance Bank Guarantee shall be maintained intact being a revolving
Guarantee.
(b) In case of repeated defaults by the Hospital / Diagnostic Laboratories, the
total amount of Performance Bank Guarantee shall be forfeited and action shall be
taken for removing the hospital / diagnostic laboratory from the empanelment of
ECHS as well as termination of the Agreement.
(c) For over-billing and unnec essary procedures, the extra amount so
charged shall be deducted from the pending / future bills of the Hospital / Diagnostic
Laboratories and the ECHS shall have the right to issue a w ritten warning to the
hospitals / diagnostic laboratory not to do so in future. The recurrence, if any, shall
lead to the stoppage of referral to that hospital / diagnostic laboratory.
(d) Before initiating action under sub clause (a) to (c) above, ECHS shall serve
a show cause notice to the Hospital / Diagnostic Laboratories for which it shall have
to respond within ten days of its receipt.
6. All these clauses may be incorporated in the MOA signed with the hospitals empanelled
under the new procedure as laid down vide a/m GOI letter.
Authority : B/49771/AG/ECHS/POLICY 08 Jul 11
Sd/-x-x-x-x-x
MD ECHS

To:
President of India
Acting through (Regional Centre ECHS)
PERFORMANCE BANK GUARANTEE
WHEREAS ___________________________________________________(Name of
Hospital) has undertaken, Agreement No. ___________________________ dated,
__________________2011 to ________ ___________ _________
________________ (Description of Services) hereinafter called "the Agreement".
AND WHEREAS it has been stipulated by you in the said Agreement that the Hospital
selected for empanelment shall furnish you with a bank Guarantee by a nationalized bank
for the sum specified therein as security for compliance with the Hospital
performance obligations in accordance with the Agreement.
AND WHEREAS we have agreed to give the Hospital a guarantee :-
THEREFORE WE ( Name of the Bank) hereby affirm that we are Guarantors
and responsible to you, on behalf of Hospital (herein after referred to "the Second Party" up to
a total of _________________________________(Amount of the guarantee in Words
and Figures) and we hereby irrevocably, unconditionally and a bsolutely
undertake to immediately pay you, upon your first written demand declaring the Second
Party to be in default under the Agreement and without cavil or argument, any sum or sums
within the limit of ___________________________ as aforesaid, without your needing to
prove or to show this grounds or reasons for your demand or the sum specified therein.
This guarantee is valid until the ___________ day of ______________
This Guarantee shall be incorporated in accordance with the laws of India.
We represent that this Bank Guarantee has been established in such form and such content
that is fully enforceable in accordance with its terms as against the Guarantor Bank in the
manner provided herein.

2
The Guarantee shall not be affected in any manner by reason of merger, amalgamation,
restructuring or any other change in the constitution of the Guarantor Bank or of the
Hospital.
Date Signature and Seal of Guarantors
Address:
_____________________________________
_____________________________________

Tele : 25684945
ASCON: 36833
B/49771/AG/ECHS/Emp 19 Sep 2011
CENTRAL ORGANISATION ECHS
PROCEDURE FOR EMPANELMENT OF HOSPITALS, NURSING HOMES AND
DIAGNOSTIC CENTRES UNDER ECHS
1. Reference MoD letter No 22D(04)/2011/US(WE)/D(Res) dated22 Jul 2011.
2. Above letter of MoD has amended Para 8 of GOI, MoD letter No 24(09)/03/
US(WE)/D(Res) dated 16 Jun 2004. However, this GOI, MoD letter on the subject has been
superseded vide MoD letter No 22B(04)/2010/US(WE)/D(Res) dt 18 Feb 2011.
3. In light of above, you are requested to issue amendment (corrigendum) to GOI, MoD
letter No 22D(04)/2011/US(WE)/D(Res) dated22 Jul 2011.
DS (Res-I)
Authority : B/49771/AG/ECHS/Emp 19 Sep 2011
Sd/-x-x-x-x-x
()
Jt Dir (Med)
for MD ECHS

GENERAL INSTRUCTIONS : EMPANELMENT OF HOSPITALS/NURSING HOMES/EYE
CARE CENTRES/ IMAGING CENTRES/DIAGNOSTIC LABORATORIES/IMAGING
CENTRES DENTAL CLINICS
AND HOSPICES
1. Reference Government of India, Ministry of Defence letter No
22B(04)/2010/US(WE)/D(Res) dated 18 Feb 2011.
2. Continuous Process. Empanelment of hospitals with ECHS is a continuous
process wherein applications for empanelment are processed as and when received.
3. Advertisement. The Regional Centres will publish advertisements in two
leading news papers (Regional and English language) every year in the month of Jan. For
this purpose documents for financial sanction of MD, ECHS must reach Central
Organisation, ECHS by 30 Nov.
4. Application Formats. Application formats for empanelment with ECHS are
available on the website of Indian Army (www.indianarmy.gov.in/arechs/echs/ htm),
ECHS (www.echs.gov.in) and NABH (www.nabh.co). Separate forms are available for the
following :-
(a) Application Form (ECHS-01) - For Hospitals/Nursing Homes/
Hospices.
(b) Application Form (ECHS-02) - For Eye Care Centres.
(c) Application Form (ECHS-03) - For Imaging Centres/Diagnostic
Laboratories.
(d) Application Form (ECHS-04) - For Dental Clinics.
5. Submission of Applications.
(a) General Instructions.
(i) Application and CD containing scanned copy of duly filled application
will be s ubmitted in one sealed envelope superscribed with ‘Application for
Empanelment with ECHS’.
2
(ii) All the pages of Application and Annexures shall be serially
numbered.
(iii) Every page of application form and Annexures need to be signed by
the authorized person. The signatory must mention as to whether he is the
sole proprietor or authorized agent. In case of partnerships, a copy of the
partnership agreement duly attested by a notary should be furnished.
Similarly, in case of authorization, appropriate legal document should be
furnished.

(iv) As far as possible, all information should be given in the application. If
a particular facility is not available, it should be entered as ‘not available’; it
should not be mentioned as ‘not applicable’.
(b) Application Fees. Hospitals opting for empanelment with ECHS have to
deposit Rs 1000.00 (Rupees one thousand only) in favour of Regional CDA through
MRO at any SBI Branch conducting Treasury business or the RBI under the Code
Head 405/03 (Misc Receipt) towards application fee. Receipted copy of MRO after
depositing Rs 1000.00 is to be attached alongwith the application.
(c) Inspection/Assessment Fees. Non-NABH accredited hospitals must
submit their application alongwith fees for inspection and assessing suitability for
empanelment by QCI (NABH) in a form of demand draft in favour of Quality Council
of India payable at New Delhi as follows :-
Ser Type of facility Bed Strength Inspection /
Assessment
Fee (Rs)
(i) Hospitals/Nursing More than 100 beds 35,000/-
Homes/ Hospices
(ii) Diagnostic, Eye &
Dental Centres
Less than 100 beds 30,000/-
Not applicable 25,000/-
(d) Earnest Money Deposit. All the hospitals applying for empanelment will
deposit Rs 1,00,000/- (Rupees one lac only) as EMD in the form of EMD Bank
Guarantee in favour of respective Regional Centre, ECHS. Detailed instructions
on the subject have been issued vide our letter No B/49797/AG/ECHS dated 14 Oct
2011. The EMD is surety to sign MoA and will be refunded at the time of signing of
MoA subject to following conditions :-
(i) In case the application is rejected on technical grounds, EMD would
be refunded in full.
(ii) In case the application is rejected after inspection on the grounds of
submitting incorrect information, then 50% of the EMD would be forfeited and
the balance would be refunded in due course.
(iii) In case the applicant hospital / eye care centre / diagnostic laboratory
/ imaging centre / dental clinic refuses to sign the MoA, 50% of the EMD
would be forfeited.
(iv) Authority to order for forfeiture of the EMD is MD, ECHS.
(e) Documents to be Submitted. Copies of the following documents (duly
notarized as true copies) are to be attached alongwith the application :-
(i) Copy of certificate or memo of State Health authority, if any
recognizing the Hospital.
(ii) Copy of audited balance sheet, profit and loss account for the last
three years (Main documents only – summary sheet).
(iii) Copy of legal status, place of registration and principal place of
business of the hospital or partnership firm, etc.

(iv) A copy of partnership deed/memorandum and articles of association,
if any.
(v) Copy of Customs duty exemption certificate and the conditions on
which exemption was accorded.
(vi) Photocopy of PAN Card.
(vii) Name and address of their bankers.
(viii) Copy of the existing list of rates approved by the Hospital for various
services/procedures being provided by it.
(ix) Registration Certificate under PNDT Act in case of Centres applying
for Ultrasonography facility.
(x) Copy of the license for running Blood bank if applicable.
(xi) Copy of certificate of NABH Accreditation alongwith Scope of
Accreditation duly attested by Notary Public (for NABH accredited hospitals
only).
(xii) Copy of NABL Accreditation Accreditation alongwith Scope of
Accreditation duly attested by Notary Public(for NABH accredited hospitals
only).
(f) Certificates to be Submitted. Certificate of Undertaking and
acceptance of rates as per formats give at Appendix ‘A’ and ‘B’ respectively
separately will be s ubmitted duly signed by the head of Institution alongwith the
application.
(g) Places of Submission. The application must be submitted in duplicate
along with a scanned copy on a CD at the following places :-
(i) NABH Accredited Hospitals. At Central Organisation ECHS,
Maude Lines, Cantonment, New Delhi – 110010.
(ii) Non NABH Accredited Hospitals. Concerned Regional Centre.
(h) Applications for Additional Facilities. Hospitals approved for
empanelment with ECHS for specified facilities can apply for empanelment of
additional facilities. The procedure to be followed will be same as being followed for
fresh empanelment. Following issues are highlighted for compliance :-
(i) Application Fee will be levied.
(ii) EMD is to be obtained.
(iii) Inspection/Assessment fees will be levied.
(iv) Additional facilities offered will be inspected by QCI(NABH).
(v) Additional facilities will be put up to Empowered Committee of MoD for
approval.
(vi) On approval fresh MoA will be signed including facilities approved
earlier and additional facilities approved by MoD.

(vii) PBG will b e common for all the facilities i.e. one hospital will be
required to submit one PBG for all the facilities approved.
6. Scrutiny of Applications.
(a) Applications shall be opened at the Regional Centres on the last Thursday
of every month. In case the last Thursday of the month happens to be a holiday
then the applications would be opened on the next working day.
(b) Every Applicant or his authorized agent should as far as possible be present
at the time of opening of the Applications at Regional Centre ECHS/ Central
Organisation ECHS.
(c) The Director/Joint Director will examine the applications to determine
whether :-
(i) They are in order and complete.
(ii) Any computational errors have been made.
(iii) Earnest Money Deposit has been furnished.
(iv) Demand Draft of correct amount for inspection / assessment fee has
been furnished (incase of non-NABH accredited facilities).
(v) The documents have been properly signed and serially numbered.
(d) Defects / shortcomings will be corrected/authenticated on the spot and the
application processed further. S pecific advice would be rendered by the Director,
Regional Centres for rectification of incomplete applications. If the hospital wishes to
submit fresh application, the MRO of Rs 1000/- (Rupees one thousand only) can be
reused.
(e) Applications that are found to be complete in all respects shall be forwarded
to Central Organisation ECHS for consideration of empanelment so as to reach by
15 th of ensuing month.
7. Inspection o f Hospitals a nd Approval for Empanelment. C entral
Organisation ECHS will forward the applications to QCI(NABH) within one week of receipt.
NABH will inspect the hospital and submit their recommendations within 45 days to Central
Organisation ECHS. Central Organisation ECHS will compile the applications and NABH
recommendations on monthly basis and submit the same alongwith Draft Govt Letter MoD
(Do ESW) by 15 of ensuing month for consideration by Empowered Committee under the
Chairmanship of Secy ESW.
8. Signing of MoA. On issue of Govt Orders, the Regional Centre ECHS will sign a
MoU with the hospitals. M oA will be valid for two years. Clauses regarding PBG and
Liquidated Damages will be added to MoA format forwarded vide our letter No
B/49771/AG/ECHS/Empanelment dated 11 Mar 2005. MoA will be signed on judicial stamp
paper of Rs 100/ (Rupees one hundred only). Following will be ensured :-

(a) EMD is returned as per instructions at Sub Para 5(d) above.
(b) PBG is obtained as elaborated in our letter No B/49797/AG/ECHS dated 14
Oct 2011.
(c) List of polyclinics authorized to refer patients to the empanelled hospital is
worked out in mutual consultation and added to the MoA (additional clause). This list
must be prepared by respective Regional Centres taking into consideration past
experience and convenience of ECHS beneficiaries.
(d) The original and duplicate copies of MoA will be retained by the concerned
Regional Centre and empanelled facility respectively. Additional photocopies of MoA
alongwith Annexures incl rate list will be forwarded/distributed as under :-
(i) One copy for PCDA/CDA.
(ii) One copy per Polyclinic.
(iii) One copy per SEMO.
(vi) One copy for Central Organisation ECHS.
9. Renewal of MoA. MoA of existing hospitals will be renewed in terms of Para 7 of
GOI letter No 24(9)/03/US(WE)/D(Res) dated 18 Feb 2011 on due date by Regional Centres
ensuring continuity of treatment for ECHS beneficiaries. Following will be ensured :-
(a) Details of empanelled hospitals alongwith copy of existing MoA and validity
dates will be obtained by Regional Centres from Station HQ in their AOR.
(b) Process of renewal will be intimated clear two months in advance of expiry
date of MoA by writing to hospitals to submit necessary documents 30 days in
advance of expiry date in case they are willing to continue with the ECHS.
(c) Instructions at Para 8 (a) to (e) will be complied with.
10. De-Recognition/Dis-Empanelment. De-Regognition/Dis-Empanelment of
Hospital / Nursing Home / Eye Care Centre / Imaging Centre / Diagnostic Laboratorie /
Dental Clinic and Hospice will be in terms of Para 13 of Appendix to GOI, MoD letter No
24(9)/03/US(WE)/D(Res) dated 18 Feb 2011 and corrigendum GOI, MoD letter No
22D(04)/2011/US(WE)/D(Res) dated 22 Jul 2011.
11. Following letters of Central Organisation ECHS are hereby superseded :-
(a) B/49771/AG/ECHS/Empanelment dated 05 Dec 2003.
(b) B/49771/AG/ECHS/Empanelment dated 13 Jan 2005.
(c) B/49771/AG/ECHS/Empanelment dated 24 Jan 2005.
(d) B/49771/AG/ECHS/Policy dated 25 Jan 2005.
(e) B/49771/AG/ECHS dated28 Feb 2005.
(f) B/49771/AG/ECHS/Empanelment dated 15 Mar 2005.
(g) B/49771/AG/ECHS/Empanel dated 15 Sep 2006.
(h) B/49771/AG/ECHS/MOA dated 29 Nov 2006.

(j) B/49771/AG/ECHS/Hosp/R dated 29 Jan 2007.
(k) B/49771/AG/ECHS/Policy dated 25 Jul 2007.
(l) B/49771/AG/ECHS/MOA dated 25 Jul 2007.
(m) B/49771/AG/ECHS/Policy dated 17 Sep 2008.
(n) B/49771/AG/ECHS/Policy dated 05 May 2009.
(o) B/49771/AG/ECHS/Policy dated 30 Jul 2009.
(p) B/49771/AG/ECHS/Policy dated 02 Sep 2009.
(q) B/49771/AG/ECHS/Policy dated 15 Sep 2009.
(r) B/49771/AG/ECHS dated 17 Mar 2010.
Appendices :- A - Certificate of Undertaking.
MD ECHS
B - Certificate for Acceptance of Rates.
Authority : B/49771/AG/ECHS/Emp/Policy 14 Oct 2011

8
CERTIFICATE OF UNDERTAKING
Appendix ‘A’
(Refers to Para 5 (f) of Central
Organisation, ECHS letter No
B/49771/AG/ECHS/Emp/Policy
14 Oct 2011)
1. It is certified that the particulars regarding physical facilities and experience/expertise
of specialty are correct.
2. That Hospital shall not charge higher than the ECHS notified rates or the rates
charged from non-ECHS patients.
3. That the rates have been provided against a facility/procedure actually available at
the institution.
4. That if any information is found to be untrue, Hospital be liable for de-recognition by
ECHS. The institution will b e liable to pay compensation for any financial loss caused to
ECHS or physical and or mental injuries caused to its beneficiaries.
5. That the Hospital has the capability to submit bills and medical records in digital
format.
6. That Hospital will allow a discount of 2% on payment that are made within ten days
from the date of submission of the bill to ECHS.
7. The Hospital will pay damage to the beneficiaries if any injury, loss of part or death
occurs due to gross negligence.
8. That the centre has not been derecognized by CGHS or any state Government or
other Organization, after being empanelled.
9. That no investigation by Central Government/State Government or any Statuary
Investigating agency is pending or contemplated against the hospital.
Signature
Head of Institution/Authorized Signatory

9
Appendix ‘B’
(Refers to Para 5 (f) of Central
Organisation, ECHS letter No
B/49771/AG/ECHS/Emp/Policy
14 Oct 2011)
CERTIFICATE FOR ACCEPTANCE OF RATES
1. It is certified that _______________________________________ (Name of the
institution/hospital) shall abide by ECHS rates promulgated from time to time and in no case
shall the rates charged be in excess of those normally charged to non-ECHS members.
2. It is further certified that on approval for empanelment the hospital/institution shall
negotiate and accept rates lower or equal to prevailing ECHS rates.
Signature
Head of Institution/Authorized Signatory

DENTAL TREATMENT UNDER ECHS
1. Reference our letter of even reference dated 07 Jun 2010 and GOI, MoD ID
No 22A(48)/2007/US/WE/D(Res) dated 19 Aug 2010.
2. CGHS has recently promulgated revised rates for various treatment/
procedure including dental treatment for 2010 for five cities. R ates for balance
CGHS cities are being finalized and shall be declared shortly. I n the revised list
CGHS has now covers 58 dental procedures compared to only 09 dental procedures
covered earlier.
3. As per the Govt letters for medical treatment (including dental) rates of CGHS
have to be followed where available for balance procedures AIIMS rates/actuals
whichever are lower is applicable. To stream line this specially in view of very limited
list of dental procedures our ibid letter had laid down rates for dental treatment in
consultation with the office of DGDS. With the promulgation of CGHS 2010 rates
most commonly required dental procedures have been covered and hence following
amendments be carried out in our ibid letter :-
(a) Delete Para 9.
(b) Re-number Paras 10, 11 and 12 as 9, 10 and 11.
(c) Delete para 13 and add fresh para 12 as follows :-
“12. CGHS rates as listed in CGHS website
http://www.mohfw.nic.in.cghs will be applicable for signing of MOA with
dental facilities approved for empanelment by Govt of India from time
to time”.
(d) Re-number Para 14 as Para 13.
(e) Appendix to the letter is deleted.
4. Payment of charges to empanelled facilities will be as per provisions of GOI
letter No 24(8)/03/US/WE/D(Res) dated 19 Dec 2003.
Authority : B/49773/AG/ECHS/Dental 28 Oct 2010
Sd/- X X X
MD ECHS

1. Ref :-
DENTAL SERVICES AT ECHS POLYCLINICS
(a) B/49773/AG/ECHS/Dental dated 07 Jun 10.
(b) B/49773/AG/ECHS/Dental dated 28 Oct 10.
2. Dental care for ECHS members especially in higher age bracket assumes great
importance. It is therefore essential to upgrade and maintain the Dental Care Section of
the ECHS Polyclinics at the level of Military Dental Centres (MDC). Guidelines for the
same for implementation by Stn Cdrs are given in succeeding Paras.
3. Accommodation :-
(a) Where Polyclinics buildings have been constructed, the dental surgery
room would require modification to enhance dimensions as per standard MES
design for surgery room of MDCs. Water supply pipes, electric points and
storage space be accordingly planned.
(b) Where Polyclinic buildings are yet to be constructed, separate waiting
area and dental surgery rooms be planned. Existing design may be suitably
modified.
(c) Funds would be made available for the upgradation.
4. Staff. Considering the importance of dental surgery only technically
competent staff be selected for ECHS. Since the availability of competent dental
officers/staff is greater than demand, selection of only the best needs to be ensured.
Competency of the dentists in performing dental surgeries should be the critical
selection criteria. Incompetent ex-servicemen are not to be selected on basis of
reservation.
5. Ambience. Ambience of waiting area and surgery rooms is essential to
comfort the patient. Stn Cdr should ensure working towards the objective to have same
ambience in the dental section of the ECHS Polyclinic as obtaining in MDC. Resources
for this purpose would be provided by Stn/Comd/Service/Govt.
Authority :B/49773/AG/ECHS/Dental 10 Jun 2011
Jt Dir (Med)
for MD ECSHS

ISSUE OF MEDICINES TO ECHS BENEFICIARIES
1. Please refer DGAFMS/DG-2C Policy letter No 19189/DGAFMS/DG-2C dated 28
Jan 2011 is fwd herewith (copy enclosed).
2. Concurrence of DGAFMS has been received to issue upto 90 days medicines on
prescription to those chronic patients who do not require review at the discretion of
treating physician. It may be disseminated for compliance by SEMOs/PMOs/SMOs and
OIC Polyclinics.
3. The instruction may be issued to Polyclinics under your AOR.
Sd/- X X X X X
Dir (Med)
Encls :- As above for MD ECHS
Authority : B/49762/AG/ECHS 11 Apr 2011

OFFICE OF THE DGAFMS/DG-2C
ISSUE OF MEDICINES TO ECHS BENEFICIARIES
1. The office of the DGAFMS had i ssued instructions vide this office letter of even
number dated 28 S ep 07 & 22 Jun 09 that, medicines to ECHS beneficiaries will be
issued for only one month. T he policy was arrived at, after due deliberation on this
sensitive issue.
2. This policy is primarily based on principle of sound medical practice for interaction
with patient to monitor treatment protocol and its outcome, ensuring better patient
compliance and so on. No fixed period can be stipulated for prescription, as at times,
reviews are warranted more often depending on the drugs prescribed and the patient’s
changing health condition. A one month review interval is the best possible balance
between patient’s convenience and sound medical practice. T his also minimizes
adverse drug reactions, reduces avoidable wastage of medicine and thus, has a positive
effect on the patient health care.
3. There have been representations from ECHS beneficiaries from time to time that
medicines must be issued for three months at a time instead of one month. This matter
has been re-examined, t his is again emphasized that the policy for issue of 30 days
medicine at a t ime, m ust be adher ed to, for the reasons cited above. H owever
appreciating the difficulties of ex-servicemen coming from far flung areas/outstations,
medicines may be i ssued for a period of 60/90 days at a time at the discretion of the
treating physician on case to case basis. In all such cases, the treating doctor will
endorse the remarks “Case does no0t require review for 60/90 days”.
4. This has the approval of Offg DGAFMS.
Sd/- x x x x x x
DGMS (Army) Addl DGAFMS (E&S)
DGMS (Navy)
DGMS (Air)
MD ECHS
Authority : 19189/DGAFMS/DG-2C 28 Jan 2011

ADVISORY NO : 13 MEDICINES FOR VETERANS TRAVELLING ABRAOD
1. Prescribing medicines for long duration has been a subject matter of protracted
debate at the Service HQ level. This has resulted in DGAFMS recently permitting issue
of medicines for 60/90 days on a c ase basis provided that the treating doctor endorses
that the “case does not require review for 60/90 days”.
2. We are aware that in exceptional cases drugs may be r equired for even longer
duration, when ECHS beneficiaries have to move abroad where medicines are not
available without a m edical prescription valid in that country. Considering such
exceptional cases, SEMOs/OICs ECHS Polyclinic may, subject to concerned specialists
endorsement, issue prescribed medicines for longer duration.
Authority :B/49762/AG/ECHS 02 Jun 2011
Sd/- X X X X X
(
Dy MD
for MD ECHS

ISSUE OF ANTI CANCER DRUGS TO ECHS BENEFICIARIES
1. Ref our letter No B/49762/AG/ECHS dated 05 Aug 2004 (copy attached for ready
reference).
2. It has been decided that the restriction on procurement of Anti Cancer Drugs by
Comdt/Co Service Hospital will be lifted with immediate effect.
3. Accordingly Anti Cancer drugs ‘Not Available’ in Service Hospitals can be
procured by Comdt/CO Service Hospital within their financial powers from ECHS funds
allotted by Office of DGAFMS.
4. Consolidated bulk/future demands for anit-cancer drugs, beyond the Financial
Powers of Comdt/CO Service Hospital be fwd to concerned procurement authorities as
under :-
(a) PVMS drugs - Dependent Med Stores Depots.
(b) NIV drugs - DGAFMS
5. In all instances drugs will be demanded by their generic names.
Authority :B/49762/AG/ECHS 14 Jan 2005
Sd/- x x x x x x
Dir (Med)
for MD

ISSUANCE OF STRIPS FOR GLUCOMETER
There has been representati9on from ECHS beneficiaries issued with Glucometer
that the consumable items like Glucostix also should be made available. It is clarified
that patients suffering from diabetes mellitus who have been issued with Glucometer kit
for estimation of blood sugar level will also be issued with requisite consumable items for
carrying out the test procedure as provisioned vide Govt of India, Min of Defence letter
No 24(8)/03/US/(WE)/D(Res) dt 19 Dec 2003.
Authority : B/49761/AG/ECHS 01 Mar 2007
Sd/- x x x x x x
Offg Dir (Med)
for MD

ADHERANCE OF POLICY ON INDENTING/ SUPPLY OF MEDICAL STOES IN
RESPECT OF ECHS POLYCLINICS
1. Refer O/O DGAFMS, New Delhi Letter No 09357/DGAFMS/DG-2D dt 10 Dec
2003
2. It has been observed by AFMSDs that the SEMOs of hospital are submitting
indents of ECHS Polyclinics under their jurisdiction polyclinic wise, whereas as per O/o
DGAFMS letter cited under reference the consolidated MMF (having a c ommon MMF
merging the MMF of all dependant Polyclinics) should be placed on Depot. In turn, the
SEMO of dependant hospitals themselves have to distribute the stores according to
demand of all ECHS polyclinics.
3. In view of the above, your are requested tom issue suitable instructions so the all
SEMOs compile the MMF and I ndents of all polyclinics under their respective
jurisdiction and fwd to dependants depot duly consolidated
Authority : B/49762/AG/ECHS 17 Apr 2007
Sd/- x x x x x x
Jt Dir (Med)
for MD

INDENTING OF MEDICAL STORES
1. The placement of indent/demand for medical stores by any medical facility
medical store depot or Service Hospital has to be based on Monthly Maintenance figure
(MMF). The MMF shows the consumption pattern which needs to be evaluated diligently
so that non availability as well as over stocking of medicine is avoided and availability of
any sealed item is assured at any point of time.
2. It has come to notice that the indents placed by ECHS Polyclinics are often not
realistic, as a r esult of which they are holding undesirable surplus stores for several
items.
3. In view of this, it is imperative that MMF must be pr epared correctly based on
issue and expenditure of medicines in previous 11 months. While preparing the MMF
only generic name items as per PVMS should be included and trade names of items
should be avoided. Alternate items are also to be included for ‘in lieu’ in case a particular
item is not available.
4. The consolidated MMF duly scrutinized and signed by o/I Med Stores nominated
by O/ic polyclinic will henceforth to be s ent to the Regional Centre for vetting by JD
(Hosp Services). The Regional Centre will the sent the MMF to the concerned SEMO.
The Regional Directors will evolve a m echanism to get feedback on consumption of
medicines every month in the polyclinics in their area of jurisdiction. The same will also
be verified on ground during their visit to PC with a view to assess the authenticity of
MMF
Authority : B/49762/AG/ECHS 22 Aug 2007
Sd/- x x x x x x
Jt Dir (Med)
for MD

MODIFICATION OF AMBULANCE AT ECHS POLYCLINICS
1. During the visit of MD to various station, inputs have been received to make
Ambulance of ECHS Polyclinics more functional and equipped, to render critical care
during move.
2. It has been dicided that following modifications/addition be incorporated in
Polyclinic Ambulance with immediate effect :-
(a) Marking of the vehicle with the word AMBULANCE in front and
AMBULANCE rear, in read.
(b) Affixing a blue flashinght and siren to work as an audio –visual alarm.
(c) Incorporation of hook(s) ?clamp(s) to hold and intravenous drip, inside the
patient cabin.
(d) Designing of bracket (s)/slot to anchort a oxygen cylinder, near the
stretcher base.
(e) Make a Critical Care Box/Bag with basic life saving drug and equipments
which can be carried conveniently in the ambulance, in times of need. The
contents and design of the same may be worked out by the MOIC Polyclinic, and
approved by the Joint Director Medical at the Regional centre.
3. The above requirements are likely be met with existing resources available at the
Polyclinic, however petty expenditure may be made from appropriate code head, within
the powers of OIC Polyclinic/Stn Cdr.
4. Appropriate directions on the subject may please be disseminated to Polyclinics
under your AOR.
Authority :B/49761/AG/ECHS 09 May 2007
Sd/- x x x x x x
Jt Dir (Med)
for MD

ISSUE OF EXPENDABLE MEDICAL STORES TO
NEW RAISING ECHS POLYCLINICS
1. A letter received from Office of DGAFMS letter No 34906/ECHS/DGAFMS/DG-
2B(ii) dated 25 jul 2011 on issued of expandable medical stores is forwarded herewith for
your further necessary action.
4. You are request to disseminate the same to all concerned under your jurisdiction
Authority : B/49761/AG/ECHS 09 May 2007
Sd/- x x x x x x
Jt Dir (Med)
for MD

ISSUE OF EXPENDABLE MEDICAL STORES TO
NEW RAISING ECHS POLYCLINICS
1. Central Org ECHS vide their Note No B/49705/Addl Polyclinic/AG/ECHS dated 23
Aug 2010 has intimated that 156 additional Polyclinics are to be established in a phased
manner. 177 Polyclinics are to operationalised by 01 Oct 2011 & 52 Polyclinics in phase-
II by 01 Apr 2012. The list of 156 Polyclinics is attd at appendix ‘A’ .
2. In view of the above, you are requested to issue expendable medical stores to the
newly established Polyclinics under your jurisdiction as and when demanded.
3. This has the approval of the DGAFMS.
Authority: 34906/ECHS/DGAFMS/DG-2B(ii .25 Jul 2011
Sd/- x x x x x x
Jt Dir AFMS (DG-2A&D)
for DGAFMS

FORWARDING OF : ANNUAL EQUIPMENT CENSUS
1. Please refer to the following :
(a) Office of the DGAFMS letter No 3505/4/CENSUS/DGAFMS/DG-2D dated
09 Jun 1988.
(b) Office of the DGAFMS letter No 20069/Eqpt/Census/DGAFMS/DG-
2C/2007.
(c) Office of the DGAFMS letter No 207/PRF/DGAFMS/DG-2E/2009 dated 10
Feb 2011.
2. The above subject report is to be s ubmitted by all the units concerned in the
prescribed format as per Appx ‘A” (16 Column) to this unit with copies to office of the
DGAFMS and your HQs so as reach by 31 Jan every year.
3. It is observed that even after repeated reminders every year ECHS Polyclinics
have not fwd the above report till date.
4. Revision of the ME scale of the Armed Forces units of Army, Navy, Air Force was
done in the year 2007, where in major revision of PVMS was carried out and ME scales
of all units/subunits have been revised.
5. In the process of this revision, a large number of NIV medical equipment have
been taken into PVMS and i ncluded in ME scale. T his major revision has created a
deficiency of large number of equipment as initial deficiency in these units.
6. However a number of equipment have also been received by the units either as
AAP procurement, SOC procurement or through other sources (gift item/procured
through any other fund).
7. Units have been earlier request through Command CRC and advised to ask unit
under their jurisdictions to ensure timely submission of “ Yearly Equipment Census”
However t he response has not been adequate. Lack of correct and complete
information in this regard by the mother Depot results in “unrealistic dues in /Dues out’.
8. It is also observed that some units consider the annual initial deficiency report
being fwd in the month of May as equivalent to unit census report which is incorrect.
Further it needs to be emphasized that the above report is required to be fwd
Annual as on 31 Dec year so as to reach this office by 31 Jan next year.
9. This letter may also be not ed as “To be Handed over on relief’ for correct,
timely and continuous input in the subsequent period.

10. The required information should be sent directly to this depot as per format
attached in soft and hard copies by 15 Oct 2011 (The format has also been placed in
the AFMSF Pune Web site for further ref). An advance copy may be sent by fax at 020-
26360812.
Authority : 6174/Census/AFMSD Pune/T/1695...06 Sep 2011
Commanding Officer

Appx ‘A’
(Letter No 617/Census/AFMSD Pune/T/165 dt 06 Sep 11)
SIXTEEN (16) COLOUMN FORMAT FOR FORWARDING ANNUAL EQUIPMENT
CENSUS AS ON 31 DEC EACH YEAR : AFMSD PUNE
S
NO
PVMS
/NIV
No
Nomenclature Qty
auth
with
ME
Scale
No
Qty
held
Source
& cost
in
Indian
rupees
Name and
address of
Manufactures
Model Year of
installation
1 2 3 4 5 6 7 8 9
Warranty/AM
C with date
and Name of
agency
Life
cycl
e
SO/AT
availabilit
y
Log-book
availabilit
y
Whether
functiona
l Yes/No
Brief reason, if
not
functional/actio
n taken
Date of
last
ATEO
inspectio
n and
remarks
10 11 12 13 14 15 16
Note : (TO BE FWD BOTH IN HARD & SOFT COPY)
TO BE FAXED ON THE LE – 020-26360821 (available 24 hours)

REPAIR OF ECHS EQUIPMENT
1. Funds for repair of medical eqpt have been allotted under budget head (Revenue)
Major head 2076, minor head 103 (D), code head 363/01.
2. It is requested that all SEMOs under your jurisdiction be intimated to carry out
timely repair of ECHS policinic eqpt from the budget head as mentioned above, for
upkeep of med eqpt.
3. This has the approval of the Addl DGAFMS (E&S).
Authority : 19189/DGAFMS/DG-2C 27 Jun 2011
Sd/- x x x x x x x
DDG (Stdn)

ISSUE OF HEARING AIDS PRESCRIBED FOR ECHS MEMBERS
1. Reference to this office letter Nos B/497770/AG/ECHS dated 12 Jan 2005.
2. In view of our experience with Hearing Aids issued to ECHS members as per
current procedure, the following amendments to procedure has been approved :-
(a) Recommendations for Haring Aids will be acceptable ONLY from a Service
ENT Specialist.
(b) In case of ‘Digital Hearing Aid’ recommendations of 02 (Two) Service ENT
specialists are required prior to endorsement of recommendations of Sr
Adviser/Addl Adviser (ENT).
(c) All cases to be forwarded to Senior Adviser (ENT) / Addl Adviser (ENT) for
recommendations. In case of non availability of Senior Adviser/ Addl Adviser
(ENT) locally in the station, docus will be forwarded to concerned Senior Adviser/
Addl Adviser desired to examine the patient, the same will be communicated to
the ECHS members for compliance under own arrangements.
(d) Details case notes will be forwarded to Senior Adviser (ENT) including
audiometry report. Audiometry to be conducted by Service ENT Specialist.
(e) All case documents after endorsement by Sr Adviser (ENT) will be
forwarded to Central Organisation ECHS for approval and return to Polyclinic.
(f) ‘Authorisation for Hearing Aid’ will be issued by OIC Polyclinic only after
receipt of approval from Central Organisation ECHS.
3. This Office letter No B/49770/AG/ECHS dated 11 Feb 2005 be treated as
cancelled.
Authority : B/49770/AG/ECHS/Hearing Aid. 27 Jul 2005
Sd/- x x x x x x
Jt Dir (Med)
for MD

ISSUE OF MEDICAL EQPT PRESCRIBED FOR ECHS MEMBERS
1. Reference is made to Govt of India Min of Defence letter No 24 (8)/03/ US(WE)
/D(Res) dated 19 Dec 2003. Issues regarding issue of medical eqpt to ECHS members
are amplified below .
2. Specified medical equipment can be pr escribed for ECHS members under
conditions laid down in Paras 9 (b), (e), (g) and (l) of GOI letter under reference. The
detailed guidelines for issue of such prescribed medical eqpt to ECHS members are
given in the succeeding paragraphs.
3. Hearing Aids – B/49770/AG/ECHS/Hearing Aid dated 27 Jul 2005.
Artificial Limbs/Appliances
4. ECHS members can obtain Artificial limbs/applicances through Armed Forces
Medical Service institutions or empanelled facilities, once referred to the facility by the
Polyclinic.
5. When referred to Service facilities, Artificial Limbs/Appliance for ECHS members
will be fitted at Artificial Limb Centre (ALC) Pune, or Artificial Limb Sub Centres in the
AFMS hospitals. The Artificial limbs / appliances will be procured for ECHS funds sub
allocated to ALC Pune and Service Hospitals by the Office of DGAFMS.
6. When treatment is undertaken in civil empanelled facilities, CGHS rates will
apply. Explenditure over and above the authorized CGHS rates, if any, will be borne by
ECHS member. Payment will be made through the cash Assignment system by the
Station Commander as per normal laid down procedures for payment to empanelled
facilities.
Glucometers and Nebuliser
7. Glucometers and N ebuliser will be issued to members, when use of such
equipment is considered absolutely essential on m edical grounds. T he eqpt will be
supplied under following conditions :-
(a) Glucometer :- ECHS members who are suffering from complications of
Diabetes Mellitus may be issued glucometers on specific recommendation of the
Medical Specialist of the ECHS Polyclinic/Service Hospital/Empanelled Hospital.
(b) Nebulisers ECHS members who are patients of Bronchial Asthma or
respiratory conditions requiring regular administration of inhalation therapy by
nebuliser may be i ssued Nebulisers on the specific recommendation of Medical
Specialist in the ECHS Polyclinic/Service Hospital/Empanelled facility.
8. Approval by the Senior Advisor and Consultant in Medicine, under whose
jurisdiction the ECHS Polyclinic is located, will be obtained for items at Para 10 (a) and
(b). The O I/C Polyclinic will thereafter initiate procurement action for the eqpt as per
local purchase procedures. The following documents will be s ubmitted to the Station
Commander for this sanction, through the SEMO/SMO/PMO.

(a) A brief case summary and adv ice of the medical specialist of the
Polyclinics/SAervice Hospital/Empanelled Hospital.
(b) Recommendation of the Senior Adviser and Consultant.
(c) Quotation from vendors.
(d) Comparative Statement.
(e) Comment from O I/C Polyclinic stating that the amount is within the
prescribed CGHS rates.
9. Payment for the item to the vendor will be made by cheque through the Cash
Assignment by the Station Commander. The item will be issued to the ECHS member
and a receipt obtained. The receipt will be attached with the case file and preserved for
audit purposes. D etails of the issue will also be ent ered in the patient record in the
Polyclinic computer and in his smart card.
10. The cost of maintenance of equipment will be bor ne by the ECHS member.
Replacement of the equipment is only permitted after 5 years on production of
condemnation certificate by the O i/C Polyclinic and recommendation for continuation of
treatment by the Medical Specialist.
CIPAP/BJPAP Machines
11. When a C IPAP/BJPAP machine is recommended for any ECHS member by
Specialist of a Service Hospital /Empanelled Hospital, a s tatement of case will be
forwarded by the OI/C Polyclinic. The Statement of Case will include basic investigation
report and S leep Lab report of the Service Hospital/Empanelled Hospital.
Recommendations of a S ervice Specialist and appr oval by the Senior Advisor and
Consultant of the concerned speciality, under whose jurisdiction the Polyclinic is located
will be obtained in all such chase.
12. The O I/C Polyclinic will thereafter initiate procurement action for the eqpt as per
local purchase procedures. The following documents will be s ubmitted to the Station
Commander for his sanction through the SEMO/SMO/PMO : -
(a) A brief case summary, basic investigation reports, sleep lab report and
advice of the medical specialist of the Service Hospital/ Empanelled Hospital .
(b) Recommendation of Service Medical Specialist, Senior Adviser and
Consultant.
(c) Quotations from vendors.
(d) Comparative statement.
13. Payment for CIPAP/BIPAP machines will be made by cheque to the vendor
through the Cash Assignment by the Station Commander. Actual cost of CIPAP/BJPAP
machines or CGHS rates, whichever is lesser, will apply. Expenditure over and above
the authorized CGHS rate will be bo rne by the ECHS member. T he CIPAP/BIPAP
machine will be issued to the ECHS member and a receipt obtained. The receipt will be
attached with the case file and preserved for audit purposes. Details of the issue will
also be entered in the patients record in the Polyclinic computer and or his Smart card.

14. The cost of upkeep and maintenance of the CIPAP/BIPAP machines will be borne
by the ECHS member. A C IPAP/BIPAP machine will only by issued once in a life time
to the member.
15. Spectacles will not be provided under ECHS system except post operatively in
case of conventional operation of cataract. Cost of spectacles in such cases will be
limited to Rs 200/- only. I n all such cases the patient will submit the bills for
reimbursement towards cost of spectacles to the O I/C Polyclinic who will forward it to
the SEMO/SMO/PMO giving date of conventional cataract surgery and recommendation
by the Medical Officer ff the Polyclinic or Eye Specialist of Service/Empanelled Hospital.
The payment will be made by the Station Commander from his Cash Assignment.
16. Records of the patient will be updated after the payment is completed.
Replacement of Spectacles will be admissible once in there years on the advice of the
Medical Officers of the Polyclinic ort empanelled Consultant .
Other Medical Equipment for Domiciliary use
17. No other equipment is authorized for issue of ECHS member at opresent. Other
Medical Equipment, as and when included for issue to patients, will be intimated to all
concerned.
Authority : B/49770/AG/ECHS/Hearing Aid 27 Jul 2005
Sd/- x x x x x x
Dir (Med)
for MD ECHS

POLICY ON DURATION OF HOSPITALIZATION
1. Refer Govt of Indioa, MoD letter No 24(8)/03/US(WE)/D/(Res) dated 19 Dec 03.
2. Hospital admission for a maximum period of 12 days is adequate for most
procedures/treatment. Hence, the ibid Govt letter stipulated package deal to include 12 days of
hospitalization and consequent high cost of treatment are on the rise. Such bills have attracted
adverse observations during scrutiny by the Screening Committee of MoD. While genuine
cases can be justified, undesirable practice of prolonged hospitalization even after the finality of
treatment has been reached needs to be curbed on priority.
3. Revised procedure to monitor and to accord sanction for extended in patient treatment at
empanelled hospitals will be as follows:-
(a) Hospitalization beyond 12 days upto a max period of 30 days will be permitted on
approval of Stn Cdr. Performa for approval is at Appx ’A’. Following procedures will be
followed:-
(i) The empanelled hosp will intimate the necessity of extended
hospitalization as per format at Appx ‘A’ to the OIC of referring polyclinic.
(ii) Policlinic MO will visit the patient in the hospital and complete the part II
of format at Appx ‘A’.
(iii) OIC ECHS will accord approval on behalf of Stn Cdr, based on
recommendations of polyclinic MO. If considered necessary he may personally
visit the patient in the hospital and interact with the treating physician/surgeon.
(b) For continuation of treatment beyond 30 days and to ascertain whether the
finality of treatment has been reached, a technical committee comprising Polyclinic
Medical Officer, rep of SEMO (tech member) and rep of Stn HQ will be formed. This
technical committee will visit the patient and consult doctor(s) treating the patient to
decide on necessary/otherwise of continued hospitalization.
(c ) The technical committee will examine whether the finality of treatment has been
reached or not. Where the finality of treatment has been reached, the patient will be
discharged to home/referred to suitable hospice/rehabilitative and palliative care centre
for terminal care. I n case the treatment necessitates further hospitalization, the
committee will accord approval for continued treatment upto a maximum period of addl
30 days (i.e. total hospitalization period upto 60 days). Performa for approval is at
appx ‘B’.

(d) Hospitalization beyond 60 days will normally NOT be permitted. Cases requiring
in-patient treatment beyond 60 days will be reviewed by the station technical
committee again between 45 th and 60 th day and in exceptional circumstance where
hospitalization beyond 60 days is absolutely necessary, their recommendations will be
recorded on Performa at Appx ‘C’ and forwarded to Central Organization for approval
by fastest means including by fax and e-mail.
(e) Central Organization will examine the recommendations of the technical
committee with in five working days and intimate approval/non-approval to Stn Cdr by
telephone followed by fax.
4. The onus of obtaining approval for extended hospitalization would be with the
empanelled hospital. A ll Stn Cdrs are requested to intimate the above provisions to their
respective empanelled hospitals.
5. Our letter on the subject dated 12 Aug 2009 is hereby superseded.
6. This has the approval of the DGAFMS.
Authority : B/49770/AG/ECHS 15 Mar 2010
Sd xxxxxxxx
Dir (Med)
For MD ECHS

Appx ‘A’
(Refers to para 3(a) of Central Organisation ECHS
Letter No B/49770/AG/ECHS dated 15 Mar 10)
ECHS Membership No…………………………………………
APPROVAL FOR EXTENDED DURATION OF HOSPITALIZATION
UP TO 30 DAYS)
Part-I (To be filled by the Empanelled Hospital)
1. Name(Patient)…………………2. Relationship with ECHS member………..
3. No……………………4. Rank…………..5. Name (Member)…………..
6. Hospital………………………………………………………………………………….
7. Diagnosis………………………………………………………………………………..
8. Treatment modality carried out so far………………………………………………..
9. Proposed Treatment/Test/Procedure………………………………………………….
10 Case summary to be attached………………………………………………………….
11. Whether finality of treatment has been attained. If not what is the approx time
required…………………………………………………………………………………………
12. Signature & Stamp of Treating Physician/Consultant/Auth Hosp
Rep…………………………………………………………………………
(Signature of treating Consultant)
Date :
PART II (To be filled by the Medical Officer of the Polyclinic)
(For Hospitalization period between 12 days to 30 days)
13. Patient visited in the hospital on……………………………………………………
14. Authenticity of treatment modality…………………………………………………
15. Effect of treatment on patient recovery…………………………………………….
16. Relevance of Diagnostic Investigation…………………………………………….
17. Reasons for extended stay beyond 12 days………………………………………
18. Likely date of finality in treatment……………………………………………………
19. Recommendation/Comments of MO……………………………………………….
Stn Stamp
APPROVED/NOT APPROVED
(Signature of MO)
Date :
OIC, ECHS
Date:

Appx ‘B’
(Refers to para 3(a) of Central Organisation ECHS
Letter No B/49770/AG/ECHS dated 15 Mar 10)
ECHS Membership No…………………………………………
APPROVAL FOR EXTENDED DURATION OF HOSPITALIZATION
UP TO 60 DAYS)
Part-I (To be filled by the Empanelled Hospital)
1. Name(Patient)…………………2. Relationship with ECHS member………..
3. No……………………4. Rank…………..5. Name (Member)…………..
6. Hospital………………………………………………………………………………….
7. Diagnosis………………………………………………………………………………..
8. Treatment modality carried out so far………………………………………………..
9. Proposed Treatment/Test/Procedure………………………………………………….
10 Case summary to be attached………………………………………………………….
11. Whether finality of treatment has been attained. If not what is the approx time
required…………………………………………………………………………………………
12. Signature & Stamp of Treating Physician/Consultant/Auth Hosp
Rep…………………………………………………………………………
(Signature of treating Consultant)
Date :
PART II (To be filled by Technical committee)
(For Hospitalization period between 31 days to 60 days)
13. Patient visited in the hospital on……………………………………………………
14. Authenticity of treatment modality…………………………………………………
15. Effect of treatment on patient recovery…………………………………………….
16. Relevance of Diagnostic Investigation…………………………………………….
17. Reasons for extended stay beyond 30 days………………………………………
18. Complication if any and likely cause……………………………………………………
19. Modality or management of complication – Satisfactory/Not
satisfactory………………
20 Whether finality of treatment has been attained. If NOT what is the likely date of
finality in treatment………………………………………………..
21. Recommendation/Comments of the Committee……………………………….
…………………… …………………….. ……………………
(MO) Rep of SEMO Rep of Stn HQ
RECOMMENDED/NOT RECOMMENDED APPROVED/NOT APPROVED
Jt Dir (Hosp Services) Dir Regional Centre

Appx ‘C’
(Refers to para 3(a) of Central Organisation ECHS
Letter No B/49770/AG/ECHS dated 15 Mar 10)
ECHS Membership No…………………………………………
APPROVAL FOR EXTENDED DURATION OF HOSPITALIZATION
UP TO 120 DAYS) IN EXCEPTIONAL CIRCUMSTANCE
Part-I (To be filled by the Empanelled Hospital)
1. Name(Patient)…………………2. Relationship with ECHS member………..
3. No……………………4. Rank…………..5. Name (Member)…………..
6. Hospital………………………………………………………………………………….
7. Diagnosis………………………………………………………………………………..
8. Treatment modality carried out so far………………………………………………..
9. Proposed Treatment/Test/Procedure………………………………………………….
10 Case summary to be attached………………………………………………………….
11. Whether finality of treatment has been attained. If not what is the approx time
required…………………………………………………………………………………………
12. Signature & Stamp of Treating Physician/Consultant/Auth Hosp
Rep…………………………………………………………………………
(Signature of treating Consultant)
Date :
PART II (To be filled by Technical committee)
(For Hospitalization period between 61 days to 120 days)
13. Patient visited in the hospital on……………………………………………………
14. Authenticity of treatment modality…………………………………………………
15. Effect of treatment on patient recovery…………………………………………….
16. Relevance of Diagnostic Investigation…………………………………………….
17. Reasons for extended stay beyond 30 days………………………………………
18. Complication if any and likely cause……………………………………………………
19. Modality or management of complication – Satisfactory/Not
satisfactory………………
20 Whether finality of treatment has been attained. If NOT what is the likely date of
finality in treatment………………………………………………..
21. Recommendation/Comments of the Committee……………………………….
…………………… …………………….. ……………………
(MO) Rep of SEMO Rep of Stn HQ
RECOMMENDED/NOT RECOMMENDED
Dir(Med), Central Organisation ECHS
APPROVED/NOT APPROVED
MD ECHS

ADVISORY NO-09 : EMERGENCY ADMISSIONS IN EMPANELLED HOSPITALS
1. Recently a study was carried out on the pattern of emergency admissions in empanelled
hospitals. The study revealed alarmingly high percentage of emergency admissions (ranging
between 70 to 95 percent) in some hospitals. Such high levels of emergency admission lead to
apprehension regarding mal/unethical practices creeping into the system of ECHS healthcare
delivery.
2. In view of the above, it is requested that Stn Cdrs be advised to be more vigilant and
incase a hospital persists with such practices despite caution/adequate warning then case for
disempanelment and or reporting the malpractices to MC/regulatory authorities be initiated.
Authority : B/49770/AG/ECHS 08 Jun 2010
sdxxxxx
Dy MD
for MD ECHS

ADVISORY NOTE NO-06
REQUIREMENT OF BLOOD FOR ECHS PATIENTS ADMITTED IN
EMPANELLED/NON –EMPANELLED HOSPITALS
1. ECHS members had highlighted the problem of arranging blood for patients admitted in
empanelled/non-empanelled hospitals. T he problem gets compounded when the ECHS
patients have no family support.
2. To assist the needy ECHS members, DGMS (Army) has recommended the following :_
(a) Self-help groups be established polyclinic-wise comprising ex-serviocemen/their
family members/other volunteers. These self –help groups to register volunteers who could
donate blood when required.
(b) Self-help groups could maintain liaison with blood banks run by Red
Cross/Rotary Club/other NGOs on internet (Viz, WWW.bharatbloodbank.com), Indian blood
donors.com, bloodgivers.com etc) to ensure availability of blood.
(c ) In case of dire emergency, local Stn Cdrs could be approached for arranging
donors.
(d) In all above cases, first donors should be family members and friends of the
patient.
3. Above guidelines are considered very appropriate and practical. It is therefore advised
that all ex-servicemen’s Organizations facilitate establishment of such an arrangement at all
ECHS Stns.
Authority :B/49770/AG/ECHS 05 Oct 2009
Dir (Med)
For MD ECHS

DEPENDENT STATUS OF NEW BORN BABY
1. Recently a case has come to notice wherein a new born baby delivered to a lady, who is
an ECHS b eneficiary, has not been provided requisite medical treatment by empanelled
medical facility/ECHS authorities on the ground that the baby is not entitled.
2. It is clarified that new born baby born to an entitled ECHS beneficiary is to be deemed as
dependent, and entitled to free medical treatment upto three months based on birth certificate.
Membership formalities should be completed subsequently within the next three months.
Jt Dir (Med)
For MD

EXAMINATION OF PATIENTS IN ECHS POLYCLINICS
1 In the Service Hospital/MI Rooms /SMCs, Armed Forces Veterans are treated as per
Service conventions. Separate queues/timings/days are fixed for medical examination of
Officers/JCOs & OR Families. Ward entitlement for admission in Service Hospitals is also well
defined for Serving personnel as well as Veterans and their dependents.
2. Entitlement of indoor treatment in Empanelled Hospitals has also been specified vide
Govt of India, Min of Defence letter No 22(16)/05/US(WE)/D(Res) dated 19 Jul 2005 as under :-
(a) Officers/dependents - Private Ward
(b) JCOs & Equivalent/dependents - Semi Private Ward
(c ) OR/Dependents - General Ward
3. HQs Command are requested to ensure that similarly separate queues/timings are
followed in ECHS Polyclinics for Registration, Consultation, Investigations and issue of
medicines to veterans and their dependents.
Authority : B/49770/AG/ECHS 20 Nov 2006
MD ECHS
For AG.

EMPANELMENT OF HOSPITALS, NURSING HOMES AND
DIAGNOSTIC CENTRES UNDER ECHS
1. Govt of India, Ministry of Defence has issued orders vide their letter No
22B(04)/2010/US(WE/D(Res)dt 18 Feb 11 on revised procedure for empanelment of
Hospitals/Nursing Homes and D iagnostic Centres. A ccordingly all applications for
empanelment with ECHS processed as per old procedure will be r eturned to the
applicants in due course of time. All applicants facilities (old procedure) are required to
submit their application for empanelment as per new procedure. Detailed guidelines are
issued vide our letter No B/49771/AG/ECHS/Emp/Policy dt 14 Oct 11.
2. Regional Centres ECHS will advice all applicant facilities (old procedure) from their
respective AOR to submit their application for empanelment with ECHS and facilitate
processing of those application on priority.
3. Applications (old procedure) submitted to Central Organisation will be returned to
respective Regional Centres in due course of time.
Auythority : B/49771/AG/ECHS 21 Oct 2011
Sd/- X X X
Jt Dir (Med)
for MD ECHS

GUIDELINES FOR DOMICILIARY REHABILITATION MEDICINE
INTERVENTION FOR REIMBURSEMENT TO ECHS BENEFICIARIES
1. Further to this Organisation letter No B/49773/AG/ECHS/Rates/Policy dated
10 Jan 2011.
2. Government of India, Ministry of Health & Family Welfare has promulgated
guidelines for domiciliary rehabilitation medicine intervention for CGHS beneficiaries vide
OM No S.11011/24/2011-CGHS(P) dated 01 Jun 2011 (Photocopy enclosed). Accordingly
guidelines are issued for domiciliary rehabilitation medical intervention for reimbursement
to ECHS beneficiaries.
3. Guidelines. Domiciliary (home based) care is medically justified in the practice
of rehabilitation medicine which involves the care of the patient with chronic diseases or
temporary or permanent disability or function limitation due to lack of health or disease. It
is justified as such persons find ambulation practically impossible or are significantly
dependent on care giver or the cost of visiting the hospitals become higher than the cost of
treatment given. In view of this, it would be necessary to consider providing holistic
domiciliary rehabilitation medicine service instead of piecemeal home based physiotherapy
only, to ECHS beneficiaries as part of their routine health coverage.
4. Scope of the service. The following allied health services need to be considered
for domiciliary care as stated above:
(a) Physiotherapy;
(b) Occupational Therapy; and
(c) Speech therapy (for patients of stroke / head injury)

2
5. The decision to provide domiciliary care should be based on thorough evaluation and
specific prescription including the exact intervention and frequency by a PMR specialist. In
a situation of non-availability of PMR specialist, the treating Service Specialist in military
stations and Government specialist in non-military stations having allopathic Post- Graduate
qualifications in Ortho / Neurology / Neurosurgery / ENT may allow such benefits following
the specific prescription criteria for conditions listed below:-
6. Conditions requiring domiciliary rehabilitation intervention and
recommended duration if domiciliary therapy.
(a) Orthopaedic disorders. Post joint replacement surgery in acute
phase: Physiotherapy after two weeks, post – discharge.
(b) Neurological disorder (for upto six weeks).
(i) Post Stroke. Occupational therapy (OT), Physiotherapy (PT),
and Speech therapy (ST).
(ii) Traumatic Brain Injury. OT, PT and ST;
(iii) Gullian- Barre Syndrome. OT and PT
(iv) Spinal Cord Injury with Significant Disability / Deformity. OT
and PT; and
(v) Motor Neuron Disease. OT, PT and ST
(c) Locomotor Disability, With a disability of over 80% or those who are
totally dependent on care- giver based on the opinion of two Government specialists
by certified care- giver. [Care giver means Rehabilitation Council of India certified
personnel + Physiotherapist and Occupational therapist (duly qualified diploma /
degree holder)].
7. Prescription Information. The prescription for home based rehabilitation
program should include the following descriptive specifics:
(a) The therapy to be used :-
(i) Electrotherapy.
(ii) Active exercise therapy.
(iii) ADL Training.
(iv) Speech therapy.
(v) Gait Training and
(vi) Passive exercises.

(b) The technical person required to institute the therapy.
(c) The frequency of the therapy required by the patient and
(d) Duration of the therapy program.
3
8. Admissible rates for reimbursement. The following rates may be reimbursed:-
(a) Physiotherapist. Maximum of Rs 300/- (Rupees Three hundred only) per
day.
(b) Occupational Therapist. Maximum of Rs 300/- (Rupees Three
hundred only) per day.
(c) Speech Therapist. Maximum of Rs 300/- (Rupees Three hundred
only) per day
(d) Certified Care Giver. Maximum of Rs 150/- (Rupees One hundred and
fifty only) per month for long- term requirements, which ever is less; and
(e) No reimbursement to be allowed for the purchase / hiring of therapy
equipment / devices.
9. The guidelines will take effect from the date of issue of this letter.
Authority : B/49770/AG/ECHS/Policy Oct 2011
MD ECHS