Treatment Process for Ex-Servicemen (ESM) through ECHS

The Ex-Servicemen Contributory Health Scheme (ECHS) provides comprehensive medical care to eligible Ex-Servicemen (ESM) and their dependents through a vast network of ECHS Polyclinics, Empanelled Hospitals, and Government/Service Hospitals. The treatment process varies based on the type of medical situation—normal, emergency, or specialized treatment in government or non-government institutions.

Normal Treatment Procedure

Step 1: Visit to ECHS Polyclinic

• The ESM visits the nearest ECHS Polyclinic (PC) with their Smart Card.
• The receptionist allocates a doctor for consultation.

Step 2: Medical Consultation

• The doctor examines the ESM and prescribes medication or further treatment.
• ESM collects medicines from the Polyclinic Pharmacy.

Step 3: Referral Process (If Required)

• If specialist treatment or hospital admission is needed, the doctor refers the case to a Service Hospital (if available).
• If no Service Hospital is available or facility is not adequate, the ESM is referred to an Empanelled Hospital through the Polyclinic.
• The Service Hospital specialist may also treat the patient as an OPD case or refer them further.

Step 4: Treatment and Billing

• The Empanelled Hospital treats the ESM on a cashless basis as per CGHS rates.
• The Empanelled facility processes the claim online through ECHS.

Emergency Treatment in Empanelled Hospitals

Step 1: Immediate Admission

• ESM reports to any Empanelled Hospital during an emergency.

Step 2: Emergency Information Report (EIR)

• The hospital assesses the case and generates an Emergency Information Report (EIR) within 48 hours.
• The EIR is sent online to the parent Polyclinic for record and follow-up.

Step 3: Referral and Treatment

• The Polyclinic issues an online referral to the same Empanelled Hospital.
• The hospital provides cashless treatment to the ESM.

Emergency Treatment in Non-Empanelled Hospitals

Step 1: Emergency Admission

• If no empanelled facility is nearby, ESM may report to a Non-Empanelled Hospital in an emergency.

Step 2: Reporting Requirement

• The ESM or relative must inform the parent Polyclinic within 48 hours of admission.

Step 3: Payment and Claim

• Treatment in a non-empanelled hospital is on a payment basis.
• The ESM pays the bills initially and later claims reimbursement from ECHS.

Step 4: Claim Timeline

• Within 90 days of discharge: ESM submits documents to the Polyclinic.
• Delayed cases (up to 180 days) require a waiver by the Regional Centre (RC).
• Further delay (up to 365 days) requires a waiver by the Central Organisation (CO).

Treatment in Non-Government National Repute Hospitals

Step 1: Prior Referral Required

• ESM must obtain referral from the Parent Polyclinic before visiting hospitals of national repute, such as:
  • Tata Memorial Hospital (TMH), Mumbai
  • Christian Medical College (CMC), Vellore
  • Shankara Nethralaya, Chennai

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Step 2: Payment and Reimbursement

• These hospitals treat ESM on payment basis.
• After treatment, reimbursement claims can be submitted through ECHS as per regulatory mechanisms.
• No cashless treatment is available here.

Treatment in Government Hospitals / Institutes

Step 1: Admission without Referral

• ESM can go directly to a Government Hospital in emergencies (no prior referral needed).
• However, the ESM must inform the Parent Polyclinic within 48 hours of admission.

Step 2: Referral Requirement for Major Treatments

Referral from Polyclinic is mandatory for the following:

1. Major cardiac surgery
2. Interventional cardiology
3. Oncology (cancer cases)
4. Organ transplant
5. Joint replacement
6. Neuro-surgical / neurological cases
7. Bariatric surgery

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Step 3: Payment and Claim

• Treatment is on a payment basis.
• ESM pays initially and then claims reimbursement as per CGHS rates.
• Government hospitals are reimbursed 100% of CGHS rates.

Reimbursement Process

Documents Required

• Discharge summary, bills, prescriptions, and claim form.
• Submission to Parent Polyclinic within 90 days of discharge.

Processing & Payment

• Polyclinic processes the reimbursement claim.
• Final sanction and payment are made by the ECHS Central Organisation.
• The sanctioned amount (as per CGHS rates) is directly credited to the ESM’s bank account.

Key Timelines at a Glance

Type of Reporting / Claim	Timeline	Authority for Delay Waiver
Inform about Emergency Admission	Within 48 hours	—
Submit Claim	Within 90 days	—
Delayed Submission	91–180 days	RC Waiver
Highly Delayed	181–365 days	Central Org Waiver

Summary

The ECHS Treatment Process ensures that all Ex-Servicemen receive timely and quality healthcare—whether in normal, emergency, or specialized situations. The system emphasizes:

• Cashless treatment in empanelled hospitals,
• Self-paid treatment with reimbursement in non-empanelled or government hospitals,
• Transparency and accountability through online documentation and timelines.

✅ Key Takeaway:
Always carry your ECHS Smart Card, keep emergency contact details updated, and inform the Polyclinic within 48 hours of any emergency hospitalization to ensure smooth processing of claims and benefits.