It has been revealed while interacted with veterans in social meet that they are unable to use the ECHS facility upto optimum level due to ignorance about the scheme and its rules. Such ignorance also leads to comparison of the ECHS with CGHS, a parallel Central govt scheme meant for civilian central govt employees. A detailed discussion on the ECHS facilities will clarify all the ambiguities. Here are some myths regarding the issue and the fact checks.
ECHS follows all policies of CGHS. All the referral rules for OPD/IPD/Inv are the same as CGHS. There are no deviations in ECHS. Even ECHS does not question any prescription written by the Doctor of an empanelled hospital. The medicines given by the Polyclinic are of Generic nature which is also the case in Wellness Centres of CGHS.
ECHS has 433 polyclinics which has about 327 contractual Employes only. The PC is not just a referral centre. It is mandated to provide Primary Healthcare and therefore has qualified doctors in its staff who examine the patients. All the patients do not need referral are treated and prescribed medicines. Only patients who require secondary or tertiary care under a specialist or a super-specialist are referred to empanelled hospitals.
The checks on veracity of visiting patients are to control fraud and Aadhar Authentication is being gradually introduced as per directions of Ministry of Electronics and Information Technology, Govt of India, to introduce two-factor authentication in all Central Govt welfare schemes. Failure of Aadhar authentication due to some reason will not lead to denial of services as alternatives are in place.
The ECHS OIC is also a veteran and a beneficiary of the scheme. ECHS is taking all steps to ensure veteran friendly OIC with good knowledge of ECHS rules and regulation is appointed. The ECHS is a cashless capless scheme which covers OPD/IPD including medicines, which no insurance scheme allows.
ECHS is run as per the directions of the Mod (DESW), Govt of India. ECHS provides all facilities as CGHS and follows all rules as per CGHS, as laid down by the Govt. of India. No policy can be changed without a government order. It is a misnomer and fallacy that policy can be changed at will. No insurance policy gives the cashless and capless cover as ECHS. Insurance is a personal choice. Even in case beneficiary utilizes a private insurance policy, ECHS will provide the balance claim amount not passed by insurance.
One of the biggest drawbacks is the limited number of empanelled hospitals and the availability of specialists in certain areas. This can lead to challenges in accessing a wide range of medical services, especially for those residing in remote or rural areas where the network of empanelled hospitals might not be as extensive.
ECHS has more empanelled hospitals than CGHS. While the CGHS has 2248 empanelled Hospital the ECHS has about 3500. ECHS has polyclinics and empanelled hospitals in hilly and most remote places in India.
Additionally, there have been concerns about the bureaucratic processes and delays in settlements of medical claims. The scheme is designed to be cashless, but sometimes, due to administrative issues, beneficiaries might have to pay upfront and then go through a reimbursement process, which can be cumbersome.
Medical treatment in empanelled hospital is cashless. The veterans are not supposed to pay any cash unless they opt for a higher grade implant or procedures. Even if the veteran has to pay the bill, it is reimbursed as individual reimbursement. According to Govt orders issued by Govt of India, ECHS will follow CGHS rates. All Hospital which get empanelled concur to this rates. Recently, the following rates have been increased:
- ICU rates
- Consultation rates
- Room rent
- Cardiology
- Surgical rates
A committee is looking into the rates for further revision. ECHS has good network of approximately 3500 empanelled hospitals including top corporate hospitals, service hospital and reputed govt hospitals like AIIMS etc. for veterans’ care.
The biggest advantage of the Central Government Health Scheme (CGHS/ECHS) is its comprehensive coverage and cost-effectiveness. It provides complete healthcare facilities to central government employees and pensioners, ensuring access to quality medical services without financial strain. Some key benefits: Cashless Treatment, Wide Network (over 12,000 government and private hospitals across India), ECHS has full Family Coverage.
ECHS referral process has been simplified over time to reduce inconvenience and delays in treatment. For instance, referrals from CGHS Wellness Centers to empanelled hospitals are valid for 30 days and can be used for consultations up to three times within this period at the same hospital.
The E-Sehat is being rolled out and it would reduce the grievances of veterans. Moreover patients in emergency can directly go to Hospital rest have to come to ECHS for taking a referral. Patients above 75 years of age can directly go to empanelled hospital without referral.
ECHS is taking proactive steps to cater to the increase in veteran over the years with initiatives like upgradation of polyclinics, opening of new polyclinics in new places, Veteran Wings and Hospital, Emp of AIIMS and other reputed hospitals. DGAFMS has given clear direction that veterans will not be turned away from service hospital. ECHS will take strict action against empanelled hospital who refuse the veteran admission.
