Govt Policy on ECHS Empaneled Hospitals : Updates

Empaneled hospitals are providing medical support on behalf of the ECHS to their beneficiaries i.e  ESM and their family members including retired short service commissioned officers.  Do you know what is the correct definition of an Empaneled Hospital ?  Lets read the detailed instructions of MoD in this regard which will guide you to know everything about your empaneled hospital.

In the context of government health schemes in India, an empaneled hospital refers to a healthcare facility that has been officially approved and included in the panel or list of hospitals that are authorized to provide medical services to beneficiaries of a particular government health scheme.

Government health schemes in India often have a network of empaneled hospitals across various cities and regions. These hospitals are selected based on certain criteria such as infrastructure, quality of medical services, availability of specialists, and adherence to prescribed standards.

Patients enrolled in a government health scheme can visit these empaneled hospitals to avail themselves of healthcare services covered by the scheme. The advantage of empanelment is that it allows beneficiaries to access medical treatment and services at these approved facilities without having to bear the entire cost themselves.

It’s important to note that the specific empaneled hospitals can vary depending on the particular government health scheme, such as ECHS, CGHS, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) or state-specific health insurance programs. To find out the list of empaneled hospitals under a specific government health scheme, individuals can usually refer to the official website of the scheme or contact the relevant authorities.

A copy of DESW letter dated 25 Sep 2019 is reproduced here to know about the empaneled hospitals and their function/responsibilities.

No.22D(01 )/2018/(WE)/ D(Res-l)
Government of India
Ministry of Defence
Department of Ex-Servicemen Welfare
Sena Bhavan, New Delhi

                                                                                               Dated: 25 Sept 2019

The Managing Director
Central Organisation
Ex-servicemen Contributory Health Scheme
Thimaya Marg, Gopinath Circle, Delhi  Cantt.

Subject Clarification regarding definition of empanelled hospital and consequent handling of cases of treatment taken by ECHS beneficiaries in such hospitals.

Sir,

The undersigned is directed to refer to CO, ECHS letter No.49770/AG/ECHS /Treatment dated 23-8-2019 and to issue the following clarifications.

(i)            A hospital shall be considered to be on ECHS panel only when it has a valid MoA or it is not under orders of stop referral.

(ii)           If any hospital does not have a valid MoA or it is under stop referral and an ECHS beneficiary takes treatment in such a hospital in an emergency by making payment, the amount should be reimbursed to the ECHS beneficiary as per CGHS rates.

(iii)         If a hospital is without valid 111loA or it is under stop referral and any ECHS beneficiary having a valid referral from ECHS polyclinic chases to take treatment in such hospital due to having taken ‘treatment in the same hospital earlier as well he should be allowed to take treatment in the hospital after making payment to the hospital and seek re-imbursement at CGHS rates.

(iv)         If a hospital is empanelled but due to huge pending bills remaining unpaid refuses to extend cashless treatment and an ECHS beneficiary takes treatment therein and seek reimbursement, the same shall be allowed at CGHS rates. However, at the same time CO, ECHS will send a proposal to MoD for dis empanelment of this hospital.

2 CO, ECHS may take necessary action accordingly.

Yours faithfully,
Under Secretary (WE)

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