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
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:
- Major cardiac surgery
- Interventional cardiology
- Oncology (cancer cases)
- Organ transplant
- Joint replacement
- Neuro-surgical / neurological cases
- Bariatric surgery
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.
