EX SERVICEMEN CONTRIBUTORY HEALTH SCHEME

MED - COMPENDIUM
1/1/2011

POLICIES | MK

E_Book V_2.0 Compendium on MED

NEW VERSION WITH UPDATES 02 Nov 2011

CONTENT
(M EDI CAL)

SNO SECTION I : REVISION OF RATES

1. 2. 3. 4. 5. 6. MOA and CGHS Rates Policy : Revision of ECHS Rates 2010

SUBJECT

Implementation instructions : Revised ECHs Rates Super specialty status : Empanelled Hospitals Clarification regarding revision of packages rates Guidelines on oncology treatment Rates

SECTION II : REFERRAL

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

ECHS referral procedure (less NCR) ECHS referral to service hospital Referral to empanelled hospitals in different station Referral to empanelled hospitals echs polyclinic Thane ECHS referral policy for outstation patients Medical care for echs beneficiaries in remote/hilly areas Referral of echs patients to army hosp (R &R) Referral to empanelled hospitals in delhi/NCR Referral to empanelled hospitals in delhi/NCR ECHS Referral Procedure

SECTION III : PRIOR APPROVAL

1. Prior approval : Unlisted procedures/tests/implants

SECTION IV : PROCESSING OF BILLS/ REIMBURSEMENT

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Reimbursement medical expenses Representations by hospital/diagnostic centres on payment Submission of claim for reimbursement by outstation ECHS members Re-imbursement of medical expenses after demise of ESM/members of ECHS Re-imbursement of Medical bills of outstation ECHS members for treatment in Delhi Diet charges for ECHS Patients admitted to Hospital. Processing of claim for reimbursement : Non empanelled Hospital Case study : Establishment of emergency psychiatric cases Reimbursement of Vat on drug and consumables Processing of bills from empanelled medical facility/individual claims Procedure for payment and Reimbursement of medical expenses under ECHS Processing of minor hospital bill and individual claims Reconcilation of Hospital Bill Code Head : 365/00 Utilisation of provisions of Fin Regs towards speedy clearence of Medical Bill

SECTION V : PROCEDURE OF EMPANELMENT

1. 2. 3. 4. 5. 6. 7. 8. Empanelment of Govt Hospital Memoranda of Agreement Empanelment of hospital/Nursing Homes, dental centres and diagnostic centres Empanelment of dialysis centres Empanelment Of Hospitals At Other Stations-Not Under The Jurisdiction Of A Station Cdr. Empanelment of hospitals, nursing homes and diagnostic centres for ECHS Referral Of Echs Patients To Medanta, The Mediciti Hospital, Gurgaon Empanelment of hospitals: Ernest Money deposit and performance bank guarantee 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. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Issue of medicines to ECHS beneficiaries

Advisory No : 13 Medicines for Veterans Travelling Abraod Issue of anti cancer drugs to ECHS beneficiaries Issuance of strips for Glucometer Adherance of policy on indenting/ supply of medical stoes in polyclinics Indenting of medical stores Modification of ambulance at ECHS polyclinics Issue of expendable medical stores to new raising ECHS polyclinics. Issue of expendable medical stores to new raising ECHS polyclinics. Forwarded of : Annual Equipment Census Repair of ECHS Equipment Issue of hearing aids prescribed for ECHS members Issue of medical eqpt prescribed for ECHS members Fwd of SOP on repair and maintenance of medical Equipment held at ECHS Polyclinic Use of Inj Eptiflo in lieu of Inj Reopro respect of echs

SECTION VIII : TREATMENT

1. 2. 3. 4. 5. 6. Policy on duration of hospitalization Advisory No-09 : Emergency admissions in empanelled hospitals Advisory note no-06 requirement of blood for ECHS patients admitted in Empanelled/non empanelled hospitals Dependent status of new born baby Examination of patients in ECHS polyclinics Medical Examination/Health check up

GO TO CONTENT

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.

Col Jt Dir (Med) for MD ECHS

GO TO CONTENT

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.

Col Jt Dir (Med) for MD ECHS

Ministry of Defence (Deptt of Ex-Servicemen Welfare) Subject :- Revision of ECHS Rates Reference Central Org ECHS ID No B/49773/AG/ECHS/CGHS dated 3rd 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 19th 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. Sd/- X X X (HK Mallick) Under Secretary to the Govt of India Tele No 23014946 MD ECHS MOD ID No 22A(48)/2007/US/WE/D(Res) dated 19 Aug 2010

GO TO CONTENT

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) (ii) (iii) Nephrology and Urology (including Renal Transplantation). Endocrinology. Neuro Surgery. and GI-Surgery including Liver

(iv) Gastroenterology 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) (b) (c) (d) (e) (f) (g) (h) (j) (k) Registration charges. Admission charges. Accommodation charges including patients diet. Operation charges. Injection charges. Dressing charges. Doctor/consultant visit charges. ICU/ICCU charges. Monitoring charges. Transfusion charges.

(l) (m) (n)

Anesthesia charges. Operation Theatre charges. Procedure charges/Surgeons fee. surgical disposables and all sundries used during

(o) Cost of hospitalization. (p) (q) (r) (s)

Cost of medicines. Related routine and essential investigations. Physiotherapy charges etc. 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) (b) (c) (d) 12 days for Specialised (Super Specialities) treatment. 7 days for other Major Surgeries. 3 days for Laparoscopic surgeries/normal deliveries. 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. to ten patients. General ward is defined as halls that accommodate four

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 (a) (b) (c) Rank at the time or retirement Entitlement

NCOs & below of Army & equivalent in Navy & General Ward Air Force JCOs in Army & equivalent in Navy & Air Force Semi Private Ward 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.

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 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Name of Hospitals Kailash Hospital Sir Gangaram Hospital Indraprastha Apollo Hospital Wockhard Hospital Manipal Hospital Narayana Hridayalaya Apollo Hospital Medvin Hospital Apollo Hospital Sri Ramachandra Medical Centre Apollo Gleaneagles Hospital Cities Noida Delhi Delhi Mumbai Bangalore Bangalore Hyderabad Hyderabad Chennai Chennai Kolkata

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 Jammu rates. 2. Himachal Pradesh Jammu -do3. Punjab Chandigarh CGHS Delhi 2010 rates till promulgation of second revision CGHS Chandigarh rates 4. Haryana Chandigarh -do5. Delhi and NCR Delhi Delhi 2010 CGHS rates Region promulgated vide MOH & FW/OM MOH & FW office

6.

Uttar Pradesh

7.

Uttaranchal

Lucknow (except districts under Allahabad, Meerut, Kanpur Area) Allahabad (except districts under Lucknow, Meerut, Kanpur) Meerut (except districts under Lucknow, Allahabad, Kanpur) Kanpur (except districts under Lucknow, Meerut, Allahabad) Dehradun

memorandum No S 11011/23/2009-CGHS D-II/ Hospital Cell (Part I) dated 17 Aug 2010.

Pre 2006 rates applicable for Lucknow till promulgation of second revision of Lucknow rates by CGHS. Pre 2006 rates applicable for Allahabad till promulgation of second revision of Allahabad rates by CGHS. Pre 2006 rates applicable for Meerut till promulgation of second revision of Meerut rates by CGHS.

Pre 2006 rates applicable for Kanpur till promulgation of second revision of Kanpur rates by CGHS. Rates applicable for Lucknow till promulgation of second revision of Dehradun rates by CGHS.

Ser State 8. Bihar

9.

Jharkhand

10.

Orissa

11.

West Bengal

CGHS Rates Remarks Applicable Patna Pre 2006 rates applicable for Patna till promulgation of second revision of Patna rates by CGHS. Ranchi Pre 2006 rates applicable for Ranchi till promulgation of second revision of Ranchi rates by CGHS. Bhubaneshwar Rates applicable for Ranchi till promulgation of second revision of Bhubaneshwar rates by CGHS. Kolkata Kolkata 2010 CGHS rates promulgated vide MOH & FW/OM MOH & FW office
memorandum No S 11011/23/2009-CGHS D-II/ Hospital Cell (Part V) issued in Aug 2010.

12. 13. 14. 15. 16. 17. 18. 19. 20.

Sikkim Assam Meghalaya Mizoram Tripura Manipur Nagaland Arunachal Pradesh Madhya Pradesh

Kolkata Guwahati Shillong Guwahati Guwahati Guwahati Guwahati Guwahati Bhopal

Rates as applicable for Kolkata. Kolkata 2010 CGHS rates till promulgation of second revision of Guwahati rates by CGHS. Rates as applicable for Guwahati till promulgation of CGHS Shillong rates. Rates as applicable for Guwahati. -do-do-do-doRates applicable for Jabalpur till promulgation of second revision of Bhopal rates by CGHS. Pre 2006 rates applicable for Jabalpur till promulgation of second revision of Jabalpur.

Jabalpur

10

Ser State 21. Chattisgarh

22.

Rajasthan

23.

Gujarat

24.

Maharashtra

CGHS Rates Remarks Applicable Jabalpur Pre 2006 rates applicable for Jabalpur till promulgation of second revision of Jabalpur rates by CGHS. Jaipur Pre 2006 rates applicable for Jaipur till promulgation of second revision of Jaipur rates by CGHS Ahmedabad Pre 2006 rates applicable for Ahmedabad till promulgation of second revision of Ahmedabad by CGHS. Mumbai & Thane Mumbai 2010 CGHS rates (except districts promulgated vide MOH & under Pune, FW/OM MOH & FW office memorandum No S Nagpur Area)
11011/23/2009-CGHS D-II/ Hospital Cell (Part II) dated 17 Sep 2010.

25. 26.

Goa Karnataka

Pune (except districts under Mumbai, Thane and Nagpur Nagpur (except districts under Mumbai, Thane and Pune) Pune Bangalore

Pre 2006 rates applicable for Pune till promulgation of second revision of Pune rates by CGHS. Pre 2006 rates applicable for Nagpur till promulgation of second revision of Nagpur rates by CGHS. Rates as applicable for Pune. Bangalore 2010 CGHS rates promulgated vide MOH & FW/OM MOH & FW office
memorandum No S 11011/23/2009-CGHS D-II/ Hospital Cell (Part III) issued in Aug 2010.

27.

Kerala

Trivandrum

Pre 2006 rates applicable for Trivandrum till promulgation of second revision of Trivandrum rates by CGHS.

11

Ser State 28. Tamil Nadu

CGHS Rates Remarks Applicable Chennai Chennai 2010 CGHS rates promulgated vide MOH & FW/OM MOH & FW office
memorandum No S 11011/23/2009-CGHS D-II/ Hospital Cell (Part VI) issued in Aug 2010.

29.

Andhra Pradesh

Hyderabad

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 31. 32. 33. 34. 35. Andaman & Nicobar Islands Puducherry Lakhsadeep Islands Daman Diu Dadra & Nagar Haveli

Chandigarh Chennai Chennai Trivandrum Mumbai Mumbai

Rates as applicable for Chandigarh Rates as applicable for Chennai. Rates as for Trivandrum. Rates as applicable for Mumbai -do-doapplicable

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 Cardiology Implantation Devices 1. The ceiling rates for Cardiology Implantation Devices are as under :Name of the item (a) Coronary stent (i) Cypher stent (ii) Taxus Stent (iii) Endeavor (iv) Xience VEECSS (v) Yukon Choice (vi) Bare Metal Stent (b) Rotablator (c) Pacemaker ( Single Chamber) (i) Without rate response (ii) With rate response (d) Pacemaker (Dual Chamber) Maximum Ceiling Rate Rs.95,000/Rs.67,300/Rs.85,000/Rs.95,000/Rs.55,000/Rs.50,000/Rs.50,000/+ VAT + VAT + VAT + VAT + VAT (inclusive all )

Rs.37,000/Rs.65,000/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 patients 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) (d) Stenting of restenotic lesions after previous angioplasty. 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 DBS Implants (Including MER) Intra Thecal Pumps (Intra Thecal Beclofen Pump, Intra Thecal Morphine Pump) Spinal Cord Stimulator Ceiling Rate Rs. 3,60,000/Rs. 2,62,000/Rs. 2,62,000 Cost of Battery Rs. 2,50,000/Rs. 2,25,000/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 Knee Implant Hip Implant Maximum Ceiling Rate Rs. 60,000/- + the cost of bone cement Rs.5,000/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 Hydrophobic Foldable IOL Silicon Foldable IOL Hydrophilic Acrylic Lens PMMA IOL Maximum Ceiling Rate Rs.5,000/Rs.3,600/Rs.5,800/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) (vi) (vii) (b) No cochlear aplasia and/ or agenesis of cochlear nerve. No retro cochlear lesion or central deafness, and Good family support for post op rehabilitation

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) (ii) (iii) (iv) (b) OAE. BERA/ASSR. Impedence (in children). Audiogram/Aided audiogram.

Radiological. (i) (ii) HRCT temporal bone for bony cochlea and middle ear cleft. 3D MRI for membranous cochlea, Neural Bundle and brain

(c)

IQ/Psychiatric evaluation in children with prelingual deafness.

LIST OF SUPERSPECIALITY HOSPITALS Ser 1. Name of Hospitals Kailash Hospital and Research Centre, H-33, Sector-27, Noida201301 Recognized for General Services Specialised Services General Medicine, ENT, Dental Surgery : Neuro Surgery, Plastic and (Prosthetic, Periodontal & Reconstructive, Cardiothoracic Orthodontics only), Orthopedics, Surgery, Vascular Surgery, Geneto 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. Medicine : Neuro Medicine, Radio Diagnosis. Cardiology, Respiratory Disease, Gastroenterology, Endocrinology, Nephrology, Clinical Haematology, Oncology (Medical), Critical Care Medicine and Interventional Cardiology. Radio-diagnosis/Imaging : MRI Paediatrics : Nenatology Surgery : Heart, Cancer, Renal, Total Hip/Knee Joint Replacement and Prostate Surgery Radio-Diagnosis Surgery : Cardiothoracic Surgery, Genito Urinary Surgery (Urology and Lithotripsy), Joint Replacement, 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. General Medicine, ENT, Surgery : Neuro Surgery, Orthopedics, Microbiology, Cardiothoracic, Vascular Surgery, General Surgery, Geneto Urinary Surgery, Paediatric Ophthalmology, Anesthesia, Surgery, Gastro Intestinal, Blood Bank, Paediatrics, Traumatology, Joint Replacement, Pathology, Radio-diagnosis and Spinal and Laproscopic Surgery. Medicine : Neuro Medicine, Emergency Cardiology, Respiratory Diseases, Gasto Enterology, Endocranology, Rheumatology, Critical Care medicine and Interventional Cardiology. Radio-diagnosis/Imaging : CT Scan and MRI. Heart and Cancer Surgery : Cardiology and Cardiac Surgery.

2. 3.

Sir Gangaram Hospital, Sir Gangaram Hospital Marg, Delhi Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi 110044

4.

Wockhard Hospital Ltd, Mulund Goregon Link Road, Mumbai 400078

5. 6.

Manipal Hospital, 98, Rustan Bag Airport Road, Bangalore Narayana Hridayalaya, Bangalore

2 Ser 7. Name of Hospitals Apollo Hospital, Deccan Hospital Ltd, Jubilee Hills, Phase 3, Hyderabad Medvin Hospital, Raghava Ratana Towers, Chirag, Ali Lane, Hyderabad Apollo Hospital, 21 Greams Land (Off Greams Road), Chennai Sri Ramachandra Medical Centre 1. Ramachandra Nagar Porur, Chennai 600116 Recognized for Specialised Services Surgery : Heart, Cancer, Renal, Total Hip, Knee, Joint Replacement, Prosthetic Surgery (TCRP) and Lithotripsy Heart, Cancer and Renal

General Services

8.

9. 10.

Gerneral Medicine, ENT, Dental, Orthopaedics, Microbiology, General Surgery, Ophthalmology, Psychiatry, Blood Bank, Obstetrics and Gynaecology, Paediatrics, Dermatology, Pathology and Radio Diagnosis

11.

Surgery : Heart, Cancer, Renal and Total Hip, Knee, Joint Replacement and Prosthetic Surgery (TCRP) Surgery : Neuro Surgery, Plastic and Reconstructive, cardiopthoracic Surgery, Vascular Surgery, Genito urinary Surgery, Paediatric Surgery, Gastro intestinal Surgery, Traumatology, Joint Replacement, Spinal Surgery and Laparascopic 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

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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 :For CGHS Cities. A s per list of super speciality hospitals notified by

(a) 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.

Col Jt Dir (Med) for MD ECHS

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CLARIFICATION REGARDING REVISION OF PACKAGE RATES 1. 2010. Reference :(a) (b) (c) Govt of India, MoD ID No 22A(48)/2007/US/WE/D(Res) dated 19 A ug Our letter No B/49773/AG/ECHS/CGHS dated 24 Aug 2010. 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. I t would be ensured that the CGHS rates of the area are followed by ECHS.

Col Jt Dir (Med) for MD ECHS

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GUIDELINES ON ONCOLOGY TREATMENT RATES 1. Refer to Central Organisation ECHS following letter Nos :(a) (b) B/49774/AG/ECHS/Referral dated 01 Dec 2009. 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 2 (ab) Category II - 3-5 days (7-10 days in respect of operations involving Abdominal/thoracic cavity). - 14 days. - 1-2 days.

(ac)

Category III, IV and V

(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. Rates applicable for room rent (Accommodation (e) Room Rent. Charges) for different categories of wards will be as given below :(i) (ii) (iii) General Ward Semi-private Ward Private Ward - Rs 1,000/- per day. - Rs 2,000/- per day. - 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 MD ECHS

3 Appendix A (Refer to Para 2(a) (i) of Central Organisation letter No B/49773/AG/ECHS/Rates/Policy dated ______ Jul 2011) RATES FOR SURGICAL ONCOLOGY Ser 1. 2. 3. Description First Consultation (Surgical Oncology) Rates *400/Remarks * Revision 1 (Apr 2010)

Cross Consultation (Surgical Oncology) 265/Follow-up consultation (Surgical 275/Oncology) 4. Chemotherapy Consultation Full 3,310/Protocol (Surgical Oncology) 5. Intravenous Bolus per Cycle (Surgical 550/Oncology) 6. Chemotherapy Indoor Charges per 3,310/Cycle (Surgical Oncology) 7. 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 3,465/2hrs 11. Major OT Service Charges for 2 4hrs 5,775/12. Major OT Service Charges for More 8,455/than 4hrs 13. Minor OT Drugs/Consumables 325/(without GA) 14. 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 Cobalt 60 Therapy 1. Radical Therapy 2. Palliative Therapy Linear Accelerator 3. Radical Therapy 4. Palliative Therapy 5. 3D Planning 6. 2D Planning 7. IMRT (Intensity Modulated Radiotherapy) 8. SRT (Stereotactric Radiotherapy) 9. SRS (Stereotactic Radio Surgery) 10. IGRT (Image Guided Radiotherapy) 11. Respiratory Gating alongwith Linear Accelerator Planning 12. Electron Beam with Linear Accelerator 13. Tomotherapy Brachytherapy High Dose Radiation 14. Intracavitory 15. Interstitial 16. Intralumil 17. Surface Moul 18. GLIADAL WAFER Rates 70,000/25,000/95,000/47,500/8,910/6,530/1,29,000/78,000/1,03,000/1,88,000/1,25,000/89,060/Remarks

23,750/1,07,830/14,250/4,750/1,07,830/-

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 Chemotherapy 1. 1186 2. 1187 3. 1188 4. 1189 5. 1190 6. 1191 7. 1192 8. 1193

Name of Treatment Procedure Neoadjuvant Adjuvant Concurrent-chemoadiation Single drug Multiple drugs Targeted therapy Chemoport facility PICC line (Peripherally Inserted Central Consultation)

Rates 1960/1960/1430/590/1345/1310/3140/2000/-

Remarks

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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 ac count 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 t aken 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 be with the ECHS member. A uthority 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. H owever, 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) :(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. Procedure for Referrals 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 c heck 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 patients 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 r eferral 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 Appendix F attached. Emergencies above are given in a diagrammatic form at

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 a ttached 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) (b) (c) (d) Specialised procedures Other procedures Laparoscopic surgery Day care/minor procedures - 12 days. - 07 days. - 03 days. - 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

room 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 H Q 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) (b) (c) (d) (e) All India Institute of Medical Science, New Delhi. Post Graduate Institute, Chandigarh. Sanjay Gandhi Post Graduate Institte, Lucknow. National Institute of Mental Health and Neurosciences, Bangalore. Tata Memorial Hospital, Mumbai (for Oncology).

(f) (g) (h) (j) 28.

JIPMER, Pondicherry. Christain Medical College, Vellore. Shankar Nethralaya, Chennai. Medical College and Hospitals under the Central or State Government.

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. Organisation ECHS letter No B/49774/AG/ECHS dated

(c) Central 27 May 05. (d) (f)

Central Organisation ECHS letter No B/49764/AG/ECHS dated 05 Nov 05. 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.

Maj Gen MD ECHS Appendices :A B C D E F G - List of General Service Facilities. - List of Specialised Services. - List of Specialities with Check Box. - List of Polyclinics without Service Hospitals. - Format of the Referral Form. - Diagrammatic Form of ECHS Referral Flow Chart. - Format of the Emergency Information Report.

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

Appendix A (Refer to Para 7(a) of letter No B/49774/AG/ECHS/Referral dt 01 Dec 2009) LIST OF GENERAL SERVICE SPECIALITIES

Type of Speciality General Medicine ENT Emergency Services Dental Microbiology

Type of Speciality General Surgery Ophthalmology Psychiatry Anaesthesia Blood Bank (Blood Transfusion)

Type of Speciality Obstetrics Gynaecology Paediatrics Dermatology Pathology Radio diagnosis and

Appendix B (Refer to Para 7(b) of letter No B/49774/AG/ECHS/Referral dt 01 Dec 2009) LIST OF SPECIALIZED SERVICES

Specialised Services Surgery Neuro Surgery

Specialised Services Medicine Neuro Medicine

Specialised Services Obstetrics and Gynaecology Gynaecological Oncology Infertility and assisted reproduction Gynaecological Endocrinology Materno foetal Medicine

Plastic and R econstructive Cardiology Surgery Cardio Thoracic Surgery Respiratory Diseases Vascular Surgery Genito Urinary Surgery Paediatric Surgery Oncology (Surgery) Gastro Intestinal Surgery Traumatology Joint Replacement Surgery Spinal Surgery Prosthetic Surgery Laparascopic Surgery Endovascular Surgery Geriatric Surgery Gastro enterology Endocrinology Nephorology Rhematologyy Clinical Haematology Clinical Immunology Oncology (Medical) Critical care medicine Interventional Cardiology Medical Genetics Geriatric Medicine Radiotherapy

Paediatrics Neonatology Cardiology Neurology Haematology Nephrology Oncology

Pathology Onco Pathology

Radio Diagnosis & Imaging CT Scan MRI Interventional and Vascular Radiology

Molecular Pathology Transplant Pathology AIDS & Virology Molecular Immuno Pathology Genetic Pathology Transfusion Medicine

Appendix C (Refer to Para 8(b) (iii) of letter No B/49774/AG/ECHS/Referral dt 01 Dec 2009) FACILITGY AVAILABLITY IN SERVICE HOSPITALS NAME OF POLYCLINIC : _________________________________ NAME OF HOSPITAL : ___________________________________ Type of Speciality General Medicine ENT Dental Orthopaedics A. GENERAL SERVICES Type of Speciality General Surgery Opthalmology Psychiatry Blood Bank(Blood transfusion) B. SPECIALIZED SERVICES Specialised Services Surgery Neuro Surgery Plastic and Reconstructive Surgery Cardio Thoracic Surgery Vascular Surgery Genito Urinary Surgery Paediatric Surgery Oncology ( Surgery) Gastro Intestinal Surgery Traumatology Joint Replacement Surgery Prosthetic Surgery Laparascopic Surgery Geriatric Surgery Radio Diagnosis & Imaging Specialised Services Medicine Neuro Medicine Cardiology(consultation and diagnostics) Interventional Cardiology Gastro enterology Endocrinology Nephrology Rhematology Clinical Haematology Clinical Immunology Oncology (Medical) Respiratory Diseases Radiotherapy Nuclear Medicine Dental Specialised Services Obstetrics & Gynaecology Gynaecology Oncology Infertility and assisted reproduction Type of Speciality Obstetrics and Gynaecology Paediatrics Dermatology Pathology Radio diagnosis

Paediatrics Neonatology

Pathology Onco Pathology Transfusion Medicine Other (Specify)

CT Scan MRI Interventional and Vascular Radiology Dated: Note : PLEASE MARK REFERRED. PLEASE MARK AVAILABLE.

Orthodontia Prosthodontia Oral Surgery Other (Signature of CO/Comdt Hospital/Designated Offr) AG AINST SPECIALITIES FOR WHICH ECHS PATIENTS CAN BE AGAINST SPECIALITIES FOR WHICH SPARE CAPACITY IS NOT

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 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Polyclinic Janglot Moga Sangrur Sirsa Jaisalmer Ajmer Saharanpur (Sarsawa) Bharatpur Balasore Nagpur Yelahanka Dimapur Shajahanpur Kotdwara Haldwani 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 : Dated : OIC POLYCLINIC * Travel reimbursement allowed (Yes/No). * Attendant reimbursement allowed (Yes/No). Place : Dated : Signature of Med Officer (with stamp)

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 : Date : Part III Final Disposal (a) (b)

(Signature and Stamp)

Admission to (Specify Hospital, Nursing Home, Diagnostic Centre) To follow treatment as specified.

Place :

Signature of Med Officer ECHS with Stamp

Appendix F (Refer to Para 11 of letter No B/49774/AG/ECHS/Referral dt 01 Dec 2009) ECHS REFERRAL FLOW CHART VERIFICATION OF ECHS MEMBER

Specialists Medical Gynaec

Medical Officer

Dental Officer

Further Diagnostic Tests / Treatment / Hospitalisation Required E M E R G E N C Y

On Advice of Concerned - Specialists Polyclinics - Specialists Service Hospitals - Specialists Govt Hospital - Specialist Empanelled Facility

General Service

Specialised Service

Is facility available in Service Hospital

On Advice of :MO Polyclinics / Specialist Polyclinic

Yes

No

Spare capacity to treat ECHS patient

Choice of Patient

Empanelled Facility

Yes

No

Service Hospital in Station

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 Generals Branch Army Headquarters L Block, New Delhi 110 001 27 Dec 2006

B/75068/DGMS-5B/ECHS 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

Lt Col JDMS (ESM Cell) For DGMS (Army)

Appendix A

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

WESTERN COMMAND

CENTRAL COMMAND

Enclosure 5 (Refer to Para 25 (b) of letter No B/49774/AG/ECHS/Referral dt ____________ 2009) Tele: 011-25684945 Mil: 233 36833 Central Organisation ECHS Adjutant Generals Branch Integrated HQ of MoD Maude Lines Delhi Cantt 10 05 Apr 07

B/49774-P/AG/ECHS/Referral 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) (b) Distance from nearest polyclinic should be more than 50 Kms. Applicable for residents of following states only :(i) (ii) (iii) Jammu & Kashmir. Himachal Pradesh. Uttranchal.

(iv) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram, Manipur, Tripura and Nagaland. (v) (vi) (vii) (viii) (ix) (c) West Bengal : District Darjiling only. Karnataka : District Chikmagalur, Kodagu only. Tamil Nadu : District Nilgiris only. Chattisgarh : Distt Bastar and Dantewara only. Orissa : District Koraput only.

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) (c) Photocopy of ECHS Smart Card/Regn Slip. 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. E mergency 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) DGMS (Navy) DGMS (Air Force All HQ Area/Sub Area All Regional Centres - for info please.

Maj Gen MD ECHS

- Please disseminate the above contents to all polyclinics under jurisdiction.

Enclosure 6 (Refer to Para 25 (b) of letter No B/49774/AG/ECHS/Referral dt ____________ 2009) Tele: 011-25684945 Mil: 233 36833 Central Organisation ECHS Adjutant Generals Branch Integrated HQ of MoD Maude Lines Delhi Cantt 10 25 Apr 07

B/49774-P/AG/ECHS/Referral 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 05 Apr 2007. to this Organisation letter No B/49774-P/AG/ECHS/Referral dt

2. Para 2(b) of this Org letter quoted in ref may please be d eleted and reconstructed as under :Applicable for residents of following stats only :(i) (ii) Himachal Pradesh. Uttranchal.

(iii) North Eastern States of Sikkim, Arunachal Pradesn, Mizoram, Manipur, Tripura, Nagaland and Meghalaya (less district Shillong). (iv) (v) (vi) (vii) (viii) West Bengal : District Darjiling only. Karnataka : District Chikmagalur and Kodagu only. Tamil Nadu : District Nilgiris only. Chattisgarh : Distt Bastar and Dantewara only. Orissa : District Koraput and Mayurbhanj only.

Copy to :DGAFMS/DG-3A DGMS (Army)/DGMS 5(B) DGMS (Navy) DGMS (Air Force All HQ Area/Sub Area All Regional Centres Tele/Fax : 011-25684945 - for info please.

Col Dir (Med) For MD ECHS

- Please disseminate the above contents to all polyclinics under jurisdiction. Central Organisation, ECHS

GO TO CONTENT

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.

Col Dir (Med) For MD Copy to : ------------------------All Regional Centers : For information and necessary action please.

GO TO CONTENT

REFERRAL TO EMPANELLED HOSPITALS IN DIFFERENT STATION 1. Representations are received from ECHS members residing in nonMetro/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 _________________________________________ OR There is no Service Hospital in _______________

(Station of origin of referral)

(Name of Service Hospital of Station where referred, if applicable)

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,

Col 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 _________________________________________ OR There is no Service Hospital in _______________

(Station of origin of referral)

(Name of Service Hospital of Station where referred, if applicable)

AND Verified that Speciality/Facility is not available In _____________________________________________

(Name of Service Hospital of Station where referred, if applicable)

GO TO CONTENT

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.

Col Dir (Med) For MD ECHS

GO TO CONTENT

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) (b) (c ) (d) (e) (f) Uttar Pradesh Uttarakhand Bihar Orissa West Bengal 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.

Lt Col Jt Dir (Med) For MD

GO TO CONTENT

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

Col Jt Dir (Med) For MD

GO TO CONTENT

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) (b) General Services - ENT, Opthalmology

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) (iv) (v) Obstetries and Gynaecology - Gynaccology Oncology Paediatrics Pathology - Cardiology, Neurology - 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) (ii) CT Scan 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.

Lt Col Jt Dir (Med) For MD

GO TO CONTENT

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. T he problem gets compounded because of old age and medical condition of the ECHS beneficiaries. (b) The issue of hardships faced by our veterans on ac ct 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 (a) NAME OF POLYCLINIC Delhi Cantt and Lodhi Road POLICY OF REFERRAL 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) (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. (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.

(b)

Noida, Gurgaon & Faridabad

(c )

Hindan

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 patients 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) (c ) 10. B/49774/AG/ECHS dated 23 Aug 2006 B/49774/AG/ECHS/Referral dated 18 May 2009 B/49774/AG/ECHS/Referral dated 01 Jul 2009

The policy shall be reviewed after six months. Maj Gen MD ECHS

GO TO CONTENT

REFERRAL TO EMPANELLED HOSPITALS IN DELHI/NCR 1. References :(a) (b) This office letter No. B/49774/AG/ECHS/Referral dated 10 Aug 2009 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.

Col Dir (Med) For MD ECHS 8. Necessary amendments to Govt letter will be carried out after the overall review of ECHS.

Wg Cdr Offg Dir (Med) For Managing Director

GO TO INTENT

ECHS REFERRAL PROCEDURE 1. The following amendment is made in B/49774/AG/ECHS/Referral dated 01 Dec 2009:Para 7 of Central Org ECHS letter No .

(a) For. Referral to empanelled facilities will be generated from ECHS Polyclinic. The choice of empanelled facility will be with the ECHS member. (b) Read. Referral to empanelled facilities will be generated from ECHS Polyclinic. The choice of empanelled facility will be with the ECHS members and those ECHS members who are 80 years and above will be given preference for admission to Service hospitals, if that is their choice, depending on bed availability in the service hospital concerned. 2. 3. The new policy will be effective from the date of issue of this letter. Central Org ECHS letter No. B/49774/AG/ECHS/Referral dated 17 Sep 2012 is hereby cancelled. . Authority: B/49774/AG/ECHS/Referral dated 17Oct 2012 Jt Dir (Med) for MD

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

Sanction

CFA

* 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 S eptember 2003 an d 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) (b) (c ) ECHS card No/Regn No Name of Patient Name of the Hospital : ____________________________ : ____________________________ : ____________________________ ____________________________ ____________________________ (d) (e) Period of Hospitalisation Diagnosis : ____________________________ : ____________________________ _____________________________ (f) Amount Santioned : Rs _________________________

(Rupees____________________________________________only) File Ref : Date (Sanction of CFA)

Encl 5 (Refer to Para 14 of letter No. B/49774/AG/ECHS/Referral Dt 01 Dec 2009) Tele : 011-25684945 Mil : 6833 Central Organisation, ECHS Adjutant Generals Branch IHQ of MoD (Army) Madue Line, Delhi Cantt -10 B/49773/AG/ECHS/Policy 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 PROCEDURE FOR PAYMENT AND REIMBURSEMENT OF MEDICAL EXPENSES UNDER ECHS 1. Reference :(a) (b) (c ) GOI, MOD letter No 24(8)/03/US(WE)/D(Res) DATED 19 Dec 2003. This HQ letter No B/49778/AG/ECHS/POLICY dated 16 May 2007. This HQ letter No B/49778/AG/ECHS/Policy dated 19 Aug 2008. 01 Dec 2008

2. Following paragraph may be adde d 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.

Lt Cot Jt Dir (Med) For Managing Director Copy to :____________________ Contents to all All Regional Centres ECHS Kendiry Saink Board Internal :Web JCO P & FC Sec - Please ensure dissemination of above Concerned under AOR -For info please

Encl 6 (Refer to Para 14 of letter No. B/49774/AG/ECHS/Referral Dt 01 Dec 2009) Tele : 011-25684945 Mil : 6833 Central Organisation, ECHS Adjutant Generals Branch IHQ of MoD (Army) Madue Line, Delhi Cantt -10 B/49773/AG/ECHS/Policy _______________ (All Regional Centres 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 E CHS member due t o 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. 26 May 2009

(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.

Wg Cdr Offg Dir (Med) For Offg MD Copy to :All Comd HQs

Encl 7 (Refer to Para 25 (b) of letter No. B/49774/AG/ECHS/Referral Dt 01 Dec 2009) Tele : 011-25684945 Mil : 6833 Central Organisation, ECHS Adjutant Generals Branch IHQ of MoD (Army) Madue Line, Delhi Cantt -10 B/49773/AG/ECHS/Policy 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 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) (b) Distance from nearest Polyclinic should be more than 50 Kms. 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) (c ) Orissa : District Koraput only. 05 Apr 07

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:-

Encl 8 (Refer to Para 25 (b) of letter No. B/49774/AG/ECHS/Referral Dt 01 Dec 2009) Tele : 011-25684945 Mil : 6833 Central Organisation, ECHS Adjutant Generals Branch IHQ of MoD (Army) Madue Line, Delhi Cantt -10 B/49773/AG/ECHS/Policy 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 :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. 25 Apr 07

Col Dir (Med) For MD ECHS Copy to :DGAFMS/DG-3A DGMS(Army)/DGMS 5(B) DGMS(Navy) DGMS(Air Force) All HQ Area/Sub Area All Regional Centres - for info please

- Please disseminate the above contents to all Polyclinics under jurisdication.

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PRIOR APPROVAL : UNLISTED PROCEDURES/TESTS/IMPLANTS

Reference 1. 2. Our letter No B/49773/AG/ECHS dt 12 May 06. 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) (b) (c) Less than two lakhs Two to four lakhs Above four lakhs SEMO/SMO/PMO/CMO Service Specialist in concerned speciality Concerned Senior Advisor/Consultant at Zonal/Comd Hosp [(for NCR- BHDC/ AH (R&R)]

Channel for Seeking Prior Approval 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.

3 Conclusion 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.

Maj Gen 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. 3. 6. 7. 8. 9. 10. 12. Name (Patient).2. Relationship with ECHS Member . No .. 4. Rank. 5. Name (Member)... Hospital. Diagnosis . Proposed Treatment Procedure/Test/Implants Estimated Cost (Rs). (in words). Case summary including investigation reports attached (Yes/No). 11. Remarks 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) PRIOR APPROVALS : UNLISTED PROCEDURES/TESTS/IMPLANTS (CHANNEL OF APPROVAL)

EMPANELLED HOSPITAL

POLYCLINIC See Note 2 See Note 2

SEMO

Upto Four Lakhs

Above Four Lakhs

Nearest Service Specialist

Senior Advisor/Consultant at nearest Zonal/Comd Hospital

Notes 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

- Fax/e.mail

(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. 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.

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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 n umber 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.

Lt Col Jt Dir (Med) for MD

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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. T he 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.

Lt Gen (Retd) MD ECHS

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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).

Col Dir (Med) For MD

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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. S mart 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.

Gp Capt 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 Oct 2006

Appendix B to letter No B/49773/AG/ECHS dated 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. 2. 3. 4. 5. CGHS Taken No and place of issue :

Validity of CGHS Card (for pensioners) from ________ to ________ Full Name of Card Holder (Block letters) Status (Govt Servant/Pensioner/Others) The following documents are submitted (Please tick(-/) the relevant column) (a) (b) (c) (d) Medical 97 Form Photocopy of CGHS Card Essentiality Certificate No of Original Bills/Vouchers : : : : : : : : : : : : : : : Yes/No Yes/No Yes/No _______ Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

(e) Whether original bills/vouchers Have been verified (f) (g) Copy of Discharge Summary Copy of Permission letter

(h) Whether the hospital has given break Lab investigations (j) Original papers have been lost the Following documents are submitted i) Photo Copies of Claim papers ii) Affidavit on Stamp Paper

(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. Deponent

Verified by Notary Public 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 : Verified by Notary Public ) W/o ( 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. 4. 5. Full name of Card Holder (Block Letters): Status (Govt,Servant/Pensioner/Other) The following documents are submitted (Please tick (-/) the relevant column) (a) (b) (c) (d) (e) (f) (g) (h) Medical 2004 Form Photocopy of CGHS card Essentiality Certificate No, of Original Bills Whether original bills/vouchers Have been verified Copy of discharge summary Copy of Permission letter : : : : : : : : : Yes/No Yes/No Yes/No _____ Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

(j)

Whether the hospital has given breakup: For lab investigations I. Photocopies of claim papers : II. Affidavit on Stamp Paper : Incase of death of card holder the Following documents are submitted __ I. II. III. Affidavit on Stamp paper by Claimant No objection from other legal Heirs on Stamp papers Copy of death certificate : : :

Yes/No Yes/No 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.

CENTRAL GOVERNMENT HEALTH SCHEME MEDICAL 2004 FORM FOR REIMBURSEMENT OF MEDICAL CLAIM OF CGHS BENEFICIARIES Computer NO 1. 2. 3. 4. 5. 6. 7. 8. (To be filled by the claimant) CGHS Token No and Place of issue : Validity of CGHS Token Card : From ____ to _____ and entitlement : Pvt/Semi Pvt/General Full name of the card holder (Block letters): Full address :

Telephone no. (O) ________ (R) _________ E-mail address if, any. Name of the Bank _________ Branch _________ SB A/C Branch MICR Code ________ Tele. No. of Bank Branch ________ 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. 11. Basic Pay/Basic Pension. 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) (b) 14. 15. OPD Treatment. Indoor Treatment. :

Details of Permission

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 : Verified by Notary Public ) W/o ( Address )

(ii)

Charges for : a) O.T b) c) d) (iii) iv) O.T. Consumables Anethesia Procedure Medicines

_________ _________ _________ _________ _________

_________ _________ _________ _________ _________

Implants like pacemaker joint replacement, Coronary Slent etc (details) _________ Artificial devices (details) Lab charges (Break-up given in Annexure). Spl. Nurse/Aya if any Miscellaneous _________ _________

_________ _________ _________

(v) (vi)

(vii) (viii) 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)

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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) (b) (c) (d) Bills of Empanelled Hospital. Bills for Emergency treatment in non Empanelled Hospitals. Bills for treatment in AIIMS/other Govt Hospitals. 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.

Lt Col Offg Dir (Med) For MD

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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.

Col Dir (Med) For Managing Director

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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.

Col 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 No 1. 2 3 4 5 6 7 8 9 10 11 Description Proof of membership(Photocopy of Smart Card/ Regn receipt Referral Form Discharge/Case Summary Bills on Original Cover Note Work sheet and Recommendation of Regionl Centre Emergency Certificate (If applicable) Emergency Treatment in Empanelled Hospital superscribed in RED on all bills (If applicable) Sanction letter of Medical Advance drawn (if applicable) Prior Approval (Appx A) Justification if Prior Approval not obtained (if applicable) Availability Yes/No/NA Flag A B C D E F G H J K L

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) CHECK LIST (Dealing Clk) 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 1. 2 3 4 5 6 7 8 9 10 11 12 Required Information/Doc Date of membership Proof of membership (Photocopy of Smart card/Receipt Referral form Emergency Certificate (If applicable) Original bills and Photocopy authenticated by OIC Polyclinic Emergency bills super scribed in Red Prior Approval Breakdown of charges by Hospital/OIC Polyclinic Receipt/Proof of payment of Hospital Endorsement by OIC Polyclinic regarding Beds/Speciality/Facility NA in Service Hospital Discharge/Case Summary/Patient record by treating Hospital Cover Note has endorsement of :(a) OIC Polyclinic (b) SEMO (c) Stn Cdr Remarks Available Not Available

Remarks :

Date :

Initial of Dealing Clk Verified by Jt Dir (Accts & Assets)

Date

(Signature)

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 Ref No PACKAGE DEAL Major Procedure : Name of Procedure Minor Procedure : Name of Procedure

Amount Claimed

Amount Entitled

Remarks

50% of authorized rate = Rate for type of ward x Duration of stay Auth/Not auth

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

= Rate for type of ward x Duration = Rate for type of ward x Duration Not auth

Recommendation (a) Recommended sanction for an amount of Rs__________________________ (b) Date : Not Recommended (Signature of Med Offr)

3 WORK SHEET AND ASEMENT 1. 2. Reference ECHS Member ID (a) (b) (c) (d) 4. 5. 6. 7. Name of Member Name of Patient ECHS No 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)

Hospital/Diagnostic Centre : (For Emergency Treatment/Urgent Investigation (a) Date of Admission _____________ (b) date of Discharge ________

Type of Claim (a) Empanelled Bill (b) Reimbursement Emergency/Urgernt Clinical Notes

8.

Bill Details (a) (b) (c) Amt billed Amt Admissible Amt Disallowed : : :

9.

Reasons for Disallowance

10.

Recommendations :Rs ___________ may be approved/sanction.

Date :

(Signature of Med Offr)

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) REMARKS OF DIR REGIONAL CENTRE

1. 2. 3. 4. 5. 6.

Membership Established Date of Hospital admission after membership Facilities NA at Service Hospital Referral Verified Prior Approval obtained/Condoned/NA Remarks/Recommendations :

: : : : :

Yes/No Yes/No Yes/No Yes/No Yes/No

Station : Date : 9Signature of Director)

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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.

Col Dir (Med) For Managing Director

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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.

Lt Col Offg Dir (Med) For Managing Director

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PROCESSING OF BILLS FROM EMPANELLED MEDICAL FACILITY/INDIVIDUAL CLAIMS 1. Ref :(a) Govt of India, Min of Def letter No 24(8)/03/US(WE)/D(Res) dated 19 Dec 2003. (b) (c) (d) Central Org ECHS letter No B/49773/AG/ECHS dated 25 May 2004. Central Org ECHS letter No B/49773/AG/ECHS dated 05 Feb 2005. 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.

Lt Col Offg Dir (Med) For Managing Director

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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 not iced in the above procedure :(a) (b) (c) (d) The procedure is time consuming. Virtually no value additional after SEMO/Stn HQ level. Avoidable paper work and addl effort. 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. C laim will be fwd to Central Organisation, ECHS for review alongwith detailed reasons for rejection. (Auth B/49773/AG/ECHS/Policy dt 01 Dec 2008)

Wg Cdr Offg Dir (Med) For Managing Director

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

Payment

SEMO

STN HQ*
Sanction

CFA

* 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) (b) (c) (d) (e) (f) ECHS Card No/Regn No Name of Patient Name of the Hospital Period of Hospitalisation Diagnosis Amount sanctioned : : : : : : Rs _________

(Rupees _______________________________________________ only)

File Ref : Date :

(Signature of CFA)

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PROCESSING OF MINOR HOSPITAL BILL AND INDIVIDUAL CLAIMS 1. References :(a) (b) Govt of India letter No 24 (8)/03/US(WE)/D(Res) dated 19 Dec 2003. 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).

Lt Col Offg Dir (Med) For Managing Director

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Tele: 28636834 ASCON : 36834 Central Organisation ECHS Adjutant Generals Branch Army Headquarters Maude Lines Delhi Cantt 110010 06 Nov 09

B/49779/AG/ECHS IHQ of MoD (Navy)/Dir ECHS(N) Air HQ (VB) /DPS HQ Southern Command (A/ECHS) HQ Eastern Command (A/ECHS) HQ Western Command (A/ECHS) HQ Central Command (A/ECHS) HQ Northern Command (A/ECHS) HQ South Western Command (A/ECHS) HQ Andaman & Nicobar Command (A/ECHS)

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. Brig Dy MD For MD ECHS Copy to :All Regional Centres.

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Tele: 28636831 ASCON: 36831 Central Organisation ECHS Adjutant Generals Branch Army Headquarters Maude Lines Delhi Cantt- 110 010 09 Sep 2009

B/49779/AG/ECHS IHQ MoD (Navy) {SO, ECHS} Air Headquarters (VB) {D Fin P} HQ Southern Command (A) HQ Eastern Command (A) HQ Western Command (A) HQ Central Command (A) HQ Northern Command (A) HQ South Western Command (A)

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 CFAs 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. Brig Dy MD For MD ECHS Copy to:CGDA Dy CDA (WC) -This refers discussion at HQ Western Command on the subject on 08 Sep 2009.

Air HQ (VB) {DPS} Air HQ (RKP) {Dte of MS (Air)} All Regional Centres . (All PCsDA / CsDA)

Appendix A (Refer Para 3 of B/49779/AG/ECHS dated 09 Sep 2009]

SPECIMEN COPY
Tele : Station HQ Delhi Area New Delhi- 10 File Reference PCDA (WC) Chandigarh Date

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

Appendix B (Refer Para 4 of B/49779/AG/ECHS dated 09 Sep 2009]

SPECIMEN COPY (Note to CFA)

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. of Name the ESM / Member Sub Singh Nk Kumar K Name of Patient with Relation Mamta Devi (Mother) Self Name & Place of the Hospital Appollo Hospital, Delhi Fortis Hospital, Mohalli Period of Hospitalisation From To 01/01/ 09 15/06/ 09 15/01 /09 21/06 /09 Diagnosis Amount Recomme nded (In Rs) 9,514/-

1.

KC00057 KC01152

liver disease RTA injury

2.

10,154/-

3. 4.

40.

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. MD ECHS Nov 2009 VCOAS

Appendix C (Refer Para 4 of B/49779/AG/ECHS dated 09 Sep 2009]

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
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:Sl No. 1. 2. ECHS Card No. KC00057 KC01152 Name of the ESM / Member Sub K Singh Nk D Kumar Name of Patient with Relation Mamta Devi (Mother) Self Name & Place of the Hospital Apollo Hospital, Delhi Fortis Hospital, Mohalli Period of Hospitalization From To 01/01/09 15/06/09 15/01/09 21/06/09 Diagnosis Amount Sanctioned (In Rs) 9,514/10,154/-

Decompensate liver disease with complication RTA Chest injury

40.

File Reference: Station / Sub Area / Area/ Command Date: (XYZ) Rank Appointment of Officer Designated

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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 1027/Empanel/ECHS/192 dated 09 Aug 2004. disposes your letter No

Col Dir (Med)

MEMORANDA OF AGREEMENT EMPANELMENT OF HOSPITALS/NURSING HOMES, DENTAL CENTRES AND DIAGNOSTIC CENTRES

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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.

Lt Col Jt Dir (Med) for MD ECHS

Appendix A

MEMORANDUM OF AGREEMENT (Format for Hospital/Nursing Home) 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. 5. The Hospital is not at liberty to revise the rate suo moto. The bills would be scrutinized by the ECHS authorities and would contain the

following :(a) (b) (c) (d) (e) (f) 6. Bills to be submitted on hospital performa. Medical advance drawn, if any. Referral slip from Polyclinic & photocopy of ECHS card. Summary of the case, including outcome. Consultation charges/Diagnostic/Package charges as applicable. Other charges if any, not included above (to be specified).

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. 9. 10. The Hospital would not refuse admission to referred case on flimsy ground. The schedule of approved charges are at Annexure II, attached hereto. 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) (f) Acute abdomen including acute obstetrical and gynaecological emergencies. Life threatening Injuries including Road traffic accidents, Head Injuries,

Multiple Injuries, Crush Injuries and thermal injuries. (g) (h) (j) (k) (l) Acute poisoning and snake bite. Acute endocrine emergencies including diabetic Ketoacidosis. Heat stroke and cold injuries of life threatening nature. Acute Renal Failure. 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 months

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. T he Arbitration proceedings will be hel d 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. period. The services would be extended on billing system to referred cases for agreed upon 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) (b) (c) (d) 6. Bills to be submitted on Diagnostic Centre performa. Referral slip from Polyclinic & photocopy of ECHS card. Diagnostic/Package Charges as applicable. Other charges if any, not included above (to be specified).

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. 9. The schedule of approved charges are at Annexure II, attached hereto. 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 months

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 Laboratory and all other expenses required by the Diagnostic

Clinic/Dental

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

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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) (b) (c) (d) (e) (f) Command Hospital, Pune. Command Hospital, Kolkata. Command Hospital, Chandimandir. Command Hospital, Lucknow. Base Hospital, Delhi Cantt. Military Hospital, Jalandhar.

2. To establish the Dialysis Centers, a corpus was created at each of the Hospitals, which was shared by AGs 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.

Lt Gen (Retd) MD ECHS

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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.

Lt Col Jt Dir (Med) For MD ECHS

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

Read. Min of Def letter No 24(9)/03/US(WE)/D(Res) dated 16 Jun 04.

Col Dir (Med) for MD ECHS

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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.

Jt Dir (Med) for MD ECHS

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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 P erformance 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 t echnical 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) (ii) (iii) (iv) Refusal of service. Undertaking unnecessary procedures. Prescribing unnecessary drugs / tests. 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) (ix) If recommended by NABH / NABL at any stage. Discrimination against ECHS beneficiaries vis--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) 5. The decision of the Ministry of Defence (ESW) in this regard shall be final.

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.

Sd/-x-x-x-x-x (A Srivastava) Maj Gen MD ECHS

PERFORMANCE BANK GUARANTEE

To: President of India Acting through (Regional Centre ECHS)

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 W E ( 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 Address:

Signature and Seal of Guarantors

_____________________________________ _____________________________________

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Tele : 25684945 ASCON: 36833 B/49771/AG/ECHS/Emp CENTRAL ORGANISATION ECHS 19 Sep 2011

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.

Sd/-x-x-x-x-x (SB Chaudhury) Wg Cdr Jt Dir (Med) for MD ECHS DS (Res-I)

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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 22B(04)/2010/US(WE)/D(Res) dated 18 Feb 2011. of Defence letter No

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) (b) (c) (d) 5. Application Form (ECHS-01) - For Hospitals/Nursing Homes/ Hospices. Application Form (ECHS-02) - For Eye Care Centres. Application Form (ECHS-03) - For Imaging Centres/Diagnostic Laboratories. Application Form (ECHS-04) - For Dental Clinics.

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 numbered. shall be serially

(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 (i) (ii) Type of facility Hospitals/Nursing Homes/ Hospices Diagnostic, Eye Dental Centres Bed Strength More than 100 beds Less than 100 beds & Not applicable Inspection / Assessment Fee (Rs) 35,000/30,000/25,000/-

(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 E MD 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) (vii) Photocopy of PAN Card. 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) (ii) (iii) (iv) Application Fee will be levied. EMD is to be obtained. Inspection/Assessment fees will be levied. 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 h oliday 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) (ii) (iii) They are in order and complete. Any computational errors have been made. 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 15th of ensuing month. 7. Inspection of Hospitals and 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. C entral 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) (ii) (iii) (vi) One copy for PCDA/CDA. One copy per Polyclinic. One copy per SEMO. 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) (c) (d) (e) (f) (g) (h) B/49771/AG/ECHS/Empanelment dated 05 Dec 2003. B/49771/AG/ECHS/Empanelment dated 13 Jan 2005. B/49771/AG/ECHS/Empanelment dated 24 Jan 2005. B/49771/AG/ECHS/Policy dated 25 Jan 2005. B/49771/AG/ECHS dated28 Feb 2005. B/49771/AG/ECHS/Empanelment dated 15 Mar 2005. B/49771/AG/ECHS/Empanel dated 15 Sep 2006. B/49771/AG/ECHS/MOA dated 29 Nov 2006.

(j) (k) (l) (m) (n) (o) (p) (q) (r)

B/49771/AG/ECHS/Hosp/R dated 29 Jan 2007. B/49771/AG/ECHS/Policy dated 25 Jul 2007. B/49771/AG/ECHS/MOA dated 25 Jul 2007. B/49771/AG/ECHS/Policy dated 17 Sep 2008. B/49771/AG/ECHS/Policy dated 05 May 2009. B/49771/AG/ECHS/Policy dated 30 Jul 2009. B/49771/AG/ECHS/Policy dated 02 Sep 2009. B/49771/AG/ECHS/Policy dated 15 Sep 2009. B/49771/AG/ECHS dated 17 Mar 2010.

(A Srivastava) Maj Gen MD ECHS

Appendices :-

A B

- Certificate of Undertaking. - Certificate for Acceptance of Rates.

8 Appendix A (Refers to Para 5 (f) of Central Organisation, ECHS letter No B/49771/AG/ECHS/Emp/Policy 14 Oct 2011) CERTIFICATE OF UNDERTAKING 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 ap proval for empanelment the hospital/institution shall negotiate and accept rates lower or equal to prevailing ECHS rates.

Signature Head of Institution/Authorized Signatory

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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) (b) (c) Delete Para 9. Re-number Paras 10, 11 and 12 as 9, 10 and 11. 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) (e) Re-number Para 14 as Para 13. 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.

Sd/- X X X (A Srivastava) Maj Gen MD ECHS

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B/49773/AG/ECHS/Dental

10 Jun 2011

DENTAL SERVICES AT ECHS POLYCLINICS 1. Ref :(a) (b) B/49773/AG/ECHS/Dental dated 07 Jun 10. 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.

Considering the importance of dental surgery only technically 4. Staff. 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. Ambience of waiting area and surgery rooms is essential to 5. Ambience. 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. (KC Das) Col Jt Dir (Med) for MD ECSHS

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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.

Encls :- As above

Sd/- X X X X X (VM Nayak) Col Dir (Med) for MD ECHS

Telephone : 23093481 19189/DGAFMS/DG-2C 28 Jan 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. N o fixed period can be s tipulated for prescription, as at times, reviews are warranted more often depending on the drugs prescribed and the patients changing health condition. A one month review interval is the best possible balance between patients 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 t ime 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.

DGMS (Army) DGMS (Navy) DGMS (Air) MD ECHS

Sd/- x x x x x x (LR Sharma) Maj Gen Addl DGAFMS (E&S)

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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.

Sd/- X X X X X (SP Patil) Brig Dy MD for MD ECHS

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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. Sd/- x x x x x x (G Ghose) Col Dir (Med) for MD

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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. I t 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.

Sd/- x x x x x x (AK Naik) Lt Col Offg Dir (Med) for MD

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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

Sd/- x x x x x x (AK Naik) Lt Col Jt Dir (Med) for MD

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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 v iew to assess the authenticity of MMF

Sd/- x x x x x x (AK Naik) Lt Col Jt Dir (Med) for MD

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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. Sd/- x x x x x x (AK Naik) Lt Col Jt Dir (Med) for MD

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ISSUE OF EXPENDABLE MEDICAL STORES TO NEW RAISING ECHS POLYCLINICS 1. A letter received from Office of DGAFMS letter No 34906/ECHS/DGAFMS/DG2B(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

Sd/- x x x x x x (KC Das) Col Jt Dir (Med) for MD

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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 phaseII 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.

Sd/- x x x x x x (MK Amar) Lt Col Jt Dir AFMS (DG-2A&D) for DGAFMS

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FORWARDING OF : ANNUAL EQUIPMENT CENSUS 1. Please refer to the following : (a) (b) (c) Office of the DGAFMS letter No 3505/4/CENSUS/DGAFMS/DG-2D dated 09 Jun 1988. Office of the DGAFMS letter No 20069/Eqpt/Census/DGAFMS/DG2C/2007. 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 02026360812.

(B Sridhar) Colonel 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 Nomenclature Qty Qty /NIV auth held No with ME Scale No 2 3 4 5 Life cycl e SO/AT availabilit y Source Name and Model Year of & cost address of installation in Manufactures Indian rupees 6 Whether functiona l Yes/No 7 8 9 Date of last ATEO inspectio n and remarks 16

Warranty/AM C with date and Name of agency 10

Log-book availabilit y

Brief reason, if not functional/actio n taken 15

11

12

13

14

Note : (TO BE FWD BOTH IN HARD & SOFT COPY) TO BE FAXED ON THE LE 020-26360821 (available 24 hours)

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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).

Sd/- x x x x x x x (AP Pandit) Brig DDG (Stdn)

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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.

Sd/- x x x x x x (KC Das) Col Jt Dir (Med) for MD

GO TO CONTENT

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. T he 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 t he 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). T he 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) (c) (d) (e) Recommendation of the Senior Adviser and Consultant. Quotation from vendors. Comparative Statement. 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 m ade 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) (d) Quotations from vendors. 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.

Sd/- x x x x x x (G Ghosh) Col Dir (Med) for MD ECHS

GO TO INTENT

FWD OF SOP ON REPAIR AND MAINTENANCE OF MEDICAL EQUIPMENT HELD AT ECHS POLYCLINIC 1. SOP on repair and maint of medical eqpt held at ECHS polyclinic is fwd herewith for your further necessary action. 2. You are requested to disseminate the same to all concerned under your jurisdiction.

Jt Dir (Med) for MD Authority- B/49761/AG/ECHS dated11 Mar 2008

STANDARD OPERATING PROCEDURE REPAIR AND MAINTENANCE OF MEDICAL EQUIPMENT HELD AT ECHS POLYCLINIC 1. References:(a) Govt of India, Min of Def letter No. 3505/4/DGAFMS/DG-2D/2861/99/D(Med) dt 23 Sep 99.

(b) Part VI of Govt of India, Min of Def letter No. 24 (3) /03/US (WE)/ D(Res) (ii) dated 09 Sep 2003. (c) (d) AO 5/99 & 12/2004 Various instructions on equipment repair and maintenance from this HQ fwd from time to time.

(e)

Recent ECHS Regional Directors Conference 07

2. This SOP lays down the repair, maintenance and sentencing of all medical equipment held at ECHS Polyclinics. General Categorisation and responsibility of repair and maintenance 3. All equipment used in the ECHS Polyclinics has been divided into three categories (Appx A- C) and category wise repair/ maintenance responsibilities in Mil and Non Mil Stations are given as under : Ser No. (a) Category of equipments Non-electro medical equipment Responsibility of repair/ maintenance Mil Station Local EME workshop / command repair cell under 363/01 except for minor urgent petty repair Non-Mil Stations Local EME workshop / comm Remarks

Minor urgent /patty repair in Non Mil Stn may be carried out from local civil firm and paid from Non Mil Polyclinic LP find under code Head under code Head 363/01 duly vetted by SEMO

(b)

Electro medical equipment

(c)

Sophisticated electro medical equipment

Nodal EME worsshop ( Appx D ) / Command Repair call (CRC) / civil firm under financial power of SEMO/AFMSD/ DGAFMS under code Head 363/01. Original equipment manufacturer (OEM)/ civil firm under financial power of SEMO /AFMSD/ DGFMS under code Head 363/01.

Same as for Mil Stations

Same for Mil Station

REPAIR AND MAINTENANCE FROM CIVIL SOURCES.

4. Conventional system of echelon of repair shall of not be applicable in case of medical and dental equipment as their repair and maintenance will be carried out by concerned repair agencies through Local purchase (LP) of spares, Local Repair Contract (LRC) or directly by the Original Equipment Manufacturer (OEMs) or the civil firm . No Non availability certificate (NAC) should be required by the workshop / Polyclinics for under taken LP of spares for medical and dental equipment . Repair and servicing of medical /Dental equipment from civil sources will be carried out under the circumstance and upto the prescribed financial limit of concerned CFAs as laid down in Govt of India letter quoted above (Para 1a). 5 .The repair and servicing / maintenance facilities civil sources have been instiuted with the aim to keep the medical equipment held by ECHS Polyclinic in a function state at all time in Mil and Non Mil Station , if local EME workshop repair facilities are inadequate and also to reduce avoidable back loading of equipment under BLR/ BER certificate , normal procedure will be adopted while processing the case for repair / servicing / maintenances of medical /dental equipment through civil firms. 6. When cost of repair and servicing / maintenance exceeds the financial powers of SEMO and SITU civil repairs and servicing / maintenance is considered essential , quotation from the firm alongwith statement of case with full justification duly recommended by Jt Dir Med , Regional Centre ECHS will be forwarded to dependent SEMO/ Store holding installation alongwith relevant information as per Para 7 below for their necessary action . Under no circumstance, repairs and servicing / maintenance form civil sources will be undertaken without prior sanction / approval of the concerted CFA. However, in exceptional cases telephone approval be obtained from the concerned CFA and EX-post facto sanction be obtained within one month form the date of repair of the Equipment. 7. While submitting the cases to SEMO / AFMSDs/ Stores holding installation for their sanction or to DGAFMS / DG-2D through dependent SEMO / Depots /, the information asked vide Appx E to this SOP will invariably be furnished. 8. Once repair and servicing / maintenance sanction of the CFA is accorded, it is the responsibility of concerned SEMO/ Depot / Polyclinic to progress the case and ensure that equipment is repaired / maintained on priority and payment is made to the firm through concerned SEMO / AFMSDs /Stores holding installation . In case of delay or difficulties encountered , the same will be intimated to concerned Regional centre ,SEMO / Depot or DGAFMS / DG-2D for information and action .

9. Necessary guarantee / warranty certificate will be obtained by concerned Polyclinic form the civil firm that equipment repaired / serviced by them , will render trouble free service for a period of at least 6 month or as agreed by the concerned Polyclinic or SEMO/ depot and in the event of breakdown within the guarantee period , the same will be repaired free of cost. 10. It may however, be ensured that while exercising the powers , now vested with the various authorities , total cost of repair should include cost of spares also, though individual cost will be shown separately . Generally accost of repair including spares is 10% of the actual cost of the equipment and in exceptional cases same should be allowed maximum upto 25 %. 11. It may also be noted that while procuring sophisticated Electro Medical equipment be DGAFMS offices a clause for entering into service / maintenance contract after expiry of the guarantee /warranty period is

incorporated. Consignee ECHS Clinic of such equipments should ensured that action is intimated as per Para 6 and 7 above to enter into initial service contract immediately on expiry of guarantee / warranty period and subsequent timely renewal of such contracts at the sanctioned rate in AT/ SO (Acceptance of Tender / Supply order). 12. Repair of Gift items/Items on loan

All gifted equipments will be taken on ledger charge that will form part of authorized load. Necessary maintenance support including annual maintenance contract will be catered for such equipments. The ECHS Polyclinic using some equipments that are taken on loan will be responsible to maintain these too. Aseperate record of all items on loan will be prepared. Projection for maintenance support will be made to the dependent Workshop after taking approval of Stn Cdr. Further in addition to the above policy / procedure, the ECHS Polyclinic must follow the following guidelines while negotiating the terms and conditions pertaining to annual service/ maintenance contract in respect of sophisticated equipment held by them with the supplier / authorized Indian agents :(a) The supplier / Indian agents should have the expertise technical know how, test tools, equipment and should be able to provide imported spares and accessories in Indian rupees at the shortest possible time. (b) To provide schedule preventive maintenance (including cleaning , lubrication, adjustment, calibration and testing) at least 3-4 times during contract period and attend breakdown calls as on required basis mutually agreed on the request of users for the smooth and un-interrupted functioning of the equipment. (c) The date of entering into service contract will commence from the date of signing the service contract by both parties on court paper at firms expense but subsequent to the date of issue of sanction letter. (d) The annual service contract charges should invariably not exceed 5% and 2.5% of the total cost of equipment for comprehensive and comprehensive contract respectively. In case of repair only max cost permissible is 25% of the cost of equipment (including cost of spares). OIC Polyclinic will personally ensure that the charges paid are reasonable. (e) The inflation cost limited to maximum 10% of the previous service contract charges can be added for each subsequent years during renewal of the contract if this clause will also be applicable to the contracts earlier sanctioned. (f) 50% payment of service contract charges can be made in advance if insisted upon or otherwise on half yearly basis. The final payment will, however, be made after successful completion of the contractual period as per the terms and conditions of the contract. Where 50% advance payment is made, necessary undertaking to provide satisfactory and timely service should be obtained. (g) The costly and imported spares if required will be on chargeable basis. However, low cost indigenously available electronic components will be replaced free of cost, to a maximum value of Rs. 1000/- by the firm. The costly parts if required to be replaced by the firm will be authenticated by users

specialist or Assistant Technical Evaluating Officer (ATEO) for proper accounting subsequently. The Performa invoice for imported and costly parts quoted in Indian Rupees will be obtained from the firm in triplicate by the users for procurement of the same through office of the DGAFMS / DG-2C. (h) All parts / items utilized during maintenance repair will be reflected in service reports which will be countersigned by the users specialists / Medical officers. (j) The repairs and servicing will be carried out in-situ by the firm. However, in exceptional cases when repairs on the part assembly / Part Circuit Board (PCB) of the equipment are considered to be attempted at factory premises, the temporary replacement shall be the firm. ( k) In case of breakdown of the equipment, the same will be attended by the firms engineer within 24 hours, if it located in the same station and in case of out station, firm will ensure to complete repairs of the defective equipment on top priority. (l) The service / repair and replacement of parts / spares details will be recorded by the firm engineer and user specialist in the History Sheet and Log book maintained for each equipment by the users. The History Sheet and Log book shall be prepared locally as per Appx F. (m) Clauses pertaining to 100% advance payment, separate expenses, transportations charges, daily allowance, over time allowance, if reflected in the terms and conditions are to be deleted in to. (n) The annual service contract is required to be signed only after expiry of Guarantee/Warranty period and duly sanctioned by the CFAs. But procedure for AMC to be initiated three months prior to expiry of Warranty / guarantee period. 13. After finalization of the terms and conditions (given below) with the firms, the consignee Polyclinic will forward the proposal for entering into annual maintenance contract of sophisticated equipment to dependent SEMO / AFMSDs as per provisions laid down in succeeding paras:(a) Particulars of the equipment as per Para 7 of above quoted letter.

(b) Statement of Case duly recommended by the OIC ECHS Polyclinic, Jt Dir (Med) and will be approved by SEMO / Comdt AFMSD/CFA. (c) Original quotation of the firm with terms and conditions as negotiated with the supplies / authorized agents on the lines as per Para 3 above alongwith two Photostat copies of the same. (d) OIC Polyclinic, Jt Dir (Med) and stores holding installations will ensure that the service rates in respect of equipment which have been standardized with the firm and come under their financial power will remain enforced and will not be revised upwards except as Para (e) below. (e) In case of renewal of maintenance contract, the rates of previous contract will be completed before according sanction by the CFAs at every level. The inflation costlimited to maximum 10% of the previous service contract charges can be added for each subsequent year.

(f) Where the clause of AMC has been accepted by TPC in A/T and Supply Orders, the rates approved there in only be acceptable. No alternation will be allowed on any terms without the prior approval of O/o DGAFMS. 14. On receipt of proposal beyond CFA limit, dependent SEMO / AFMSDs will forward the same to the office of the DGAFMS /DG-2D duly vetted technically for obtaining necessary CFA sanction as shown in Govt of India, Ministry of Defence letter No. 3505/4/DGAFMS/DG-2D and 23 Sep 99. 15. The contract will be signed by users with the firm only after receipt of CFA sanction and the Photostat copy of the contract will be forwarded by the units to the office of DGAFMS / DG-2D and dependent SEMO / AFMSDs for reference and records. 16. The consignee OIC ECHS Polyclinic will forward the bill duly receipted to the concerned SEMO/ AFMSD for payment to the firm as per the terms and conditions agreed upon. 17. It will be ensured by all Regional Centers that all sophisticated medical equipments which require Annual Maintenance should be covered under AMC. The same will be reflected in quarterly return being forwarded to this office. The copy of Army Order No. 05/99 &12/2004 on the subject will be made available to all ECHS Polyclinics. 18. In case of difficulties with vendors / firm regarding compliance to AMC / Repairs Polyclinics should be proactive and forward advance intimation to civil firm for planned preventive maintenance laid down in AMC. In case of breakdown / Urgent repair Polyclinics should contact the firm through telephone / Telegram/ letter with copy to this HQ and O/o DGAFMS. In case the civil firm is not attending the calls even after two reminders, Polyclinic to approach Regional Centre / SEMO. Simultaneously Regional Centre will also approach O/o DGAFMS for similar action. However telephonic / personal contacts with firm to be made for early action. Finally if a particular firm is repeatedly failing to respond on time, a case may be taken up for appropriate actions against that firm through Regional Centre. Allotment of funds: 19. DGAFMS will allot adequate funds from ECHS allotment under Code Head 363/01 every year to EME for undertaking repair of the equipment through LP of spares/LRC. Annual requirement of funds is to be projected by EME (Fin) to O/o DGAFMS every year. Demand for Annual Maintenance Contract, repair and spres by SEMOs / AFMSD, will be made from DGLP (ECHS). Annual requirement will be projected along with the projection of DGLP. Reports and Returns 20. In addition to existing Medical Equipment return policy ECHS Polyclinic will submit addl annual return to followings through SEMO: (a) (b) Non Electro Medical Equipment : To dependent workshop Electro Medical Equipment: To dependent Nodal Workshop & CRC

(C)

Sophisticated Medical equipment under AMC: To O/o DGAFMS (DG-2D)

Sentencing of ECHS Medical Equipment 21. Since no procurement of spares on any equipment is contemplated and repairs and maintenance are to be carried out through LP of spares or by civil firms under local repair contract / AMC, the equipment will not be sentenced Eqpt of Action (EOA). However these may be sentenced BLR/BER/UNSV as given below (Appx G). (a) Non Electro medical Equipment: These equipments will not be sentenced BLR and all efforts will be made by the dependent workshop to repair and maintain these through LP of spares / LRC till they become BER.certificate. Retrieval of serviceable components / accessories may be done at Wksp level to repair other eqpt. Such spares will however be properly accounted. Units will dispose off these equipment to local salvage depot under intimation to dependent / SEMO / Regional Centre / AFMSD for provisioning action. (b) Electro medical Equipment: These equipment will be sentenced BER by dependent Nodal workshop / CRC and a certificate issued to the ECHS Polyclinic, sentencing of equipment as BER may be done by BOO as per advise of workshop/ CRCs based on its life &usage vide Appx B &G. (c) Sophisticated Equipment under AMC: These equipment will be sentenced BER only. ECHS Polyclinic will initiate action for sentencing the eqpt as BER by convening a board of officers consisting of specialists concerned and Assistant Technical Evaluating Officer (ATEO) as members. The service engineer of the firm if available is to be associated to give his opinion on the equipment. The board proceedings in triplicate, duly approved by SEMO will be forwarded to Central Organisation for issue of disposal instruction and subsequent initiation of procurement action. Feasibility of retrieval of components / assemblies will be ascertained in consultation with ATEO, at Command Repair Cell (CRC), so that they can be utilized for repair of similar equipment. Retrieval of components will be properly accounted for by CRC.

22. Policy and procedure for procurement, and installation of Medical Equipment for ECHS Polyclinic has already been dealt in various Govt letters and fwd by this HQ, hence same is not included in this SOP.

Dy MD For MD

Appendix A

EQPT UNDER ANNUAL MAINT CONTRACT

SOPHISTICATED EQUIPMENT

Ser No 1. 2.

Equipment Fibre optic Gastrology / Colonoscopic Equipment Bronchoscopic / Laproscopic Equipment

Probable life 06 Yrs 06 Yrs

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43.

Volume Controlled Respirators (Computerised) Whole Body CT Scanner Cobalt Therapy Units Image Intensifier (Surgical & Medical) Cardiac Cath Lab Equipment Heart Lung Machine Haemo Dialysis machine Gamma Camera Diagnostic Instruments (Nuclear Medicine) Ultrasound Imaging & Colour Doppler Trade mill Computerised with monitoring system Dental X-Ray Units (imported) Spectrophotometers Computerised Central Monitoring Station Evoked Potential cum EMG machine Pulmonary test system computerized Fast Medical Scanners MRI Mamography Unit Laser Therapy / Surgical Eqpt Ventillator (imported) Elisa Readers Microscope (Electronic) Anesthetic Appratus (Microprocessor Based) Fibre scope (ENT) Set Dental Chair Unit (Microprocessor Based) Anaesthesia System with Ventilator and Multi parameter App. X-Ray Radiographic/Fluoroscopic 500 Ma & above (imported) Ultrasound Aspirator Ultrasound Scanner Ultrasound portable Camera and illumination system Uretro Renoscope Semi Auto Analyser Digital ECG Machine Fibre Optic Bronchoscope Platelet Agitator Cardiotocograph App. Anaesthetic (Boyle) MK IV with vaporizer field Electronic Weighing Machine Automatic Film Processor

07 Yrs 10 Yrs 10 Yrs 10 Yrs 10 Yrs 08 Yrs 08 Yrs 10 Yrs 10 Yrs 08 Yrs 08 Yrs 10 Yrs 08 Yrs 08 Yrs 08 Yrs 08 Yrs 08 Yrs 10 Yrs 10 Yrs 08 Yrs 10 Yrs 10 Yrs 10 Yrs 10 Yrs 10 Yrs 15 Yrs 08 Yrs 08 Yrs 06 Yrs 10 Yrs 08 Yrs 08 Yrs 10 Yrs 06 Yrs 07 Yrs 08 Yrs 06 Yrs 08 Yrs 08 Yrs 06 Yrs 10 Yrs

Note : Various other models of above equipment and any other equipment which is considered ot be maintained through trade will also be deemed to be covered under this list.

Appendix B

EQPT UNDER REPAIR RESPONSIBILITY OF EME / CRCs ELECTROMEDICAL EQUIPMENT

Ser No 1. 2. 3. 4. 5.

Equipment X-Ray Portable / Mobile & Dental below 100 ma X-Ray Eqpt Static 100 Ma/200 Ma X-Ray Eqpt Static 100 mA & above (indigenous) DC Defibriliators ( all types) Bed Side Monitors

Probable life 10 Yrs / 1Lac exposures 09 Yrs / 1Lac exposures 08 Yrs / 30,000 readings 07 Yrs / 6,000 shots 07 Yrs / 30,000 hours

6. 7. 8. 9. 10. 11 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. Note

Micro Wave Diathermy Units Surgical Diathermy Units (All types) ECT (Electro Convulsion Treatment) machine Stimulator and vibrators Selective Treatment Unit (GSF) ECG machine single channel Infra Red Lamps Ultrasonic Therapy Units Flame Photometers Photo Electric Colorimeters Ph Meters Electrophoresis Power Supply Units Photo Therapy Units Baby Incubator Microprocessor based (Indigenous) Ventilator & Respirators (Indigenous) Audiometers Shadowless OT Lamps Therapeutic Short Wave Diathemy Oxygen Concentrator Aspiration Unit (Indigenous) Nebuliser Glucometers Computerised ECG machine Foetal Heat Rate Monitor (Doppler) Auto NIBP Monitor Portable Cardiac Monitor Infusion Pump (All Types) Pulse Oxymeter Lamp Electric Field

10 Yrs / 10,000 exposures 10 Yrs / 15,000 exposures 07 Yrs 07 Yrs 10 Yrs / 8,000 hours 10 Yrs / 1 Lac readings 10 Yrs / 15,000 cases 06 Yrs / 8,000 exposures 10 Yrs / 9,000 hours 10 Yrs / 9,000 hours 06 Yrs 08 Yrs 06 Yrs / 30,000 hours 07 Yrs / 50,000 hours 08 Yrs / 2 Lac hours 10 Yrs 10 Yrs 10 Yrs / 9,000 exposures 07 Yrs 06 Yrs 06 Yrs 07 Yrs 10 Yrs 07 Yrs 07 Yrs 08 Yrs 07 Yrs 07 Yrs 08 Yrs

: Various other models of above equipment will also be deemed to be covered under this list. Appendix C

EQPT UNDER REPAIR RESPONSIBILITY OF EME ELECTROMEDICAL EQUIPMENT

Ser No 1. 2. 3. 4. 5.

Equipment Anaesthetic Apparatus (Indigenous) Suction Appratus Steriliser all types Autoclaves OT Lamps (Wall Mounted)

Probable life 08 Yrs 08 Yrs 10 Yrs 06 Yrs 10 Yrs

6. 7. 8. 9. 10. 11 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

Operation Tables Air circulation equipment Sphygmomanometers Laryngoscopes Opthalmoscopes Still Automatic Comprators Microscope (Optical types) Ovens Centrifuges Wheel Chairs Dental Chair (Indigenous) Micrometers Portable Electric Generators Blood Storage Cabinate / Refrigerators Incubator Electric Bull Nose complete Examination Table Recovery Trolley Spot light for examination Weighing machine Han and wrist exerciser Portable Resuscitator Exam spot light (Cold) Strecher Trolleys folding type Fluid warmer Vet endoscope

10 Yrs 10 Yrs 08 Yrs 05 Yrs 06 Yrs 06 Yrs 06 Yrs 10 Yrs 06 Yrs 06 Yrs 06 Yrs 15 Yrs 08 Yrs 08 Yrs 10 Yrs 06 Yrs 06 Yrs 10 Yrs 06 Yrs 10 Yrs 06 Yrs 08 Yrs 08 Yrs 10 Yrs 06 Yrs 08 Yrs 06 Yrs

Note

: Various other models of above equipment will also be deemed to be covered under this list.

Appendix C

NOMINATED NODAL EME WORKSHOPS FOR REPAIR OF ELECTROMEDICAL EQUIPMENT

Ser No

Name of Nodal Workshop

CRC

Southern Command 1. 2. 3. Station Workshop, Mumbai Station Workshop, Secunderabad Station Workshop, Chennai CRC, C/o CH (AF) Banglore

4. 5. 6. 7.

12 Corps Zone Workshop Station Workshop, Pune Station Workshop, Bambolim Station Workshop, Baroda

CRC and AFMSD Wksp, Pune

Eastern Command 1. 2. 3. 4. 5. 6. 7. 8. 862 Fd Wksp Coy 3 Corps Zonal Wksp 4 Corps Zonal Wksp 33 Corps Zonal Wksp Station Workshop, Kolkata 306 Station Workshop, EME 307 Station Workshop, EME 311 Station Workshop, EME CRC, C/O CH(EC) Kolkata

Western Command 1. 2. 3. 4. 5. 6. Station Workshop, Jabalpur Station Workshop, Chandimandir 11 Corps Zone Workshop 7002 EME Bn AHQ Static Workshop, Delhi Cantt 7010 EME Bn CRC, C/o AFMSD Lucknow

Central Command 1. 2. 3. 4. 5. 6. 7. 8. 9. Station Workshop, Jabalpur Station Workshop, Lucknow 7001 EME Bn Station Workshop Dehradun Station Workshop Allahabad Station Workshop Bareily Station Workshop Roorkee Station Workshop Kanpur 196 (I) Fd Wksp Coy CRC, C/o AFMSD Lucknow

Northern Command 1. 2. 3. 4. 5. Note 193 Fd Workshop (14 EME Bn) CRC, C/o CH (NC) Udhampur 7015 EME Bn 14 Corps Zonal Workshop 626 EME Bn 304 Station Workshop :AFMSD Workshop Pune is responsible for major repair of electro medical eqpt.

Appendix E CHECKLIST (a) (b) (c) (d) (e) PVMS / NIV No. Full Nomenclature A/U Quantity Source of receipt indicating A/T Supply Order No. Depot IV No. &dated.

(f) (g) (h) (j) (k)

Quantity held with their condition i.e. Ser / Rep / Unsv. Quantity required to be repaired. Nature of repair including -----------, if any, required. Cost of equipment Comparative statement of quotations received for repairs and basis of selection / recommendation of particular quotation. Reasons for recommending civil repairs and Servicing/ maintenance, whether local station workshop/ Command Repair Cell expressed their inability to repair and servicing / maintenance of the equipment. BLR/BER certificate from dependent EME Workshop / Command Repair Cell where Applicable. Breakdown of repair charges indicating service charges, cost of components and other misc charges. Reasonableness of cost repair and servicing/maintenance considering cost of original equipment. Number of times equipment went out of order and repaired through civil firm/CRC/EME sources. Cost of repair and servicing/maintenance each time. Cost of repair / AMC entered last time. Appendix F

(l)

(m)

(n)

(o)

(p)

(q) (r)

Maintenance of History sheet and Equipment Log Book. For maintaining a chronological, equence of incidents occurring during the life cycle of an equipment, it has become imperative to maintain Equipment History sheet and Logbook for all sophisticated and expensive equipments. The suggested contents of both the docus are as follows:(a) Equipment History Sheet (i) (ii) Name of equipment Date of purchase

(iii) (iv) (v) (vi)

Cost of Equipment Name & Address of Supplier Date of Manufacture Date of Intallation

(vii) Environmental requirements in terms of temperature, Lighting, ventilation and electrical load (viii) Spare parts Inventory (ix) (x) (xi) (xii) Technical Manual & Circuit Diagrams Guarantee/warranty period Use co-efficient Life of the equipment

(xiii) Down-time/up-time (xiv) Any other Remarks.

(b) Equipment Logbook ( for all equipment costing more than Rs. 10,000) Auth: DGAFMS Memorandum No-159 (i) (ii) (iii) (iv) (v) (vi) (vii) Nomenclature and source PVMS No/NIV No Cost of the equipment Date of acquisition AMC with validity Name of Manufacture & Supplier Date of defect/cession of function

(viii) Nature of Defect (ix) Date of call for Repair

(x) (xi)

Date of completion of Repair Signature of NCO/C ward/Dept

Appendix G

Sentence of Equipment

(a)

Non electro medical equipment : (Appx C) ECHS Polyclinics Dependent local EME workshop

BER

(ECHS Polyclinic ) ( Deposit in salvage as per direction of BOO)

(b)

Electro medical equipment : ( Appx B) ECHS Polyclinic Nodal EME workshop / CRC

BER (ECHS Polyclinic ) Local board of officer with ATEP as member) Disposal as per BOO Sophisticated electrometrical equipment : (Appx A) ECHS Polyclinic Local Board of officer with ATEO as a member) BER Disposal as per BOO

(c)

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USE OF INJ EPTIFLO IN LIEU OF INJ REOPRO

1. 2. 3. 4 . Please ref this office letter NoB/49773/AG/ECHS/Processing Bills dated 02 Mar 2005. A photocopy of Army Hospital (R&R) letter No. Card/Med/2012 dated 13 Sep 2012 is enclosed herewith for your info and necessary action. The above mentioned letter of Army Hospital (R&R) clearly mentions that Inj Eptiflo can be used for PTCA in lieu of Inj Reopro. The new policy will be effective from 13 Sep 2012. Col Offg Dir (Med) for MD

Auth-BB/49762/AG/ECHS DT 04 OCT 2012

! ! !

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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 45th and 60th 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. 6. Our letter on the subject dated 12 Aug 2009 is hereby superseded. This has the approval of the DGAFMS. Sd xxxxxxxx (D Mohapatra) Col 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. No4. 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) Patient visited in the hospital on Authenticity of treatment modality Effect of treatment on patient recovery. Relevance of Diagnostic Investigation. Reasons for extended stay beyond 12 days Likely date of finality in treatment Recommendation/Comments of MO. (Signature of MO) Date : Stn Stamp APPROVED/NOT APPROVED OIC, ECHS Date:

13. 14. 15. 16. 17. 18. 19.

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. No4. 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) Patient visited in the hospital on Authenticity of treatment modality Effect of treatment on patient recovery. Relevance of Diagnostic Investigation. Reasons for extended stay beyond 30 days Complication if any and likely cause Modality or management of complication Satisfactory/Not satisfactory Whether finality of treatment has been attained. If NOT what is the likely date of finality in treatment.. Recommendation/Comments of the Committee. (MO) .. Rep of SEMO Rep of Stn HQ

13. 14. 15. 16. 17. 18. 19. 20 21.

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. No4. 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) Patient visited in the hospital on Authenticity of treatment modality Effect of treatment on patient recovery. Relevance of Diagnostic Investigation. Reasons for extended stay beyond 30 days Complication if any and likely cause Modality or management of complication Satisfactory/Not satisfactory Whether finality of treatment has been attained. If NOT what is the likely date of finality in treatment.. Recommendation/Comments of the Committee. (MO) .. Rep of SEMO Rep of Stn HQ

13. 14. 15. 16. 17. 18. 19. 20 21.

RECOMMENDED/NOT RECOMMENDED Dir(Med), Central Organisation ECHS APPROVED/NOT APPROVED

MD ECHS

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ADVISORY NO-09 : EMERGENCY ADMISSIONS IN EMPANELLED HOSPITALS 1. Recently a study was carried out on the pattern of emergency admissions in empanelled hospitals. T he 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.

sdxxxxx (SP Patil) Brig Dy MD for MD ECHS

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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 ) donors. patient. (d) In case of dire emergency, local Stn Cdrs could be approached for arranging In all above cases, first donors should be family members and friends of the

3. Above guidelines are considered very appropriate and practical. It is therefore advised that all ex-servicemens Organizations facilitate establishment of such an arrangement at all ECHS Stns.

(D Mohapatra) Col Dir (Med) For MD ECHS

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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.

(AK Naik) Lt Col Jt Dir (Med) For MD

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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) (b) (c ) Officers/dependents JCOs & Equivalent/dependents OR/Dependents Private Ward Semi Private Ward 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.

(RK Kalra) Maj Gen MD ECHS For AG.

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MEDICAL EXAMINATION/HEALTH CHECK UP 1. Refer GOI, MoD letter No. 24 (B)/03/05(WE) 19 (RES) Para 9 (h) dt 19 Dec 2003.

2. ECHS beneficiaries may undergo medical examination/health check up at ECHS Polyclinics once a year. The medical examination/health check up however will be limited to the faci lities available in the Polyclinic 3. Referrals to empanelled facilities/Service hospitals for the same are not permissible.

5. All Regional Centers are requested to confirm that this letter has been forwarded and received by all the Polyclinics in their respective AOR.

Offg Dir (Med) for MD Authority- B/49770/AG/ECHS/Treatment 10 Oct 2012

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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.

Sd/- X X X (KC Das) Col Jt Dir (Med) for MD ECHS