ECHS rules: Government issues clarifications on definition of empanelled hospitals

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Updated: November 16, 2019 4:56:31 PM

Hospitals need to furnish an undertaking to ECHS accepting the rates notified by ECHS or the negotiated rates which under no circumstances can exceed the applicable CGHS rates.

 ECHS , CGHS, rules, clarifications, empanelled hospital, Ex-servicemen Contributory Health Scheme, Ex-servicemen, government, hospitals, CGHS rates,A hospital will be considered to be on ECHS panel only when it has a valid MoA or it is not under orders of stop referral.

Department of Ex-Servicemen Welfare of the Ministry of Defence had recently come out with a clarification regarding the definition of empanelled hospitals under the Ex-servicemen Contributory Health Scheme (ECHS). Hospitals or nursing homes, dental care facilities and diagnostic centres for specific treatment and diagnostic procedures of specialised nature are allowed to be the empanelled medical centres.

Hospitals need to furnish an undertaking to ECHS accepting the rates notified by ECHS or the negotiated rates which under no circumstances can exceed the applicable CGHS rates or the rates being charged by the hospital from their normal patients who are not ECHS beneficiaries. A Memorandum of Agreement (MoA) is to be signed by the empanelled hospital.

In addition to the clarification on empanelled hospital, any consequent handling of cases of treatment taken by ECHS beneficiaries in such hospitals has also been made.

The clarifications that have come from the government are:

  • A hospital will be considered to be on ECHS panel only when it has a valid MoA or it is not under orders of stop referral.
  • If any hospital does not have a valid MoA or it is under stop referral and an ECHS beneficiary takes treatment in such hospital in an emergency by making payments, the amount should be reimbursed to the beneficiary as per the CGHS rates.
  • If any hospital does not have a valid MoA or it is under stop referral and any beneficiary having valid referral from ECHS polyclinic chooses to take treatment in such hospital due to having treatment in the same hospital earlier as well he should be allowed to take treatment in the hospital after making payment to the hospital and seek reimbursement at CGHS rates.
  • If a hospital is empanelled but due to huge pending bills remaining unpaid refuse to extend cashless treatment and an ECHS beneficiary takes treatment therein and seek reimbursement, the same shall be allowed at CGHS rates. However, at the same time the hospital may be dis-empanelled under ECHS.

Ex-servicemen pensioners and their dependants, in addition to treatment in service hospital, are also authorised to take treatment in the civil or private hospitals which are specifically empanelled with ECHS. ECHS provides cashless medical coverage for the ex-servicemen and their dependents in the established polyclinic/military hospitals/empanelled hospitals across India. The clarifications will help the ex-servicemen to avail the medical facilities in the empanelled hospitals.

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