HAND BOOK ON EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME ISSUED BY DIRECTORATE OF PERSONAL SERVICES AIR HQ (VAYU BHAVAN)

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1 HAND BOOK ON EXSERVICEMEN CONTRIBUTORY HEALTH SCHEME ISSUED BY DIRECTORATE OF PERSONAL SERVICES AIR HQ (VAYU BHAVAN)

2 CONTENTS CHAPTER SUBJECT PAGE NO. 1. Introduction 1 2. Eligibility 2 3. MembershipEnrolment procedure Contribution Organisation Treatment Parent Polyclinic Smart Card 47 APPENDICES A List of 227 Polyclinics 52 B List of Hospitals Empanelled for ECHS 58 C Affidavit 214 Application Form

3 1 CHAPTER 1 INTRODUCTION 1. With a noble aim to provide medicare to the Armed Forces pensioners at the twilight of their lives, Ex Servicemen Contributory Health Scheme (ECHS), a triservices project, was launched wef 01 Apr 03 vide Govt of India letter No. 22(1)/01/US (WE)/D (Res) dated 30 Dec 02. The Scheme is functioning under the integral staff with its central office located at Maudelines, Delhi Cantt and 13 Regional Centres located at various major cities. ECHS will cater for medicare of all exservicemen (ESM), who are in receipt of pension of any kind i.e., normal, disability, invalid, prorata, ordinary family pension & special family pension/liberalised family pension. This would also include wife/husband, legitimate children and wholly dependent parents. 2. The Scheme is to provide quality medicare to its members and their authorised dependents through a spectrum of 227 ECHS Polyclinics (106 in Military Stations and 121 in Non Military Stations) countrywide(list annexed as Appendix A ) and a network of service and empanelled hospitals and diagnostic centres (list of hospitals empannelled currently annexed as Appendix B ). 3. ECHS is a contributory scheme. Every service person retired/retiring after 01 Apr 03 will compulsorily become member of ECHS by contributing his/her share. The Scheme is voluntary for those who retired prior to 01 Apr 03 and they can become member by paying the contribution and completing the formalities. Certain sections of ESM/their dependents are exempted from paying the contribution, details of which are envisaged in Chapter 4 of this Hand Book. 4. The Scheme covers all diseases and there is no restriction on age or medical condition at the time of seeking membership of the Scheme.

4 2 CHAPTER 2 ELIGIBILITY 1. Entitlement for ECHS. The Scheme has been launched to provide comprehensive medicare to all ESM in receipt of pension or disability pension, as also to his/her dependents, which includes wife/husband, legitimate children and wholly dependent parents. The Scheme is also applicable to NOKs of deceased pensioners who are drawing family/special family /liberalised family pension. 2. Pension. For the purposes of eligibility for the ECHS, the word pension implies any type of pension paid by the Controller of Defence Accounts (Pension) or his subordinate offices. 3. Following are the eligible categories to become member of ECHS(Authy: ECHS ltrs B/49764/AG/ECHS dated 10 Oct 03, B/49764/AG/ECHS/R dated 15 Feb 05, B/49701SP/AG/ECHS dated 06 May 05 and B/49701/MOD/AG/ECHS dated 24 Feb 06): (a) ExServicemen Pensioner. Any person who has served in any rank (whether as combatant or as noncombatant) in the regular Army, Navy and Air Force of the Indian Union, and fulfills the following conditions: (i) Who has retired from such service after earning his/her pension. (ii) Who has been released from such service on medical grounds attributable to military service, or in circumstances beyond his/her control and is in receipt of disability pension. (iii) Who is a personnel of the Territorial Army and falls under any of the following categories: (aa) (ab) (ac) Pension holders for continuous embodied service. Persons with disability attributable to military service. Gallantry award winners. (iv) Who falls under any of the following categories: (aa) Members of Military Nursing Service. (ab) Whole time officers of National Cadet Corps who are ExServicemen /NOK and are in receipt of pension /disability pension/family pension. (ac) 588 Emergency Commissioned Officers/Short Service Commissioned Officers who were permanently absorbed in

5 3 National Cadet Corps as Whole Time Officers (WTOs) after their release from the Armed Forces. (ad) Service officers who, prior to completing their pensionable service, in organisational interest, joined PSUs like Air India, Indian Airlines, Pawan Hans, and Shipping Corporation of India, and to whom Govt had sanctioned pension on a prorata basis. On secondment or transfer to PSUs these officers received their pension either as a lump sum on full commutation or on monthly basis. For those who commuted full amount, the monthly pension was to be restored at 43% after 15 years from their date of retirement on prorata basis. Hence, they would be deemed to comply with the condition of being in receipt of pension from defence authorities. However, following additional conditions will have to be complied with by these ESM pensioners: (aaa) A mandatory certificate will have to be endorsed in their affidavit stating that, I certify that I am not a member of any other Govt/PSU Medical Health Scheme. (aab) The contribution amount for enrolling as member of ECHS will be based on the rank held by the individual at the time of release and NOT on the restored pension amount. The amount will be similar to the current basic pension of the rank held at the time of retirement. (For example, if the individual retired as a Lt Col/Commander/Wing Commander, he will be required to deposit contribution through MRO as per current basic pension of this rank). (aac) Each case will be considered on its merits. (ae) Indian Coast Guard Pensioners and Personnel of Defence Security Corps(DSC)(Authy : GoI Ltr 22(68)/2006/US(WE)/D(Res) dated 22 jan 08) (af) All Nepal Domicile Gorkhas staying in India. (Authy: ECHS Signal A333021/AG/ECHS dated 19 Jan 09) (b) Family Pensioner. It implies the legally wedded spouse of an Armed Forces personnel, whose name figures in the service records of the personnel and whose husband/ wife (as the case may be) has died either while in service or after retirement and is granted family pension. This term also includes a child or children drawing family pension on the death of his/her pension drawing father/mother, as also parents of a deceased bachelor soldier, who are in receipt of family pension. To ameliorate the difficulties of family pensioners who cannot produce a Part II Order, they can now apply with an Affidavit on Rs.10/(Rupees Ten only) Non Judicial

6 4 Stamp paper attested by two witnesses and notarized. A copy is attached as Appendix C. (c) Exservicemen drawing disability pension. (d) War Widows (Exempted from Payment of Contribution) War widows are those whose spouse had died due to any of actions appended below: (i) Enemy action in international war. (ii) abroad. Action during deployment with a peace keeping mission (iii) Border skirmishes. (iv) During laying or clearance of mines, including enemy mines as also mine sweeping operations. (v) On account of accidental explosions of mines while laying operationally oriented minefield or lifting or negotiating minefield laid by the enemy or own forces in operational areas near international borders or the Line of Control. (vi) War like situations. (vii) An act of violence, attack by extremists, antisocial elements, etc., while on operational duty. (viii) Action against extremists, antisocial elements, etc., while employed in the aid of civil power in quelling agitation riots by demonstrators. (ix) Operations specially notified by the Govt from time to time. (e) The Army Postal Service personnel are permitted to enroll into the ECHS subject to fulfilling the following conditions: (i) The retiring APS personnel must fulfill the primary condition of being an exservicemen, i.e. he/she should have served in the Armed Forces of India, in any rank as a combatant or noncombatant. (ii) Must retire finally from the Armed Forces, without reversion to the P&T Department. (iii) Must be in receipt of pension consequent to retirement or be in receipt of disability pension, if prematurely retired/released on medical grounds which are attributable to military service.

7 5 (iv) Must NOT be a member of CGHS or any other Govt Medical Scheme. (f) Reservists who are drawing pension including family pension are permitted to join the Scheme. However Reservists who opted for exgratia payment are not eligible(authy: ECHS Ltr B/49701Reservist/AG/ECHS dated 02 Jun 06. (g) A Recruit who is in receipt of medical/disability pension is alone eligible to join the ECHS. The following dependents of the recruit are NOT permitted to be included for ECHS benefits(authy: ECHS Ltr B/49708 RECT/AG/ECHS dated 22 May 06): (i) (ii) (iii) Parents. Wife. Children. The recruit who was already married prior to joining the training at the Regimental Centre would be permitted to have his wife and children, if any, included as his dependents. This fact would be checked from the Part II Order published. However, the parents of such a recruit would not be entitled to be shown as dependents. 4. Eligibility Status for Dependants. The following categories qualify to be called dependants(authy: ECHS Ltr B/49701PR/AG/ECHS dated 01 Jun 06).: (a) Parents. Father and Mother of the veteran pensioner shall be deemed to be dependent if they normally reside with the veteran pensioner and their combined income from all sources does NOT exceed Rs 3500/ pm. Parent of the spouse of the Veteran are NOT permitted to become members. In case a widow, who is in receipt of Family Pension, joins the ECHS, then the parents of her late husband can be made dependants, subject to fulfilling the conditions. However, her own parents CANNOT be made dependants. In a case where both the husband and wife are ESM pensioners, then both can opt to cover their parents as dependents. In this case both pensioners will have to make ECHS contribution, as applicable. Parents, ie, mother and father of unmarried deceased soldier and in case of deceased parents, then NOK of unmarried deceased soldier are also eligible, provided they are in receipt of liberalised family pension. (b) Spouse. Legally wedded spouse(more than one spouse and children from the second spouse are not permitted to avail ECHS benefits). Name should be included in the records of service. Spouse living separately is included as dependent, as long as the Veteran pensioner is responsible for her maintenance. When the spouse is legally separated, he/she cannot be termed as a dependent and hence cannot be made member of ECHS.

8 6 (c) If the spouse is employed in Govt service then he/she can only be a member of any one Govt/Public sector medical benefit scheme and not the second one. (d) If a war widow remarries, she would still remain eligible. Her husband, however, will NOT be eligible. (e) In case the ESM pensioner marries after retirement, following documents will be required as proof for dependency of wife : (i) Marriage certificate from authorized Registrar of Marriages/Municipal Committee. (ii) Application form will have to be submitted for enrolling the spouse as a dependant. (f) Daughter(s). (i) Details must exist in the service record of the pensioner. (ii) Unmarried as well as divorced daughter(s) with total income from all sources less than Rs.3500/ per month. (iii) Widowed daughters who are dependant on the Pensioner and whose income from all sources is less than Rs.3500/per month are entitled. (iv) Daughters with permanent mental or physical disability, irrespective of age/medical condition. (v) In case where daughter is born after the pensioner s retirement, following documents will be required to enable the child to be declared as a dependant and to become entitled to ECHS benefits: (aa) (ab) Birth Certificate. Submission of application form to enrol as a dependant. (g) (ac) Part II Orders/Gen Forms/Personal Occurrence are required to be published stating birth of the child or an Affidavit as per Appendix C by the widow in case the ESM pensioner could not get Part II Orders published for birth of his children. Son(s). (i) Unemployed and unmarried son(s) upto the age of 25 years are permitted to be included as dependents if his total income from all sources should not exceed Rs.3500/ per month.(authy: ECHS ltr B49701PR/AG/ECHS dated 21 Aug 07)

9 7 (ii) Details must be included in the service record of the pensioner. (iii) Sons suffering from permanent physical or mental disability, irrespective of age or medical condition. (iv) In case the son is born after the pensioner s retirement, the following documents will be required as proof of dependancy: (aa) Birth Certificate. (ab) Submission of additional application form to enrol as a dependant. (ac) Part II Orders/Gen Forms/Personal Occurrence are required to be published stating birth of the child or an Affidavit as per Appendix CE by the widow in case the ESM pensioner could not get Part II Orders published for birth of his children. (h) Mentally/Handicapped Children. Mentally/Handicapped children who are unable to earn their livelihood are permitted to be dependents for life time. The following conditions are required to be met(authy ECHS Ltr B/49701PR/AG/ECHS dated 18 Dec 07): (i) Onset of disability should be prior to attainment of 25 years of age. (ii) Permanent disability should be certified by Service Classified Specialist/Civil Surgeon duly indicating percentage of disability and the child s inability to earn his livelihood. 5. Amplifications on addition/deletion of names of dependents for ECHS on the above are as follows(authy: ECHS Ltr B/49701PR/AG/ECHS dated 28 Jun 05): (a) Addition of Dependent. A newly born child or parents becoming dependant on the ECHS member subsequent to retirement, will require the member to submit a Part II order published by the respective Record Office. In the case of divorced/widowed daughter becoming dependant on the ECHS member, the divorce paper or death certificate respectively will have to be submitted. In all these cases the ESM has to submit a fresh application along with the documents and master card for issue of new cards. (b) Deletion of dependent. In the event, wherein the ECHS member dies, his/her spouse can continue to use the Master card, however the option lies with the spouse to get a new card made by filling up a fresh application form in order to get a smart card on his/her name. However in the case of demise of dependant the deletion can be made at any polyclinic, but if an add on card has been issued to that dependent, it will have to be returned to the Stn HQ from where the card was initially issued for cancellation. Sons above 25 years of age will be automatically deleted from

10 8 dependency. Married/employed daughter is to be intimated by the member to the polyclinic. 6. Specific Conditions for Continuance of Eligibility. In case an ESM pensioner (male/female) has declared his/her parents as dependants, they shall continue to receive ECHS benefits for their life time, subject only to the condition that their joint income does not exceed Rs.3500/ per month from all sources. In the event of the pensioner s death, the widow shall be covered as she will start drawing family pension, but her parents will NOT become eligible as dependents. However, parents of the deceased pensioner, if already enrolled as dependents, would continue to enjoy benefits of the ECHS in the event of death of their ESM pensioner son/daughter, provided their joint income does not exceed Rs. 3500/ per month. (Authy for income criteria of dependents: ECHS letter B/49701PR/AG/ECHS dated 04 Feb 09) 7. New Born Baby. New born baby to an entitled ECHS beneficiary is 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 month.(authy: ECHS Ltr B/49770/AG/ECHS/Policy dated 25 Sep 07) 8. Emergency Commissioned Officers/Short Commissioned Officers who, after their release from the Armed Forces, were permanently absorbed in the National Cadet Corps as Whole Time Officers(WTOs/WTLOs) are eligible for availing benefits of ECHS. WTOs/WTLOs not complying with above conditions are NOT eligible. 9. ECHS Membership When Husband and Wife are Defence Personnel(Authy: ECHS Ltr B/49701MoD/AG/ECHS dated 24 Feb 06): (a) When Both Husband and Wife are Defence Pensioners: (i) Only one has to give ECHS contribution. (ii) Both can cover their respective parents by making two ECHS contributions. (b) When one is a defence person and other is a Central Govt employee, the latter has the choice to withdraw from CGHS when the spouse becomes a member of the ECHS. 10. Persons Not Eligible Under ECHS. The following are NOT eligible for becoming members of ECHS: (a) Whole time NCC officers who do not meet the twin conditions, that a prospective member must be an exserviceman who has served in the Armed Forces of India in any rank, and in receipt of pension/family pension/disability pension paid by Government.

11 9 (b) ExECOs/SSCOs who do not meet twin conditions as mentioned above. (c) Legally divorced spouse. (d) Married and/ or employed daughters. (e) Parents of widow/war widow. (f) Husband of a remarried war widow. (g) Officer cadets, who get injured during training and are boarded out on medical grounds.

12 10 CHAPTER 3 MEMBERSHIP PROCEDURE FOR ENROLMENT 1. All Armed Forces new pensioners retiring on or after 01 April 2003 compulsorily become members of ECHS, whereas those previous pensioners who retired prior to 31 March 2003 can exercise their option to become member of the Scheme. Such previous pensioners joining the scheme will forfeit the medical allowance of Rs. 100/ pm presently admissible to them as part of pension. 2. It is stipulated in Government Orders that one individual cannot become a member of two Govt/PSU schemes. He/she has to cancel membership of the other scheme, in case opting for the ECHS. If any facts are concealed, membership of this scheme will be denied. This mainly applies to those pensioners who after retirement have joined some other Government service/psu. 3. To acquire membership of ECHS, the ESM pensioner has to follow the undermentioned steps: (a) (b) (c) (d) (e) (f) Collection of application form. Payment of contribution by MRO. Provision of affidavit. Filling up application form. Submission of completed application form. Collection of ECHS Smart Card on intimatiom. 4. Collection of Application Forms. Application form for enrolment into ECHS is an unnumbered & self explanatory form which is provided free of cost wherever possible(annexed at the back of this hand book after Appendix C ). These forms are available at all Army Station HQs, all Navy/Air Force Stations, and Rajya Sainik Board offices. For those having access to the internet, it can also be downloaded from website or or htpp://indian air force.nic.in. 5. Contribution. All ESM pensioners are required to make a onetime contribution based on their uncommuted basic monthly pension+ Dearness pension. However, certain categories of Veterans and family pensioners have been exempted from paying the contribution and details of the same are envisaged in Chapter Affidavit. All ESM are required to make a declaration of their dependants & children and changes, if any, through an affidavit. Also, they have to declare that they are not members of any other Govt Medical Scheme. The format of the affidavit is given in the application form and is to be executed on a nonjudicial stamp paper of Rs. 10/ and attested by a Magistrate or Public Notary. Affidavit is a legal document and in case of misuse of ECHS benefits, submission of fraudulent information or any other misdemeanour, ECHS has the right to take

13 11 legal action. Photographs of all dependants are required to be pasted on the original affidavit, which is to be submitted to Station HQs or designated offices along with the completed application form. Further, the following may be added in page No.11 of application form as para 12 (Authy: ECHS Ltr B/49701 Appl/AG/ECHS dated 04 Dec 07): I understand that the contribution I am making is a one time token amount and is nonrefundable even if I do not make use of any ECHS facilities. 7. Filling Up Application Form. Detailed instructions are given in the application form. Further, Welfare Officers at all Air Force stations and similar officials in Army/Navy Station HQs have been directed to help ESM pensioners in filling up the application form. While filling, care must be taken that name(s) of dependants(s) tally with service document/records. All columns and necessary details must be filled up, otherwise the application form will be rejected. The form is required to be legible and filled in black ink and in capital letters only. Passport size photographs of the pensioner, spouse, children and dependant (as the case may be) are to be affixed at appropriate boxes/places in the form. 8. Submission of Completed Application Form. Designated Station Headquarters (Army/Navy/Air Force) at specified locations are the only authorized collection points. Pensioners are required to personally report to their nearest Station HQs with the completed application forms, alongwith original/photocopy of the following documents. Dependants are NOT required to accompany pensioners during this process: (a) Pension Payment Order(PPO) duly attested by bank/treasury from where pension is being drawn, or endorsed by CDA in original. It is to be shown to the checking staff at the time of submission of application form. (b) Discharge Book/Service Certificate. (c) Two passport size photographs each of the pensioner and dependants, who are proposed to be enrolled as ECHS members/dependants, are to be attached. (Paste one copy of each photo on indicated places in the application form, and one copy each on the affidavit). (d) Attach original copy of the Military Receivable Order (MRO) to the application form as proof of deposit of contribution. This is not required to be done in case of direct deduction of contribution through PPO by CDA (Pension). (e) Affidavit duly notarized in original. (f) ExServicemen Identity Card. Original to be shown for verification to the Station HQ. Photocopy is NOT required to be submitted. 9. Receipt, scrutiny and verification of the forms is a legal requirement to prevent fraudulent entry of nonentitled personnel. Nominated officers at collection points will collect the completed application forms, compare originals with

14 12 photocopies, verify all documents provided by the pensioner and then hand over receipt to the ESM. Original PPO, ExServicemen Identity Card and any/other documents will be returned. Detailed vetting and verification shall be undertaken subsequently, which may take 15 days to two months, depending on the information to be sought. An ESM pensioner is only considered as a member once he/she is issued a valid ECHS membership Smart Card. 10. Collection of Smart Card. The applicant will be intimated the date of collection by the concerned Stn HQ. The original receipt of documents is required to be produced in order to collect his/her Smart Card in person. ECHS Smart Card will not be dispatched by post or handed over to any representative of the applicant. ESM shall be issued with minimum one card for the whole family and two addon cards, if desired. This choice is to be indicated in the application form. 11. Procedure for Becoming a Member of ECHS (For Those Who Retired Before 01 Apr 03 and Whose Contribution Has Not Been Directly Deducted by the Respective Pay Pension Authorities). (a) Collect computerized application forms from the nearest Station HQs of Army/Navy/Air Force. Forms can also be downloaded from internet website nic.in/arechs.htm or Navy/Air Force website. (b) Pensioners to report personally to any of the Station Headquarters listed at para 14 (a), (b) & c with completed application form along with the original and photocopy of following documents: (i) PPO duly attested by bank/treasury from which drawing pension, or a certificate from DPDO/Treasury (as per format) in case ESM is drawing pension from DPDO/Treasury. The certificate must be signed by DPDO/Treasury Officer, and will suffice in lieu of PPO. Pre 1986 pensioners may submit copy of Pension Book showing rate of pension. (ii) Discharge Book/Discharge Certificate for PBOR (iii) Original copy of Military Receivable Order (MRO) as a proof of deposit of contribution(not applicable to those who are exepmpted from payment of ECHS contribution). (iv) Affidavit duly notarized, in original. (v) Retired Officers Identity Card (photocopy not required to be attached). (c) Applicants to come in person to Station Headquarters when informed for collection of ECHS membership SMART Card. Applicants to produce receipt of documents, as proof of their identity. Smart Card(s) will NOT be handed over to any representative. (d) It is mandatory for members and dependents to report to nearest Polyclinic along with SMART Card within 120 days for onetime initial

15 13 registration. The Smart Card will always be required to be produced thereafter to avail treatment at a Polyclinic/empanelled hospital. ECHS Smart Card will not be activated for use, unless above registration is done. (e) The Smart Card is the proof of identity & authorisation for ECHS benefits for the member/dependant(s), and hence, will always have to be produced. (f) Membership will commence from the date of receipt of correctly filled application form at Station HQ. On receipt of correctly filled application form, Stn HQ will give receipt to the individual, based on which the individual can start availing the ECHS facilities. 12. Procedure for Becoming Members of ECHS (Retirees on or After 01 Apr 03 and Whose Contribution Has Not Been Directly Deducted by Pay Pension Authorities). For pensioners retiring w.e.f. 01 Apr 03 and after, the Scheme is compulsory. The forms are being supplied to all retiring personnel alongwith DO approximately 12 months in advance. Also, sample format of the application has been provided to all units/stations through their respective Command with instructions to provide application forms to retiring personnel (abnormal discharges) by photocopying locally. The ECHS forms duly completed in all respects are received at AFRO/DPP&R four months prior to their discharge date. The applications are scrutinized and all observations are cleared with in two months. PPO for ESM is issued four to six weeks before the date of retiremnt. On receipt, the PPO number is endorsed on the application form and then alongwith its photocopy, the application form is forwarded to the Regional Centre (ECHS) Delhi Cantt for preparation of Smart Card. The ECHS Smart Card is manufactured in six weeks from the date of submission of application. The receipt of the application alongwith Registration No. is then issued to the individual before his date of discharge. On receipt, AFRO/DPP&R will despatch the Smart Card to the ESM through registered post. 13. Retirees, whose ECHS contribution amount has NOT been directly deducted by CDA (Pension) in PPO, will be required to deposit their contribution amount through MRO in any authorised banks. They will be required to attach original copy of MRO as a proof of remitting their contribution. In case this is not done, ECHS membership will not be valid. 14. StationWise Responsibility for Receipt and Scrutiny /Verification of ECHS Application Forms. (a) Navy. (i) (ii) (iii) (iv) (v) (vi) (vii) Kochi Vishakhapatnam Cuttack Port Blair Karwar Balasore Mumbai Upnagar

16 14 (b) Air Force. (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) Banglore Nagpur Coimbatore Kanpur Jorhat Sirsa Gorakhpur Saharanpur Faridabad Hindon Mysore (c) Army. All military stations other than those mentioned at Para14 (a) and (b) above. For the purposes of receipt and scrutiny of application forms, all exservicemen shall be treated at par. Any exservicemen reporting at any designated military station headquarters, no matter which service he is from, his/her documents will be accepted and scrutinized. 15. Retirement at Short Notice. Officers/PBOR retiring proceeding on retirement at short notice are permitted to submit their application forms to concerned Record Office any time prior to the date of retirement or even after retirement if he/she is not in possession of PPO. ECHS membership Application can be submitted through nearest Stn HQs/Regional Centre provided it is supported by a copy of PPO and other necessary documents(authy: ECHS Ltr B/49779/AG/ECHS/6009 dated 09 May 08). 16. Submission/Acceptance Of ECHS Application Form without PPO for Pre1986 Retirees. ECHS Application Form in respect of pre1986 retirees are accepted without a copy of PPO provided membership applied by Armed Forces Veteran pensioner is only for himself/herself and his/her spouse In such cases a copy of following documents would be insisted upon alongwith the Application Form(Authy: ECHS Ltr B/49717C/AG/ECHS dated 24 Jan 07: (a) Discharge Book showing name of spouse. (b) Pension Book showing details of pension sanctioned. (c) DPDO/Banker's Certificate. (d) Non Effective Strength Records Part II order in case of marriage after retirement and the fact is not shown in the DPDO/Banker's Certificate. 17 In case of birth of any child after retirement of pre1986 retirees submission of Non Effective Strength Records Part II Order is a must. In no case submission of 'Affidavit' will be dispensed with. 18. Advantages of Becoming an ECHS Member. The advantages of becoming an ECHS member are as under:

17 15 (a) The scheme will provide comprehensive medicare to all ESM pensioners, their widows and authorized dependants. (b) It will cover complete spectrum of ESM settled in far flung areas, through a network of polyclinics in military and nonmilitary stations. (c) The Scheme is fully financed by the Government. (d) There is an established network of 227 Polyclinics, i.e, 104 military and 123 nonmilitary station Polyclinics, based entirely on density of ESM in various regions. 196 Polyclinics may be included in phase II to cover all nooks & corners of country. (e) This arrangement will reduce load on service hospitals, as there will be an exclusive facility located along side service hospitals. (f) There will be civil empanelled hospitals, diagnostic centres and consultants to provide inpatient treatment/ consultancy, in addition to service hospitals. (g) The doctors at Polyclinics will provide required outpatient treatment and medicines, free of cost. (h) For further treatment, an ECHS patient will be referred initially to a service hospital, and in case of non availability of bedspace/treatment, he will be sent to a civil empanelled hospital. The ECHS member will be provided treatment and medicines and ward facilities as per entitlement. (j) The procedure for dealing with an ECHS member or his/her dependents in service hospitals will be the same as for serving soldiers and their dependents. (k) The ECHS patient can also be referred to the desired empanelled hospital/ diagnostic centre/consultant as per choice of the ECHS patient in case of nonavailability of treatment in service hospital. The ECHS member alone will have the right to make the selection of desired civil empanelled hospital and will NOT be influenced by any doctor. (l) An ECHS member does not have to clear bills or make payment (except for dietary charges) either on admission or when discharged from the empanelled hospital. The empanelled hospitals will be paid directly by the concerned Station Headquarters on behalf of ECHS. (m) It covers all diseases. (n) An ECHS member who possesses a valid Smart Card can avail of treatment at any ECHS Polyclinic any where in India. (p) There is no restriction on age or medical condition at the time of seeking membership of the Scheme.

18 16 CHAPTER 4 CONTRIBUTION 1. ECHS is a contributory scheme. On retirement, each pensioner (wef. 01 Apr 03) will compulsorily become a member of ECHS by contributing his/her share and the s cheme would be applicable for life time. 2. Similarly, exservicemen pensioners who have already retired on or prior to 31 Mar 03 can voluntarily become members, by paying a one time contribution. The contribution will be according to the table given below(authy: ECHS Ltr B/49784/AG/ECHS dated 15 Jan 05): Revised Pension/Family Pension (Uncommuted Basic Pension + Dearness Pension) (Rupees per month) Upto Rs.3000/ Rs.3001/ to Rs.6000/ Rs.6001/ to Rs.10000/ Rs.10001/ to Rs.15000/ Rs.15001/ and above Contribution (In Rupees) Rs.1800/ Rs.4800/ Rs.8400/ Rs.12000/ Rs.18000/ 3. Contribution to be paid by the Widows of the service personnel whose death is attributable to Military Service, will be based on the amount of the basic pension they will be drawing at a later date and not on the enhanced family pension they are initially granted. 4. All ExServicemen who are drawing pension from Controller of Defence Accounts and who have retired prior to 01 Jan 1996 are exempted from payment of contribution under ExServicemen Contributory Health Scheme. However, they will continue to apply for membership. All documents except MRO will be submitted alongwith application form(authy: GoI Ltr 17(10)/06/US(WE)/D(Res) dated 13 Apr 07). 5. The following categories of liberalised family pensioners have also been exempted from paying the one time contribution for ECHS membership: (a) 04). War Widows(Authy:GoI letter 22(1)/01/US(WE)/D(Res) dated 08 Mar (b) Spouse/Husband of a deceased woman Officer/PBOR covered by actions in category D or E as appended below(authy: ECHS Ltr B/49701WW/AG/ECHS dated 24 May 04): (i) Category `D. Death due to acts of violence/attack by terrorists, antisocial elements, etc whether on duty other than operational duty or even when not on duty. Bomb blasts in public, etc. would be covered under this category, besides death/disability

19 17 occurring while employed in the aid of civil power in dealing with natural calamities. (ii) Category `E. Death arising as a result of : (aa) (ab) mission abroad. (ac) Enemy action in international war. Action during deployment with a peace keeping Border skirmishes. (ad) During laying or clearance of mines including enemy mines as also minesweeping operations. (ae) On account of accidental explosions of mines while laying operationally oriented minefield or lifting or negotiating minefield laid; the enemy or own forces in operational areas near international borders or the line of control. (af) War like situations, including cases which are attributable to/aggravated by: (aaa) Extremist acts, exploding mines etc, while on way to an operational area. (aab) Battle inoculation training exercises or demonstration with live ammunition. (aac) duty. Kidnapping by extremists while on operational (ag) An act of violence/attack by extremists, antisocial elements etc while on operational duty. (ah) Action against extremists, antisocial elements, etc. Death while employed in the aid of civil power in quelling agitation riots by demonstrators will be covered under this category. ( aj) Operations specially notified by the Govt from time to time. (c) Parents, ie, mother & father of unmarried deceased soldier, provided they are in receipt of Liberalised Family Pension. (d) In case parents at 4 (c) above are deceased, then NOK of unmarried deceased soldier, provided he/she are in receipt of Liberalised Family Pension. 5. In the case of 4 (a) & (b), dependant children of the married deceased soldier are also covered by the ECHS, subject to age/marriage and other conditions of eligibility. In case of Paras 4 (c) & (d) above, children or dependants of the

20 18 individuals listed thereat are NOT entitled to ECHS eligibility, since the deceased soldier was unmarried. 6. War disabled pensioners who have sustained disability under above conditions have also been exempted from payment of contribution for ECHS membership(authy : GoI letter 24(2)/05/US(WE)/D(Res) dated 24 Jul 05) Documents to be submitted for seeking Exemption from Contribution 7. ESM seeking exemption of contribution/refund of contribution must submit the following documents to establish proof of disability having been sustained in operations: (a) Army (i) Officers (aa) Battle casualty report issued by MP 5/6 (erstwhile Org 3) AG s Branch, Army HQ. (ab) PPO. The following details will be checked: (aaa) PPO of M/DIS series. (aab) The details of injury sustained by the ESM in an Operation/War should be mentioned in the main text of the PPO on account of which he is receiving the disability pension. (ii) PBOR (aa) book. (ab) Battle casualty endorsed at Part VI of the discharge PPO. The PPO should be of D/BC Series. (b) Air Force (i) (ii) Officers. The War disabled pensioner will be certified by DPP&R. PBOR. The War disabled pensioner will be certified by AFRO. (c) Navy (i) (ii) Officers. The War disabled pensioner will be certified by PDOP. PBOR. The War disabled pensioner will be certified by CABS.

21 19 CHAPTER 5 ORGANISATION 1. ECHS, a triservices project organisation with its Central Organisation located at New Delhi, is headed by a Managing Director (Major General) of the Indian Army. In Air Force, Director of Personal Services, Air HQ (VB) under AOA s Branch coordinates. There are 13 Regional Centres located all over the country headed by Regional Directors. Postal addresses of the Central Organisation and the Regional Centres are appended below. The scheme would cater for medicare through 227 polyclinics (List placed at Appendix A ) out of which 106 military polyclinics exist along side service hospitals. 121 nonmilitary polyclinics are set up in various towns, independently. It is proposed to set up 196 additional polyclinics in due course so that each district of the country is covered. ECHS Central Organisation Telephone (O) Maude lines, Delhi Cantt, New Delhi Addresses of the Regional Centres. (a) Jammu Regional Director Regional Centre, Jammu C/o Stn HQ Jammu Tele : ( b) Delhi Regional Director Regional Centre ECHS, C/O HQ Delhi Area, Maude Lines New Delhi Tele: (c) Chandimandir Regional Director Regional Centre ECHS, C/o HQ Western Command Chandimandir Cantt Tele: (d) Jaipur Regional Director Regional Centre, Jaipur C/o HQ 61 (I) Sub Area C/o 56 APO Tele: (e) Lucknow Regional Director Regional Centre ECHS, Luknow C/o HQ Lucknow Sub Area Lucknow (UP) Tele:

22 20 (f) Kolkata Regional Director Regional Centre ECHS, Kolkata C/o HQ Eastern Command Fort William, Kolkata (g) Patna Regional Director Regional Centre ECHS, Patna C/O HQ JOB Sub Area, Danapur Cantt (Bihar) Tele: (h) Jabalpur Regional Director Regional Centre, Jabalpur 132/2 Robert Lines, Near Manas Mandir Jabalpur (MP) Tele : (j) Pune Regional Director Regional Centre ECHS, Pune C/o HQ Pune Sub Area Pune (Maharashtra) Tele : (k) Chennai Regional Director Regional Centre, Chennai C/O Stn HQ, Fort Saint George Chennai Tele: (l) Hyderabad Regional Director Regional Centre ECHS C/o Air Force Station Begumpet, Secunderabad(AP) Tele : (m) Kochi Regional Director Regional Center ECHS, Kochi C/o HQ Southern Naval Command Naval Base, Kochi (Kerla) Tele: Fax (n) Guwahati Regional Director Regional Centre ECHS, Guwahati C/O 51 Sub Area, C/O 99 APO Tele:

23 21 3. The Organisation Chart of ECHS cell at Air HQ (VB) is as follows: AOA ACAS(P&D) D P S Tele Fax: Tele: /7165(Extn) JDPS (OIC ECHS) Tele: /7160(Extn)

24 22 CHAPTER 6 TREATMENT Treatment at Polyclinics 1. The starting point for medical attendance will be the nearest military/non military polyclinic. All available treatment within the capabilities of the polyclinic shall be provided at the first instance. Medical and para medical staff are hired/employed on contract for working at polyclinics. These polyclinics remain open for eight hours during week days and shall remain closed on Sundays and Gazetted holidays. Patients requiring attention outside working hours will be handled by duty MOs of service hospitals (in military stations) and by oncall civilian doctors in nonmilitary stations. One nursing assistant will be available in all clinics in nonmilitary stations after working hours. Depending on the type (A, B, C, D) which has been decided on the number of Veterans residing in that area, each polyclinic will have emergency bed with monitor, physiotherapy equipment, analysis with regents, digital ECG machine, dental chair, Ultra Sound machine, X Ray machine, Oxygen Concentrator, Nebulisor, minor OT and BP machine etc. 2. Manpower at Polyclinics* Details Type A Type B Type C Type D Mil Non Mil Mil Non Mil Mil Non Mil Mil Non Mil Medical Officer Medical Specialist Dental Officers OIC (Non Medical) Gynaecologist 1 1 Nursing Asst/Nurse Lab Asst Dental Hygienist Receptionist 1 1 Driver Peon Safaiwala Female Attendant *Note This may undergo change with additional manpower sanctioned by MoD. Treatment at Military Hospital/Empanelled Hospitals. 3. In case the required treatment is beyond the scope of the polyclinics, the Medical Officer in the first stage will refer the patient to the local MH where required treatment facility is available. Should MH not have the desired treatment/doctor/bed space, the ECHS patient will have the choice of going to any empanelled hospital in the station. In case the treatment is not available in that station, the ECHS member can go to any empanelled hospital in India. However, the cost of conveyance is to be borne by the individual. The list of the hospitals

25 23 already empanelled along with details regarding the specialties for which the hospitals are empanelled is placed as Appendix B. Authority for Referral to Empanelled Facility. 4. Referrals to empanelled facilities will be generated from ECHS Polyclinics. The choice of empanelled facility will be with the ECHS member(authority to initiate referrals will be as follows(authy: ECHS letter B/49774/AG/ECHS dated 01Dec 09 for entire referral procedure unless mentioned specifically): (a) Referral for General Service Specialities. For General Service Specialities( list appened below), Polyclinic Medical Officers, Specialists and Dental Officers (for dental treatment) are authorised to initiate referrals. Type of Speciality Type of Speciality Type of Speciality General Medicine General Surgery Obstetrics and Gynaecology ENT Ophthalmology Paediatrics Emergency Services Psychiatry Dermatology Dental Anaesthesia Pathology Microbiology Blood Bank (Blood Transfusion) Radio diagnosisc (b) Referral for Specialised Services. Referral for specialized services( list appended below), can only be made by a specialist at the Polyclinic or on advice 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). Type of Speciality Type of Speciality Type of Speciality Surgery Medicine Obstetrics and Gynaecology Neuro Surgery Neuro Medicine Gynaecological Oncology Plastic&Reconstructive Surgery Cardiology Infertility and assisted reproduction Cardio Thoracic Surgery Respiratory Diseases Gynaecological Endocrinology Vascular Surgery Gastro enterology Materno foetal Medicine Genito Urinary Surgery Endocrinology Paediatric Surgery Nephrology Paediatrics Oncology (Surgery) Rheumatology Neonatology Gastro Intestinal Surgery Clinical Haematology Cardiology Traumatology Clinical Immunology Neurology Joint Replacement Oncology (Medical) Haematology Surgery Spinal Surgery Critical care medicine Nephrology Prosthetic Surgery Interventional Oncology Cardiology Laparascopic Surgery Medical Genetics Endovascular Surgery Geriatric Medicine

26 24 Geriatric Surgery Radiotherapy Pathology Onco Pathology Radio Diagnosis & Molecular Pathology Imaging CT Scan Transplant Pathology MRI AIDS & Virology Interventional and Vascular Radiology Molecular Immuno Pathology Genetic Pathology Transfusion Medicine (c) Emergency Referrals. In case of emergency / life threatening conditions a patient is permitted to take treatment in any hospital. However, 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. In 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 nonavailability of spare capacity in service hospitals. The endorsement should state as under: Procedure for Referrals (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". Referral from Military Polyclinics (with Service Hospitals). 5. Exservicemen and their dependents requiring hospital admission will, in normal course, be referred to service hospitals in the station. In case of nonavailability of beds/facilities in service hospital, patients will be referred to empanelled hospitals for admission. The stipulation of referral to service hospital before referring a patient to empanelled hospital is primarily to economize on the meagre resources of the state. Intention 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. 6. The following guidelines will be adhered to in the process: (a) Patients would be referred directly to civil empanelled facilities by Medical Officer/Medical Specialist (as applicable) at ECHS Polyclinics in case of overloading or nonexistence of medical facilities at the service hospital.

27 25 (b) 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. (c) At times the facilities for a disease may exist in a service hospital but it may be overloaded / bed space may not be available. Such information must be provided by SEMO to the OIC ECHS Polyclinics under their SEMO cover on a regular basis. 7. A service hospital of the station would genrally NOT refer the patient to service hospital of a different station, unless in the opinion of the concerned 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 patient s choice in that station through the ECHS Polyclinic. Referral from Non Military Polyclinics (Including Military Polyclinics without Service Hospitals). 8. For the purpose of referrals Military Polyclinics without service hospitals( list appended below), will follow the procedure applicable to Non Military Polyclinics. (a) (b) (c) (d) (e) (f) (g) (h) (j) (k) (l) (m) (n) (o) (p) (q) Janglot Moga Sangrur Sirsa Jaisalmer Ajmer Saharanpur (Sarsawa) Bharatpur Balasore Nagpur Yelahanka Dimapur Shajahanpur Kotdwara Haldwani Mumbai (Upnagar) Powai 9. ECHS patients will be referred to civil empanelled facility having valid MOA with the Station Headquarters as per instructions contained in Para 7 above. 10. 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). 11. A patient can be referred directly to empanelled facility in nearby city provided the Station Commander of originating Polyclinic has a valid MOA with the concerned hospital. Such crossempanelment is essential to widen the network of referral facilities.

28 Till the time instructions on crossempanelment are implemented all referrals to outs tation 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 is required to be referred to a outstation hospital for Cancer therapy because there is no facility available in his town, the ECHS Polyclinic at Bhatinda will initiate a referral for treatment at an empanelled facility at Ludhiana/Amritsar. ECHS Member will register himself/herself with the Polyclinic at Ludhiana/Amritsar and get his/her referral form duly stamped and countersigned by the OIC Polyclinic before the patient takes treatment at the empanelled cancer hospital at Ludhiana/Amritsar. 13. 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. 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 endorsed 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 endorsed as Referred for Review/Followup (Includes consultation and investigations). Emergencies 14. 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. 15. Conditions of Emergency covered under the ECHS are envisaged as follows: (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 aneurysms, medical & surgical shock and peripheral circulatory failure.

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