Introduction

Ex-Servicemen’s Contributory Health Scheme (ECHS) is a comprehensive medical care scheme covering all diseases including cardiac, renal, joint replacement, cancer, and many others. It provides benefits to the complete spectrum of ESM pensioners settled in far-flung areas of the Country through a network of 227 polyclinics. The Scheme has been implemented from 01 Apr 2003.

(a) Step 1

(i) Collect computerized forms from nearest Station HQs of Army/Navy/Air Force.
(ii) Forms can also be downloaded from internet website http://www.indianarmy.nic.in/arechs.htm or Navy/Air Force website.

(b) Step 2

(i) Pensioners to report personally to any of the Station Headquarters listed at Annexure to Appendix ‘A’ with completed application form along with the original photocopy of following documents: -

(aa) 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.

(ab) Discharge book/Discharge certificate for PBOR.

(ac) Original copy of Military Receivable Order (MRO) as a proof of deposit of contribution.

(ad) Affidavit duly notarized, in original only.

(ae) Retired Officers Identity card (photocopy not required to be attached).

(af) Demand draft for Rs.90/- per card in favour of Regional Centre

(c) Step 3

(i) Applicant to come in person to Station Headquarters when informed for collection of ECHS membership SMART Card. Applicant to produce Receipt of documents, as proof of his/her identity. Smart Card(s) will NOT be handed over to any representative.

(ii) Card to be kept carefully as it is the only passport to entitled treatment under the Scheme.

(d) Step 4

(i) Use the Polyclinics facilities.

(ii) It is mandatory for members and dependants to report to nearest Polyclinic along with SMART Card within 120 days, for one-time initial Registration. The Smart Card will always be required to be produced thereafter to avail treatment at a Polyclinic empanelled hospital.

(iii) ECHS smart Card will NOT be activated for use, unless above Registration is done.

(iv) The Smart Card is the member/dependant(s) proof of identity and authorization for ECHS benefits, and hence, will always have to be produced.

The following will be sent to Managing Director, AGI :

(a) An application on a plain paper.
(b) Photocopy of ECHS Smart Card.
(c) Original AGI (MBS) Card with joint photograph.

Use of Polyclinic Facilities. When visiting a Polyclinic subsequently, it is mandatory for the pensioner or his/her dependant to carry the ECHS SMART CARD as proof of eligibility. The Polyclinic may not accept the individual for treatment in its absence.

Enroll yourself as member of ECHS at the earliest, if not already done

Any other clarification not covered above-approach AFA

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 being hired/employed on contract for working at polyclinics. These polyclinics will be opened for eight hours during weekdays and shall remain closed on Sundays and Gazette holidays. Patients requiring attention outside working hours will be handled by duty MOs of service hospitals (in military. stations) and by on-call civilian doctors in non-military stations.

2. In case the parent polyclinic is designated to the ECHS member, in case of any change in polyclinic, change of address and dependency, the ECHS member is to submit the following to the nearest Station HQs to the new address.

(a) An application on plain paper giving reasons for change
(b) A fresh application form with relevant columns filled and superscribed ‘CHANGE OF ADDRESS’ on top
(c) Affidavit as per format endorsed on Rs. 10 non judicial stamp paper duly notarized.
(d) Enclose the old cards duly cut into 2 pieces
(e) Deposit Cash/DD @ Rs. 90/- per card requested.

3. The procedure for utilizing ECHS facilities at polyclinics other than parent polyclinics will be as follows:-

(a) Members will be handled in OPD and given medicine for 07 days at a time.
(b) Referral to an empanelled facility will be authorized for an emergency/essential along with its related treatment.
(c) Medical equipment authorized for home use will only be sanctioned by parent polyclinics.

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. The choice of empanelled hospital will be of his choice and not of the doctor. 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.

4. The payments by ECHS to the empanelled Hospitals, nursing Homes and Diagnostic Centers will be governed by the following procedure:¬

(a) Referral to Empanelled hospital/Nursing Home/Diagnostic Center.
Payment of bills to empanelled concerns will only be authorised when patients are referred from ECHS Polyclinic. for necessary treatment/investigation. Hospitals will only treat patients for conditions for which they have been specifically referred from the ECHS Polyclinic, except in life saving/emergency situations.

(b) Payment to empanelled Hospitals/Diagnostic Centers:-The rates of payment to empanelled hospitals/Diagnostic centers in cities/towns covered under CGHS will be governed by the package deal rates as laid down for CGHS. The rates laid down for CGHS for various towns/cities will be applicable for ECHS Polyclinics located in corresponding/adjoining geographical areas.

(i) For the Polyclinics located in cities/towns not covered under CGHS, the rates of payment to the Empanelled Hospitals/Diagnostic centers 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 CGRS rates applicable to the nearest cities/towns covered under CGRS.

(ii) For diseases and conditions not in the list of CGRS package deals, the payment to the empanelled hospital/Diagnostic center would be at rates of AIIMS New Delhi or Actual, which ever is less. Where AIIMS rates are not available, the actual cost of drugs and room rent etc will be reimbursed.

(iiii) The package deal rates will include all charges pertaining to a particular treatment/procedure including admission charges, accommodation charges, ICU/ICCU charges, monitoring charges, operation theatre charges, operation charges, anesthetic charges, procedural charges/Surgeons fee, cost of disposables, surgical charges and cost of medicines used during hospitalization, related routine investigations, physiotherapy charges etc.

(iv) The package rate does not include diet, telephone charges, TVcharges and cost of cosmetics, toiletry, and tonics. Cost of these, if offered, on request of patient will be realized from individual patient and are not to be included in package charges.

(v) The package deal includes
(ia) 12 days for Specialized procedure
(ib) 7-8 days for other procedures
(ic) 3 days for laparascopic surgery
(id) 1 day for day care/minor procedures(OPD)

(vi) If the beneficiary has to stay in the hospital for his/her recovery for more than the period covered in the package rate, the additional reimbursement will be limited to room rent as per entitlement, cost of prescribed medicines and investigations, doctors visits (not more than 2 times a day) for additional stay.

(vii) If one or more treatment procedures form part of a major treatment procedure, package charges would be made against the major procedures and only half of approved charges quoted for other procedures would be added to the package charges of the first major procedure.

(viii) The rates will be applicable only for allopathic system of medicine. No charges will be reimbursed for Homeopathic, Unani, Ayurveda or traditional systems of medicines.

(ix) An empanelled hospital/diagnostic center whose rates for a procedure/test/facility are lower than the approved rates shall charge the beneficiaries as per actual. Expenditure in excess of approved/package deal rates would be borne by the beneficiaries.

(x) Any legal liability arising out of such services shall be dealt with by the empanelled hospital, nursing homes, and diagnostic centers who shall alone be responsible. ECHS will not have any legal liability in such cases.

(c) Allied Charges

(i) Diet Charges. ECHS beneficiaries drawing basic pension up to Rs.2025/- per month will be entitled to free diet during hospitalization in empanelled hospitals. In case suffering from T.B or mental diseases, beneficiaries with basic pension up to Rs.3000/- per month will be entitled to free diet during hospitalization.

(ii) Special Nursing Attendant Charges. Special nursing charges
and/or attendant charges will be admissible when such nursing/attendance is essential for recovery/prevention of serious deterioration of the patient as certified by the Medical Officer-in-charge of the case. The approval of SEMO/SMO/PMO will be obtained through the concerned polyclinic in all such cases. The rate ceiling for special nursing and attendant charges will be as per guidelines of the COHS. Special nursing/attendant charges will be applicable only for patients admitted in hospitals/nursing homes and will not be applicable for treatment taken at residence.

(iii) Entitlement for Indoor Treatment. Charges as applicable to CGHS will apply. ECHS beneficiaries shall be entitled to a general/semi private/ private ward facility in empanelled hospitals according to their monthly pension as under: ¬

(iv) Entitlement of Hospital Beds. Entitlement of Hospital Beds in empanelled hospital is according to the rank held as structured below.

Officers - Private Ward
Warrant Rank/Honorary Ranks and equivalent – Semi Private ward
Sergeant and below and its equivalent – General Ward

(v) A/C Charges. AlC charges will be included for ICU/ICCU patients, private ward patients, and specialized treatment patients. In all other conditions where AlC is absolutely essential for treatment of the patient, such charges will be included with a necessary certificate from the treating physician.

(d) The Bills from the empanelled hospital will include the following:¬

(i) Medical advances drawn, if any.
(ii) Referral slip from Polyclinic & photocopy of ECHS card.
(iii) Copy of admission and discharge slip
(iv) Summary of the case, including outcome
(v) Consultation charges/Diagnostic/ Package charges as applicable
(vi) Other charges if any not included above (to be specified).

(e) Mode of Payment. Bills and connected documents will be
Submitted by Hospitals, Nursing homes and diagnostic Centers to the Polyclinic from where the patient was referred. Officer In-Charge (OIC) Polyclinic will authenticate the bills and forward to concerned Senior Executive Medical Officer (SEMO)/Principal medical Officer (PMO)/Senior Medical Officer (SMO) for scrutiny and onward dispatch to station headquarters for payment. Payment will be made by cheque and will be subject to post -audit.

(f) Treatment at Military Hospitals. Hospital stoppage rolls and any other charges expended for the member will pay treatment in military hospitals in full and are not reimbursable.

Specialized Treatment

5. The procedure for referral and reimbursement for specialized procedures will be as follows:

(a) Specialized Tests and Treatment. The specialist at Polyclinic, specialist of service hospital or specialist at empanelled hospitals/diagnostic centre, will only refer ESM or dependents to the empanelled hospitals/diagnostic centres for Specialised tests and treatment. Only in case of emergencies arid life threatening situations will a non-specialist medical officer of the Polyclinic refer a patient directly for specialized tests and treatment. In such cases, the referring medical officer will endorse a certificate to this effect. Payment to empanelled specialist/super specialist will be made as per procedure laid down.

(b) Specialized Treatment. For treatment in cardiology, nephrology, oncology, joint replacement, and other expensive specialized treatment/surgery, payment will be governed by the CGHS rates for various procedures as revised from time to time. When the CGHS rates for treatment are not available, rates of AIIMS or actual, whichever is less, will be applicable. Where the AIIMS rates are not available, the actual cost of drugs and room rent etc will be reimbursed.
(c) Treatment at Institutes of National Repute/Govt Institutions. Certain hospitals/institutes do not accept post-payment. Such institutes will not ordinarily be empanelled under' the' ECHS. However, admission/treatment in the institutes of national repute fisted below will be 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 crossed cheque payable to the concerned hospital will be drawn by the patient from the concerned station headquarter after submitting the referral form by an ECHS Polyclinic and estimate from the concerned hospital. The hospitals where such an arrangement will be permitted are:

(i) All India Institute of Medical Sciences New Delhi
(ii) Post Graduate Institute, Chandigarh
(iii) Sanjay Gandhi Post Graduate Institute, Lucknow
(iv) National Institute of Mental Health and Neurosciences,Bangalore
(v) Tata Memorial Hospital, Mumbai (For Oncology)
(vi) JIPMER, Pondicherry
(vii) Christian Medical College, Vellore
(viii) Shankar N ethralaya, Chennai
(ix) Medical Colleges and hospitals under the Central or State Govts

6. Under certain special circumstances, reimbursement of cost of medicines will be permitted only if the patient was referred by the Polyclinic for specialized treatment and the medicines were prescribed to be taken with immediate effect on discharge. The special conditions are:

(a) Post operative cases of major cardiac surgery/international cardiology
(b) Oncology
(c) Post operative organ transplant cases
(d) Post operative joint replacement cases
( e) Post operative major neuro surgical/neurology cases

7. The Ex-serviceman should present the suitable prescriptions for medicines for above conditions to the O ic Polyclinic immediately.

8. In emergencies and life threatening conditions, when patients may not be able to follow the normal referral procedure, the patients may report to the nearest hospital, preferably empanelled.

(a) Conditions of Emergency. By and large all conditions emergencies covered under the ECHS are listed below. In all cases of emergency, the onus of proof lies with ECHS member.

(i) 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.

(ii) Vascular catastrophies including acute limb ischaemia, Rupture of aneurysms, medical & surgical shock, and peripheral circulatory failure.

(iii) Cerebro vascular accidents including strokes, neurological emergencies including coma, cerebro meningeal infections, convulsions, acute paralysis, acute visual loss.

(iv) Acute respiratory emergencies including respiratory failure and de compensated lung disease.

(v) Acute abdomen emergencies including acute obstetrical and. Gynecological emergencies.

(vi) Life threatening injuries including road traffic accidents, head: injuries, multiple injuries, crush injuries and, thermal injuries.

(vii) Acute poisoning and snake bite.

(viii) Acute endocrine emergencies including diabetic ketoacidosis.

(ix) Heat stroke and cold injuries of life threatening nature.

(x) Acute renal failure.

(xi) Severe infections leading to life threatening sequelae including septicemia, disseminated/ miliary tuberculosis.

(xii) Any other condition in which delay could result in loss of life or limb.

(b) Empanelled Hospital- Immediate emergency treatment in any empanelled hospital will be rendered to ESM on confirmation of ECHS membership from the ECHS card. Payment for such treatment will be regulated as under:¬

(i) Empanelled hospital will inform ECHS Polyclinic about the emergency admission at the earliest but not later than 24 hrs.

(ii) The empanelled hospital will not collect payment from ECHS member.

(iii) The actual cost incurred for emergency procedure will be payable by ECHS. Bill for emergency treatment will be forwarded to concerned Polyclinic for payment as per normal procedure. Such bills will be super scribed with 'EMERGENCY TREATMENT' written in Block capitals in Red.

(iv) On learning about admission of an ECHS member in an Empanelled hospital, the 0 i/c Polyclinic will make arrangements for verification of the facts.

(v) If, during the course of investigations/treatment a specific diagnosis is established requiring further management, the facts will be verified by concerned 0 i/c Polyclinic and the patient referred for the same formally.

(vi) In case of malpractice, unethical practices or medical negligence by an empanelled Hospital or Nursing home particularly in management of emergencies necessary action will be taken by the Station Commander to dis-empanel the Hospital or Nursing Home.

(c) Non-empanelled Hospital- Ex-servicemen or his representative should inform nearest
Polyclinic within 48 hrs of such admission. The responsibility for clearing bills will rest with the
Ex-Serviceman. He/She will submit the bills along with summary of the case to the concerned
Polyclinic. Central Organisation, ECHS, will accord the sanction for reimbursement as per approved rates. Such bills will be submitted within a period of one month from the date of discharge from hospital.

(d) The Empanelled or Non-empanelled Hospital will be liable to pay damages to the beneficiaries in case of medical negligence in emergencies, and the Hospital/ Nursing Home alone shall deal with legal liabilities, if any. ECHS will not have any legal liability in such cases.

Notification of Emergency Admission

          The contents of Central Organisation ECHS letter No B/49773/AG/ECHS/Policy   20 Apr  2007 are appended below :-

 "1.         Reference  :-

             (a)        Govt of India, MoD letter No 24(8)/03/03(WE)/D(Res) dated 19 Dec 2003.

 (b)        This HQ letter No B/49773/AG/ECHS dated 25 May 04.

             (c)        This HQ letter No B/49778/AG/ECHS/Referral dated 01 Sep 04

 2.         Feedback has been received from the environment, that ECHS members are being  subjected to avoidable inconvenience due to delayed intimation to the concerned Polyclinic of their Emergency admission and treatment in Empanelled Hospitals. In some instances, Empanelled Hospitals  have forced the admitted ECHS patient to make payments apprehending non clearance of  their Hospital bills at a later date. In this regard relevant policy, already issued vide above quoted ref, is re-iterated and following clarification are made :-

(a)        Emergency in a Non Empanelled Hospital.  The onus of informing the OIC polyclinic within 48 hrs lies with the ECHS member/Patient/NOK. Thereafter the OIC will initiate an Emergency Information Report (EIR) after ascertaining the emergency. The bills will be cleared by the patient and submitted to the Polyclinic within 30 days of his discharge from the hospital. Bills will be processed subsequently if the EIR is in order and reimbursement will be as per CGHS rates.

(b)        Emergency in an Empanelled Hospital.  The onus of informing the OIC Polyclinic within  48 hrs lies with the Empanelled Hospital and not with the ECHS member/patient. However, the ECHS member may also convey the information on his own to ensure action. Thereafter, the OIC Polyclinic will initiate an emergency referral after verifying the emergency. He will also ensure that the Emergency referral reaches the Empanelled Hospital in time and that the Empanelled Hospital does not charge the patient, inadvertently or otherwise. Empanelled Hospital bills, once received at the Polyclinic alongwith necessary supporting documents, will be processed as per approved rates. Payment to the Empanelled Hospital will be made within 60 days of  submission of claim.

(c)        Treatment of emergency will be provided by the empanelled hospital, irrespective of the fact whether the generalized/ specialized service required for treating the patient is covered under the Memorandum of Agreement (MOA) with ECHS. The bills in such cases will be cleared by ECHS, as per authorised rates,  provided necessary emergency information  has been given to the OIC Polyclinic in time, by the said Empanelled Hospital.

(d)        In cases where emergency admission information has not been received at the  Polyclinic in time from an Empanelled Hospital, the patient should not be held responsible. Instead the hospital authorities will be made answerable and bills cleared/passed accordingly. OIC Polyclinics will ensure that under NO rpt NO circumstances the Empanelled Hospital will compel the ECHS member to pay for Emergency treatment. All cases where an ECHS member has been compelled by an Empanelled Hospital to make payment under duress, for emergency treatment taken therein, should be reported to the Stn HQ under intimation to concerned HQ Command,  Regional Centre and this HQ. The matter should be investigated and resolved by the Stn HQ or referred to higher HQ if required. Disempanelment proceedings of the errant Empanelled Hospital may be considered, if warranted.

(e)        The OIC Polyclinics and OIC Stn Cell ECHS are requested to clarify the above issue with all the hospitals empanelled with the Stn, such that the policy matter is followed in letter and spirit and ECHS members are not unnecessarily inconvenienced

 4.         Stn HQs be requested to ensure percolation of subject issue down to  each ECHS empanelled establishment by way of issue of instructions, organising  a conference or liaison visits, as appropriate.

Sd/ xxx

(Col. G Ghose), Dir (Med)"

Conditions

9. In cases where facilities for treatment are not available in Armed Forces hospitals and in certain special conditions, the procedure for referral and treatment will be as follows: ¬

(a) TB & Leprosv. No OPD charges will be reimbursable. TB and Leprosy will be treated through national programs at district level. However, when the patients require admission in such cases, rates of CGHS as applicable to LRS institute of TB and Allied Disease will be applicable for hospitalization. ..

(b) Hearing Aids. The equipment will be issued to the entitled patients based on the recommendations of ENT specialist after clinical and audiometric justification. The OIC Polyclinic, will procure the hearing aid in consultation with the SEMO, and issue to ESM. Replacement is permitted after minimum of 5 years life, based on a condemnation certificate and approval of ENT specialist. Digital hearing aid will only be given on recommendations of three ENT specialists, including at least one service specialist. Actual cost of hearing aid or CGHS rates, whichever is less, will apply.

(c) Mental Diseases. In all mental illness cases, the patient will be referred to service Psychiatrist/empanelled hospitals for OPD consultation. The Ole Polyclinics/SEMO through special demand will procure drugs prescribed for the patient. Cases requiring hospital admission will be referred to authorised empanelled/Govt hospitals only. Provisions of Mental Health Act, 1987, as amended, will be applicable for all such hospital admissions. Payment will be made in full for admission to Govt hospitals and prescribed rates of CGHS will apply for empanelled hospitals.

(d) HIV AIDS. Ex -service pensioners boarded out of service due to AIDS will be provided treatment as prescribed by Armed Forces Centers for such treatment at the time of discharge. Treatment will be made available to such individuals with effect from two months after the date of discharge. Fresh cases of HIV / AIDS amongst members of ECHS, including dependents will be referred to the nearest Armed Forces Immuno- Deficiency Centers, and treatment as prescribed from these centers only will be made available.

(e) Artificial Limbs/Appliances. Artificial limbs/appliances will be
Reimbursed in full when procured and fitted at Artificial Limb Center(ALC), Pune, and Artificial Limb Sub Centres in the AFMS hospitals. CGHS rates will apply in other cases treated in empanelled hospitals.

(f) Rehabilitation/Terminal Care. Rehabilitation/terminal care will be provided in empanelled rehabilitative homes and hospitals. Patients, admitted to service hospitals or empanelled hospitals/nursing homes where the finality of treatment has been reached and definitive medical treatment has run its course, will be referred to rehabilitative homes/hospitals for nursing care and rehabilitation. The conditions for which rehabilitative care will be admissible are paraplegia, quadriplegia, Alzheimer's disease, cerebra-vascular accidents, other neurological and degenerative disorders, amputations, cancer terminal care and other such medical conditions, when duly referred by treating specialists. Approval of SEMO/SMO/PMO will be obtained for these referrals. The payments for such cases will be regulated as under:

(i) Rates of payment for rehabilitation/terminal care cases will be limited to maximum rates permissible under CGHS for Special Nursing/ Aya/ Attendant charges PLUS charges for medical treatment as per CGHS rules. Where the rates of CGHS are not laid down, AIIMS charges or actual which ever is less will be applicable. In case rates have not been defined by AIIMS, the actual will be reimbursed. Rehabilitative care/terminal care does not include old age homes.

(ii) Reimbursement will be limited to maximum period of 6 months. Thereafter cost of such care has to be borne by the patient.

(g) Medical Equipment for Residences. Medical equipment including
nebulisers, CIP AP/BIP AP machines and glucometers etc., as authorised under the CGHS will be issued to members, on recommendations of the specialist, when use of such equipment is considered absolutely essential on medical grounds, on recommendations of the Specialist and approved by the Senior Advisor and Consultant of the concerned specialty, under whose jurisdiction the Polyclinic is located. The equipment will be procured through a special demand by the 0 ic Polyclinic. Consumables for the equipment will be issued under arrangements of 0 ic Polyclinic. Cost on repair and annual maintenance contracts will be borne by the, member himself or herself and will not be reimbursable. .

(h) Medical Examination/Health Check Up/Screening Tests. The ECHS beneficiaries may undergo medical examination/health check up at the Polyclinic once a year. The medical examination/health check up will be limited to facilities available in the Polyclinic. Referrals to empanel. Institutes for medical examination/health check up/screening tests are not permissible.

(j) Dental Treatment. Dental treatment including referral will be as per laid down procedures for other medical cases. Dentures will be permitted only if advised by Dental Officer at ECHS Polyclinic or service Dental Officer. A particular type of partial/complete denture. will be permitted on one time basis only for each member/dependent of the Scheme as per CGHS rates.

(k) Intra Ocular Lens. Intra Ocular lens (IOL} implantation will be provided to ECHS members at the nearest service eye center. Incase of 10L implantation undertaken at Civil hospitals, payment will be limited to prevailing CGHS rates. Type/make of 10L implanted will be specified in the bills by empanelled hospital.

(l) Spectacles. Spectacles will not be provided under ECHS, except post operatively in cases of conventional operation of cataract. Cost of spectacles in such cases will be limited to Rs.200/-. Replacement of spectacles will be admissible once in three years provided the same is under taken on the advice of the Medical officers of the Polyclinic or empanelled consultant.

(m) Plastic Surgery. Reimbursements and payments for plastic surgery will not be permissible under ECHS except for therapeutic reasons and in posttraumatic cases on recommendations of SEMO/SMO/PMO. Provisions of CGHS and package deal rates/ceilings will apply.

10. Diagnostic Tests & Other Investigation Charges. Investigations/ laboratory diagnoses will be carried out at ECHS clinics in normal course. The Medical Officer ECHS/Specialist will, only make referral for the tests, if required, to empanelled Diagnostic Centers/Hospitals/nursing Homes. The charges as approved by the CGHS for investigations will be valid for ECHS.

11. OPD Charges. Charges for drugs and other consumables for outpatient treatment are not reimbursable except under special conditions as listed in Para 6 above. Medicines will be procured by the ECHS clinics and issued to the patients.

12. Traveling allowance. The following procedure will govern the movement of patient to referred clinics:-
(a) Admissibility:

(i) Traveling allowance for journeys undertaken for medical treatment (both ways) is admissible to ECHS beneficiaries for treatment in another city, if such treatment is not available in the same city and ECHS Medical Officer/Specialist advises referral. Amount admissible will be limited to rail fare in entitled classes as applicable at the time of retirement, by shortest/main route or actual expenditure, which ever is less.

(ii) One attendant or escort who is required to travel along with the patient will be entitled to traveling allowance if the Medical Officer attending the patient certifies in writing that it is unsafe for the patient to travel alone and such attendant escort is necessary to accompany the patient. Amount as admissible to the patient is reimbursable.

(b) Ambulance-Ambulance services authorized in Polyclinic may be utilized for patients when being referred to service/empanelled hospitals in the same city