Definition of empanelled hospital and handling of cases of treatment taken by ECHS beneficiaries in such hospitals – Clarification by DESW
File No. 22D(01)/26018/ (WE)/D( Res -1)
Government of India
Ministry of Defence
Department of Ex-Servicemen Welfare
Room No. 221,B,Wing
Sena Bhavan, New Delhi
Dated: 25 Sept. 2019
The Managing Director
Ex-servicemen Contributory Health Scheme
Subject: Clarification regarding definition of empanelled hospital and consequent handling of cases of treatment taken by ECHS beneficiaries in such hospitals.
The undersigned is directed to refer to CO, ECHS letter No.49770/AG/ECHS /Treatment dated 23-8-2019 and to issue the following clarifications.
(i) A hospital shall be considered to be on ECHS panel only when it has a valid MoA or it is not under orders of stop referral.
(ii) 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 emergency by making payment, the amount should be re-imbursed to the ECHS beneficiary as per CGHS rates.
(iii) If a hospital is without valid MoA or it is under stop referral and any ECHS beneficiary having a valid referral from ECHS polyclinic choses to take treatment in such hospital due to having taken 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 re-imbursement at CGHS rates.
(iv) If a hospital is empanelled but due to huge pending bills remaining unpaid refuses 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 CO, ECHS will send a proposal to MoD for disempanelment of this hospital.
2. CO, ECHS may take necessary action accordingly.
(A. K. Karn)
Under Secretary (WE)
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