EXSERVICEMEN CONTRIBUTORY HEALTH SCHEME

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EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME
ECHS BRIEFING NAVAL FOUNDATION 03 OCT 06
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A PREVIEW ON ECHS
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CURRENT STATUS
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TOTAL MEMBERSHIP (AS ON 29 SEP 06)

• 1. TOTAL MEMBERSHIP
• OLD RETIREES - 1,81,317
• NEW RETIREES - 1,60,790
• TOTAL - 3,42,107
• TOTAL INCLUDING - 11,91,560
• DEPENDANTS
• 2. MEMBERSHIP INCREASING AT THE RATE OF 4100 PER
  WEEK.

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STATUS OF ECHS POLYCLINICS
ORAI AND THANE
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EMPANELLED FACILITIES

• TOTAL EMPANELLED HOSPITAL
  - 504
• TOTAL CGHS/RLY/GOVT HOSPITAL
  - 81
• EMP FACILITIES IN SOUTHERN COMD
  - 202
• HOSPITALS - 164
• DIAG CENTRES - 38

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EMPANELMENT STATUS
INCL 24 36 EMPANELLED FACILITIES IN NAVAL
AIR FORCE STNS RESPECTIVELY.
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FUND STATUS
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OVERALL EXPENDITURE (REVENUE)
10th PLAN (in Cr)
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OVERALL EXPENDITURE (CAPITAL)
10th PLAN (in Cr)
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TOTAL RECEIPTSECHS (In Crores)
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POLICY ISSUES
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ELIGIBILITY CRITERIA FOR MEMBERSHIP OF ECHS

• SHOULD BE ESM.
• SHOULD BE DRAWING NORMAL / DISABILITY/ FAMILY
  PENSION.

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DEPENDANTS

• SPOUSE.
• OTHER DEPENDANTS EARNING lt RS 2550/-PM TO
  INCLUDE-
• SON lt 25 YRS.
• UNMARRIED DAUGHTER.
• PARENTS (NORMALY RESIDING WITH THE
  PENSIONER).
• SPECIAL CHILD FOR LIFE.

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SMART CARD

• MASTER CARD FOR MEMBER.
• MAX TWO ADD ON CARDS FOR SPOUSE/CHILD.
• ADDL ADD ON CARD PERMITTED FOR SPECIAL
• CHILD.
• ADD ON CARD FOR MEMBER AND DEPENDANT PARENTS
  NOT PERMITTED UNDER NORMAL CIRCUMSTANCES.

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PARENT POLYCLINIC
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POLYCLINIC DEPENDENCY

• GEOGRAPHICALY CLOSEST DESIG AS PARENT POLYCLINC.
• MEMBER CAN RECOMMEND CHOICE OF POLYCLINIC.
• PARENT POLYCLINIC CAN BE CHANGED ON CHANGE OF
  RESIDENCE.
• CARD ACTIVATION AT ANY POLYCLINIC.

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OUT STATION PATIENTS

• ENTITLED TREATMENT AT ANY POLYCLINIC.
• TAC VALID FOR 06 MONTHS TO BE OBTAINED FROM
  PARENT POLYCLINIC.
• PATIENTS PERMITTED UPTO 30 DAYS MEDICINES ON TAC.

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MANPOWER
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AUTH OF MANPOWER POLYCLINICS
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SICK REPORT STATUS
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REFERAL PROCEDURE
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REFERRAL IN ECHS

• NON MIL STNS/ MIL STNS WITHOUT SERVICE HOSPITALS

• MIL STNS

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REFERRAL IMP ISSUES

• POLYCLINIC SOLE AUTH TO REFER.
• FULLY UTILISE LOCAL SERVICE HOSPITAL FACILITIES.
• ANY PATIENT CAN BE REFERRED BY ANY POLYCLINIC IN
  INDIA (EXCEPT IN NCR) TO AN EMPANELLED FACILITY.
• OUT STN PATIENTS TO REPORT TO POLYCLINIC OF STN
  WHERE REFERRED FOR TREATMENT.

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REFERRALS TO NCR FROM OTHER STATIONS

• ALL REFERRALS FROM OUTSIDE DELHI (NCR) WILL
  BE ROUTED THROUGH ECHS POLYCLINIC - BASE
  HOSPITAL, DELHI CANTT.

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REFERRAL PROCEDURE NCR
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REFERRAL PROCEDURE NCR
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CONDITIONS WHERE REIMBURSEMENT PERMITTED TO
PATIENTS

• 1. EMERGENCIES IN NON-EMPANELLED HOSPITALS.
• 2. MEDICINES
• - 5 SPECIALITY CONDITIONS ONLY.
• - MAX PERIOD 1 MONTH FROM DISCHARGE.
• 3. TREATMENT IN INSTITUTES OF NATIONAL
  REPUTE/GOVT HOSPITALS
• - ON REFERRAL.

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CONDITIONS WHERE REIMBURSEMENT PERMITTED TO
PATIENTS (Contd)

• 4. TRAVELLING EXPENSES
• - FACILITY NA.
• - TO NEAREST POINT.
• - ENTITLED CLASS BY TRAIN.
• 5. SPECTACLES
• - ONLY POST CONVENTIONAL CATARACT OPERATION
  CASES.
• 
  
• 
  

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SPECIALITY CONDITIONS FOR REIMBURSEMENT 0F COST
OF DRUGS.

• POST OPERATIVE CASES OF MAJOR CARDIAC
  SURGERY/INTERVENTIONAL CARDIOLOGY.
• ONCOLOGY.
• POST OPERATIVE ORGAN TRANSPLANT CASES.
• POST OPERATIVE JOINT REPLACEMENT CASES.
• POST OPERATIVE MAJOR NEUROSURGICAL/ NEUROLOGY
  CASES.

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MEDICINES AND DRUGS
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PROCUREMENT OF DRUGS

• 1. AFMSD BULK SUPPLY.
• SEMO DGLP FUND
• - NAC NOT REQUIRED FOR PVMS DRUGS.
• - PROCUREMENT THROUGH REGISTERED DEALERS.
• 3. LP BY OIC POLYCLINIC EMPANELLED CHEMIST.

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PROCUREMENT OF DRUGS

• RATE CONTRACT BEING CONCLUDED BY DGAFMS.
• 23 COMMAND/ ZONAL HOSPITALS TO PROCURE
  DIRECTLY.
• SUPPLY ORDER WILL BE PLACED DIRECTLY BY THESE
  HOSPITALS WITH IDENTIFIED SUPPLIERS.

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ISSUE OF MEDICINES

• IN STATIONS OTHER THAN PARENT STATIONS.
• MORE THAN 30 DAYS FOR
  
  CHRONIC DISEASES.
• BRANDED MEDICINES.

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BILLING PROCEDURE

• ALL HOSPITAL BILLS FROM EMPANELLED FACILITY
  EMERGENCY CLAIMS FROM MEMBERS ARE SUBMITTED TO
  OIC POLYCLINIC.
• FORWARDED TO STN CDR AFTER VETTING BY SEMO.
• SANCTION GIVEN BY STN CDR IF WITHIN CFA POWER.
  OTHERWISE FORWARDED TO APPROPIRATE CFA THROUGH
  PROPER CHANNEL FOR APPROVAL.
• ALL PAYMENTS ARE MADE BY STN HQ.

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EMERGENCY TREATMENT
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EMERGENCY TREATMENT

• LIFE THREATENING/TRAUMA CASES.
• ONUS OF ESTABLISHING
• EMERGENCY ON MEMBER.
• APPLY FOR RE-IMBURSEMENT OF COST
• OF TREATMENT IN NON EMPANELLED
• FACILITIES WITHIN 30 DAYS.
• RE-IMBURSEMENT LIMITED TO CGHS RATES.

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EMERGENCY TREATMENT

• CASHLESS TREATMENT IN EMPANELLED FACILITY.
• INFORM NEAREST POLYCLINIC
• WITHIN 48 HOURS.
• O I/C OR MO TO VISIT HOSP TO VERIFY.
• TFR TO SERVICE/EMPANELLED HOSP ON
  STABILISATION.

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AGENDA POINTS
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DISCUSSION POINTS

• NON AVAILABILITY OF FUND.
• - GOVT POLICY STIPULATES ONE TIME CONTRIBUTION.
• - CONTRIBUTION CREDITED TO CONSOLIDATED
  FUND OF INDIA.
• - AMALGAMATING CONTRIBUTION TO UTILISE
  INTREST NOT FEASIBLE.

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DISCUSSION POINTS

• EST OF MORE POLYCLINICS.
• SANCTION FOR ADDL POLYCLINICS WILL BE SOUGHT
  POST APR 2008 IN PHASE II OF THE SCHEME.

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MEDICAL INSURANCE
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ANNUAL PREMIUMS FOR RS 1 LAKH COVER
INDICATES HIGHEST PREMIUMS
INDICATES LOWEST PREMIUMS
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ANNUAL PREMIUMS FOR RS 1 LAKH COVER
INDICATES HIGHEST PREMIUMS
INDICATES LOWEST PREMIUMS
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ADVANTAGES ECHS

• NO AGE BAR FOR BECOMING A MEMBER.
• LIFE TIME PREMIUM RS 1800/- TO RS
  18000/- ONLY.
• ECHS COVERS ALL DEPENDANTS.
• NO MONETARY CEILING ON TREATMENT.
• COUNTRY WIDE NETWORK OF ECHS POLYCLINICS.
• FAMILIAR ENVIRONMENT AND SENSE OF BELONGINGNESS.

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DISADVANTAGES ECHS

• THROUGH POLYCLINIC.
• PROCEDURE - TEDIOUS.
• - WAITING.
• - TRAVELLING.
• GENERIC MEDICINES.
• AVAILABILITY OF MEDICINES.

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CONCLUSION

• TREATMENT AT SERVICE HOSPITALS.
• LIMITED AVAILABILITY OF FUNDS.
• PREVENTION OF MISUSE BY
• CIVIL HOSPITALS
• UNNECESSARY DIAGNOSTICS.
• UNNECESSARY TREATMENT.
• PRESCRIBING BRANDING MEDICINES.
• MISGUIDING PATIENTS.
• INDIVIDUALS.
• ECHS INVESTMENT IN FUTURE

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• THANK YOU

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EMPANELMENT COVERAGE

• NO. OF STNs COVERED 98
• NO. OF STNs STILL UNCOVERED
• (a) MIL -37
• (b) NON MIL -77
• (c) TOTAL -114

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NAVY FOUNDATION
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NAVY FOUNDATION
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OUTSTANDING POINTS
KERALA CHARTER
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OUTSTANDING POINTS
BANGALORE CHARTER

• Second Polyclinic operationalised at
  Yelahanka.
• Referal at Mil Stn is as per policy laid
  down.

GOA CHARTER

• Various Policies are being reviewed to make
  the Scheme more user friendly. However these
  will be formulated within the broad guidelines
  laid down by the Govt.
• 02 Hospitals have been empanelled. Stn HQs
  to motivate facilities to apply for empanelled.

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MUMBAI CHARTER

• Station HQ Mumbai has to devise necessary
  steps to motivate to Hospitals to apply for
  empanelment.
• The existing infrastructure exclude the
  feasibility of having separate lines based on
  ranks structures.

BHUBANESHWAR CHARTER

• 01 Diagnostic Centre empanelled. 02 Cases
  returned for correction of observations.
• Local authorities to motivate additional
  facilities to apply for empanellment.

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ADDL AGENDA POINTS
1. NON ISSUE OF CARDS TO PARENTS.
Dependant parents are to be generally residing
with the ESM. Separate Cards are not being
issued. 2. NON ACCEPTANCE OF CARDS AT OTHER
STATIONS. Policy revised and now members can
temporarily shift for 6 months at a
time. 3. REIMBURSEMENT. Procedure streamlined
and it is being endeavored to clear the bills
within 40 days. 4. ECHS COMMISSION. Necessary
review of procedures is being carried out on a
regular basis and changes being carried out. A
commission can only be considered once the Scheme
has stabilized.
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5. ALTERNATE MEDICINE. Authorizes only
allopathic treatment. After fully
operationalised the provision of alternate
medicine could be considered.
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FUNDS ALLOTMENT TO NAVAL HQ REVENUE (IN
LAKHS)
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FUNDS ALLOTMENT TO NAVAL HQ REVENUE (IN
LAKHS)
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FUNDS ALLOTMENT TO NAVAL HQ CAPITAL (IN
LAKHS)
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FUNDS ALLOTMENT TO NAVAL HQ UNDER CODE HEAD
365/00(MEDICAL TREATMENT RELATED EXPDR) (IN LAKHS)