EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME ECHS BRIEFING NAVAL FOUNDATION 03 OCT 06
A PREVIEW ON ECHS
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
2. MEMBERSHIP INCREASING AT THE RATE OF 4100 PER WEEK.
STATUS OF ECHS POLYCLINICS * ORAI AND THANE 02 - 02* - - - - - YET TO BE OPERATIONALISED 119 121 NON MIL 59 61 NON MIL 22 22 NON MIL 38 38 NON MIL MIL MIL MIL MIL 106 06 43 57 OPERATIONALISED 106 06 43 57 TO BE OPERATIONALISED TOTAL PHASE II PHASE II PHASE I POLYCLINICS
TOTAL EMPANELLED HOSPITAL - 504
TOTAL CGHS/RLY/GOVT HOSPITAL - 81
EMP FACILITIES IN SOUTHERN COMD - 202
HOSPITALS - 164
DIAG CENTRES - 38
EMPANELMENT STATUS * INCL 24 & 36 EMPANELLED FACILITIES IN NAVAL & AIR FORCE STNS RESPECTIVELY. 32 - 32 03 09 05 03 12 Rejected 111 504* 536 232 879 TOTAL 81 - - - CGHS/Rly / Govt. 11 67 147 36 243 Approved by Empowered Committee 14 76 152 39 255 Submitted to Empowered Committee 111 03 39 45 02 22 Pending for Empowered Committee 585 GRAND TOTAL 21 38 Northern 5 61 176 Central 4 62 259 Western 3 02 43 Eastern 2 86 363 Southern 1 BPs returned Appl Forms received and Processed Service/ Command S No
OVERALL EXPENDITURE (REVENUE) 10 th PLAN (in Cr) 274.14 555.60 181.39 82.85 17.22 Total 20.48 4.66 3.15 3.01 Others 135.41 113.53 47.65 Nil Med Treatment 77.75 47.35 24.43 13.96 Medicine 40.50 15.65 7.62 0.25 Salary 2006-07 (BE) 2005-06 2004-05 2003-04 Code Head 2076/107 (Revenue)
OVERALL EXPENDITURE (CAPITAL) 10 th PLAN (in Cr) 44.00 65.83 16.81 5.02 Nil Total 20.00 11.90 4.56 Nil Medical Eqpt 21.00 4.91 0.46 Nil Constr of Bldg 3.00 Nil Nil Nil Land 2006-07 (BE) 2005-06 2004-05 2003-04 Code Head 4076/107 (Capital)
TOTAL RECEIPTS:ECHS (In Crores) 63.08 9.75 53.33 2005-06 65.01 1.13 63.88 2004-05 216.69 88.60 Total 43.76 32.88 Savings on FMA (approx) 172.93 55.72 ECHS Contribution Total 2006-07 (Estimated) Receipts
ELIGIBILITY CRITERIA FOR MEMBERSHIP OF ECHS
SHOULD BE ESM.
SHOULD BE DRAWING NORMAL / DISABILITY/ FAMILY PENSION.
OTHER DEPENDANTS EARNING < RS 2550/-PM TO INCLUDE:-
* SON < 25 YRS.
* UNMARRIED DAUGHTER.
* PARENTS (NORMALY RESIDING WITH THE PENSIONER).
SPECIAL CHILD FOR LIFE.
MASTER CARD FOR MEMBER.
MAX TWO ADD ON CARDS FOR SPOUSE/CHILD.
ADDL ADD ON CARD PERMITTED FOR SPECIAL
ADD ON CARD FOR MEMBER AND DEPENDANT PARENTS NOT PERMITTED UNDER NORMAL CIRCUMSTANCES.
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.
OUT STATION PATIENTS
ENTITLED TREATMENT AT ANY POLYCLINIC.
TAC VALID FOR 06 MONTHS TO BE OBTAINED FROM PARENT POLYCLINIC.
SICK REPORT STATUS 109 LESS THAN 19 5. 56 BETWEEN 20 TO 49 4. 38 BETWEEN 50 TO 99 3. 10 BETWEEN 100 TO 200 2. 12 ABOVE 200 1. NO OF POLYCLINICS AV DAILY SICK REPORT S.NO
REFERRAL IN ECHS
NON MIL STNS/ MIL STNS WITHOUT SERVICE HOSPITALS
POLYCLINIC NEAREST SERVICE HOSPITAL EMPANELLED FACILITY POLYCLINIC SERVICE HOSPITAL EMPANELLED FACILITY BEDS/ FACILITIES NOT AVAILABLE
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.
REFERRALS TO NCR FROM OTHER STATIONS
ALL REFERRALS FROM OUTSIDE DELHI (NCR) WILL BE ROUTED THROUGH ECHS POLYCLINIC - BASE HOSPITAL, DELHI CANTT.
REFERRAL PROCEDURE : NCR GURGAON (A) DIRECT REFERRAL TO LOCAL EMPANELLED HOSPITALS PERMITTED FOR CARDIOLOGY AND OPHTHALMOLOGY. (B) OPD CONSULTATION FOR ENT AND SKIN BE PERMITTED TO LOCAL EMPANELLED HOSPITALS. EYE, ENT, ORTHO, PSYCHIATRY, SKIN, CARDIOLOGY AND JOINT REPLACEMENT TO BE REFERRED TO BASE HOSPITAL/ ARMY HOSPITAL (R&R). OUTSOURCING PERMITTED FOR REMAINING SPECIALTIES. NOIDA LODHI ROAD ALL REFERRALS TO BASE HOSP/ARMY HOSPITAL SUBJECT TO AVAILABILITY OF FACILITY. ALL REFERRALS THROUGH BASE HOSPITAL/ARMY HOSPITAL SUBJECT TO AVAILABILITY OF FACILITY. BASE HOSPITAL NEW OLD REFERRAL POLICY POLYCLINIC
REFERRAL PROCEDURE : NCR REFERRAL TO LOCAL EMPANELLED HOSPITALS PERMITTED. HINDON CAN REFER TO NOIDA HOSPITALS FOR SPECIALTIES AS APPLICABLE IN NOIDA. ALL REFERRALS TO OTHER HOSPITALS IN DELHI THROUGH BASE/ARMY HOSPITALS. OUTSOURCING ALLOWED TO LOCAL HOSPITALS. ALL REFERRALS IN DELHI THROUGH SERVICE HOSPITALS. HINDON FARIDABAD NEW OLD REFERRAL POLICY POLYCLINIC
CONDITIONS WHERE REIMBURSEMENT PERMITTED TO PATIENTS
1. EMERGENCIES – IN NON-EMPANELLED HOSPITALS.
- 5 SPECIALITY CONDITIONS ONLY.
- MAX PERIOD 1 MONTH FROM DISCHARGE.
3. TREATMENT IN INSTITUTES OF NATIONAL REPUTE/GOVT HOSPITALS
- ON REFERRAL.
4. TRAVELLING EXPENSES
- FACILITY NA.
- TO NEAREST POINT.
- ENTITLED CLASS BY TRAIN.
- ONLY POST CONVENTIONAL CATARACT OPERATION CASES.
CONDITIONS WHERE REIMBURSEMENT PERMITTED TO PATIENTS (Cont’d)
SPECIALITY CONDITIONS FOR REIMBURSEMENT 0F COST OF DRUGS.
POST OPERATIVE CASES OF MAJOR CARDIAC SURGERY/INTERVENTIONAL CARDIOLOGY.
POST OPERATIVE ORGAN TRANSPLANT CASES.
POST OPERATIVE JOINT REPLACEMENT CASES.
POST OPERATIVE MAJOR NEUROSURGICAL/ NEUROLOGY CASES.
MEDICINES AND DRUGS
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.
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.
ISSUE OF MEDICINES
IN STATIONS OTHER THAN PARENT STATIONS.
MORE THAN 30 DAYS FOR CHRONIC DISEASES.
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.
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.
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.
NON AVAILABILITY OF FUND.
- GOVT POLICY STIPULATES ONE TIME CONTRIBUTION.
- CONTRIBUTION CREDITED TO CONSOLIDATED FUND OF INDIA.
- AMALGAMATING CONTRIBUTION TO UTILISE INTREST NOT FEASIBLE.
EST OF MORE POLYCLINICS.
SANCTION FOR ADDL POLYCLINICS WILL BE SOUGHT POST APR 2008 IN PHASE II OF THE SCHEME.
NAVY FOUNDATION Out patient management is a Stn/Fmn arrangement. This will be based on the total OPD attendance and Medical staff available etc. Out Patient Treatment Different times to be allocated to different categories. 5 2. NYA series of Service Numbers are being allotted since Jun 05. Non- Issue of Smart Cards to offcers without ‘Personal Number’. 2 1. Comments Points Pt No. Ser No.
NAVY FOUNDATION (a) Case already taken up with Govt. (b) Not feasible as per Govt policy. Likely tol lead to misuse. Local Purchase (a) LP by OIC Polyclinic in Mil Stn should be allowed (b) Empanelled Hospital should issue medicine. 6 3. Comments Points Pt No. Ser No.
(a) MOD/CGDA have instructed to all PCDAs to expedite refund. No refund permitted prior to 01 Apr 04. (b) MD, ECHS discussed with CGDA for expeditious refund by concerned PCDAs/CDAs. (c) All Regional Centres regularly liaisioning with PCDAs for early refund Refund of excess contribution . Refund of excess contribution is not being paid back to the ESM. 7. 4. (c) Several Steps taken to improve drug supply. Some of the drugs prescribed by empanelled hospitals are as per trade names some of which cannot be made available . In such cases concerned doctor will prescribe Generic alternatives. Tonics/Supplements/Vitamins are not allowed unless therapeutically indicated. (c) Issue of medicines is poor. Comments Points Pt No. Ser No.
Not acceptable. Referral Procedure as per laid down regulations. Procedure of Referral Members should be allowed to go to any hospital and get reimbursement at CGHS rates. 10 6. Contract (Memorandum of Agreement) with empanelled hospital is as per terms and conditions laid down by GOI/MOD . Contract Terms with Empanelled Hospital User rep should be party to contract. 9 5. Comments Points Para No. Ser No.
Provision already exists. Referral form should be valid from consultation and diagnostic procedure for at least one month. 12 8. Referral procedure can be suitably modified to meet specific local requirement within laid down norms. However, the existing infrastructure of service hospitals need to be utilized fully prior to referral. Referral procedure is troublesome. 11 7. Comments Points Pt No. Ser No.
(a) Existing Govt Policy not for monthly contributions from serving personnel and final adjustment at the time of retirement. (b) Contribution goes to consolidated fund of Govt & not related to running of Scheme. (c) Amalgamating the contribution for utilising the interest not feasible. Non Availability of Fund 14. 10. Comments Points Para No. Ser No.
Help desk started at each Regional Centre and Station Headquarters. In addition an Advisory Committee. Consisting of two Armed Forces Veterans co-opted for unbiased feedback. Patient Fiendly ECHS at Big Citis. 16. 12. Comments Points Para No. Ser No.
Santion for additional Polyclinics will be sought post Apr 2008 in Phase II of the Scheme. Establishment of more policlinic . 18. 14. Comments Points Para No. Ser No.
OUTSTANDING POINTS KERALA CHARTER Suggestions in this regard are welcome for consideration. However the following merits consideration. (a) High premium. (b) Upper Caps. (c) Existing ailments not coocked. Involvement of Insurance Compaines. (d) 18. Reply save as 7. Referal Procedure (c)(1) 17. The same procedure as prevalent in service Hospitals is followed. It needs to be appreciated that the results in addl LP Cost of medicenes. Issue of medicines (b) 16. Case has been taken upto permit local commanders to redeploy staff within Polyclinics in their AOR based on the load factor. Augmentation of Staff at Polyclinic (a) 15. Comments Points Para No. Ser No.
An empanelled facility can be chosen only after spare capacity in Service Hospitals is utilised. Selection of Hospital (b)(i) 24. All Railway Hospitals already empanelled. Augment Empanelment (a) 23. A feedback format has been instituted and being analysed. Feedback Report (h) 22 The staff from Regional Centres is required to visit the polyclinics in their AOR once a quarter. Visit Polyclinics (h) 21. A committee of two Armed Forces Veteran nominated by each polyclinic have been set up to provide constructive suggestions. Advisory Committee (g) 20. ECHS members can go directly to an empanelled facility in an emergency or to a service Hospital in off working hours. Treatment on Holidays (e) 19. Comments Points Para No. Ser No.
Second Polyclinic operationalised at Yelahanka.
Referal at Mil Stn is as per policy laid down.
BANGALORE CHARTER 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.
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.
01 Diagnostic Centre empanelled. 02 Cases returned for correction of observations.
Local authorities to motivate additional facilities to apply for empanellment.
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.
5. ALTERNATE MEDICINE . Authorizes only allopathic treatment. After fully operationalised the provision of alternate medicine could be considered.
FUNDS ALLOTMENT TO NAVAL HQ : REVENUE (IN LAKHS) Expdr Up to Aug 06 Expdr Allot Allot 16.50 7.20 0.36 0.54 12.96 20.16 54.24 3.90 3.99 0.06 0.25 10.06 23.51 51.12 1.07 1.84 0.06 0.25 8.77 23.51 50.68 2005-06 12.19 2.08 363/01-Medical Stores 0.22 0.29 363/02-Other Stores - 0.06 362/02-Movement of Store - 0.57 2.21 3.61 CGDA Booking (2006-07) upto Aug 06 0.07 362/01-Movement of Pers 4.24 361/04- Payment Non Medical Staff 10.27 361/02-Payment Para Medical Staff 24.81 361/01- Officers Salary 2006-07 Code Head/Detailed Head
FUNDS ALLOTMENT TO NAVAL HQ : REVENUE (IN LAKHS) Expdr up to Aug 06 Expdr Allot Allot 620.02 0.69 5.00 500.00 1.85 0.52 Nil. Proc of PCs for polyclinics completed. 863.82 2.05 4.63 757.47 2.58 - 4.20 1.06 3.31 747.99 1.50 - 3.09 2005-06 - 0.21 367/00-Revenue Works 139.22 326.44 Total Revenue 0.09 1.34 366/00- Miscellaneous 120.33 0.00 0.00 CGDA Booking (2006 -07) upto Aug 06 283.00 365/00-Medical Treatment 0.07 364/07-Computer Stny & Cons 0.00 364/05-IT Maintenance 364/01-IT Hardware 2006-07 Code Head/Detailed Head
FUNDS ALLOTMENT TO NAVAL HQ : CAPITAL (IN LAKHS) Expdr up to Aug 06 Expdr Allot Allot 70.00 70.00 23.00 23.00 15.00 15.00 2005-06 0.00 0.00 CGDA Booking (2006-07) upto Aug 06 0.00 Total 0.00 907/39- Construction of Building 2006-07 Code Head/Detailed Head
FUNDS ALLOTMENT TO NAVAL HQ UNDER CODE HEAD 365/00(MEDICAL TREATMENT RELATED EXPDR) (IN LAKHS) 162.49 162.49 Expdr 163.65 163.65 Allot 2004-05 Expdr up to Aug 06 Expdr Allot Allot 500.00 500.00 757.47 757.47 747.99 747.99 2005-06 283.00 Total 283.00 365/00(Medical Treatment Related Expenditue) 2006-07 Code Head/Detailed Head