mdechs
TRANSCRIPT
04/12/23 1
ECHS BRIEFING NAVAL FOUNDATION 03 OCT 06
04/12/23 2
A PREVIEW ON ECHS
04/12/23 3
CURRENT STATUS
04/12/23 4
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.
04/12/23 5
STATUS OF ECHS POLYCLINICS
POLYCLINICS PHASE I PHASE II PHASE II TOTAL
MIL NON MIL
MIL NON MIL
MIL NON MIL
MIL NON MIL
TO BE OPERATIONALISED
57 38 43 22 06 61 106 121
OPERATIONALISED 57 38 43 22 06 59 106 119
YET TO BE OPERATIONALISED
- - - - - 02* - 02
* 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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FUND STATUS
04/12/23 9
OVERALL EXPENDITURE (REVENUE) 10th PLAN (in Cr)
Code Head2076/107 (Revenue)
2003-04 2004-05 2005-06 2006-07(BE)
Salary 0.25 7.62 15.65 40.50
Medicine 13.96 24.43 47.35 77.75
Med Treatment
Nil 47.65 113.53 135.41
Others
3.01 3.15 4.66 20.48
Total 17.22 82.85 181.39 274.14
555.60
04/12/23 10
OVERALL EXPENDITURE (CAPITAL) 10th PLAN (in Cr)
Code Head4076/107 (Capital)
2003-04 2004-05 2005-06 2006-07(BE)
Land Nil Nil Nil 3.00
Constr of Bldg
Nil 0.46 4.91 21.00
Medical Eqpt
Nil 4.56 11.90 20.00
Total Nil 5.02 16.81 44.00
65.83
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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 < RS 2550/-PM TO INCLUDE:-
* SON < 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
04/12/23 20
AUTH OF MANPOWER : POLYCLINICSAUTH OF MANPOWER : POLYCLINICS
S.NO DETAILS TYPE ‘A’ TYPE ‘B’ TYPE ‘C’ TYPE ‘D’
MIL NON-MIL
MIL NON-MIL
MIL NON-MIL
MIL NON-MIL
1 MEDICAL OFFICER 02 02 02 02 01 02 01 02
2 MEDICAL SPECIALIST 01 02 01 02 - 01 - 01
3 DENTAL OFFICERS 01 02 01 02 01 01 01 01
4 OIC (NON MEDICAL) 01 01 01 01 01 01 01 01
5 GYNOCOLOGIST - 01 - 01 - - - -
6 NURSING ASST/NURSE 03 03 02 03 01 02 01 02
7 LAB ASST 02 02 03 02 01 01 01 01
8 DENTAL HYGIENIST 01 01 01 01 - - - -
9 RECEPTIONIST - 01 - 01 - - - -
10 DRIVER 01 03 01 03 01 01 01 01
11 PEON 01 01 01 01 01 01 01 01
12 SAFAIWALA 01 01 01 01 01 01 01 01
13 FEMALE ATTENDANT 01 01 01 01 01 01 01 01
TOTAL 15 21 15 21 09 12 09 12
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REFERAL PROCEDURE
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REFERRAL IN ECHS
MIL STNS NON MIL STNS/ MIL STNS WITHOUT
SERVICE HOSPITALS
POLYCLINIC
NEAREST SERVICE
HOSPITAL
EMPANELLED FACILITY
POLYCLINIC
SERVICE HOSPITAL
EMPANELLED FACILITY
BEDS/ FACILITIES
NOT AVAILABLE
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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.
04/12/23 25
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
POLYCLINIC REFERRAL POLICY
OLD NEW
BASE HOSPITAL
ALL REFERRALS THROUGH BASE HOSPITAL/ARMY HOSPITAL SUBJECT TO AVAILABILITY OF FACILITY.
ALL REFERRALS TO BASE HOSP/ARMY HOSPITAL SUBJECT TO AVAILABILITY OF FACILITY.
LODHI ROAD
NOIDA EYE, ENT, ORTHO, PSYCHIATRY, SKIN, CARDIOLOGY AND JOINT REPLACEMENT TO BE REFERRED TO BASE HOSPITAL/ ARMY HOSPITAL (R&R). OUTSOURCING PERMITTED FOR REMAINING SPECIALTIES.
(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.
GURGAON
04/12/23 27
REFERRAL PROCEDURE : NCR
POLYCLINIC REFERRAL POLICY
OLD NEW
HINDON FARIDABAD
OUTSOURCING ALLOWED TO LOCAL HOSPITALS. ALL REFERRALS IN DELHI THROUGH SERVICE HOSPITALS.
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.
04/12/23 28
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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4. TRAVELLING EXPENSES
- FACILITY NA.
- TO NEAREST POINT.
- ENTITLED CLASS BY TRAIN.
5. SPECTACLES
- ONLY POST CONVENTIONAL CATARACT OPERATION CASES.
CONDITIONS WHERE REIMBURSEMENT PERMITTED TO
PATIENTS (Cont’d)
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MEDICINES AND DRUGS
04/12/23 32
PROCUREMENT OF DRUGS
1. AFMSD : BULK SUPPLY.
2. SEMO : DGLP FUND
- NAC NOT REQUIRED FOR PVMS DRUGS.
- PROCUREMENT THROUGH REGISTERED DEALERS.
3. LP BY OIC POLYCLINIC – EMPANELLED CHEMIST.
04/12/23 33
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.
04/12/23 34
ISSUE OF MEDICINES
• IN STATIONS OTHER THAN PARENT STATIONS.
• MORE THAN 30 DAYS FOR CHRONIC DISEASES.
• BRANDED MEDICINES.
04/12/23 35
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.
04/12/23 36
EMERGENCY TREATMENT
04/12/23 37
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.
04/12/23 38
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.
04/12/23 42
MEDICAL INSURANCE
04/12/23 43
ANNUAL PREMIUMS FOR RS 1 LAKH COVER
AGE (YRS)
STAR HEALTH BAJAJ ALLIANZ PSU
20 1200 1254 1310#
30 1200 1453 1310
40 1350* 1453 1425
50 2447 2793# 2039*
60 3000 - 2322*
70 4547 - 2598*
80 6029 - 3445*
# INDICATES HIGHEST PREMIUMS * INDICATES LOWEST PREMIUMS
04/12/23 44
ANNUAL PREMIUMS FOR RS 1 LAKH COVER
AGE (YRS)
RELIANCE ROYAL SUNDARAM
ORIENTAL
20 1310# 985* 1179
30 1310 1692# 1310
40 1425 1692# 1566
50 2039* 2275 2447
60 2322* 3277 3483#
70 2598* 4719 5196#
80 3445* - 6960#
# INDICATES HIGHEST PREMIUMS * INDICATES LOWEST PREMIUMS
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.
DISADVANTAGES : ECHS
THROUGH POLYCLINIC.
PROCEDURE - TEDIOUS.
- WAITING.
- TRAVELLING.
GENERIC MEDICINES.
AVAILABILITY OF MEDICINES.
04/12/23 47
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
04/12/23 48
THANK YOU