CONTENT (OPS AND COORD) SECTION I: SMART CARD SNO SUBJECT 1. Issue of ECHS smart card 2. Revised Application Form For ECHS Smart Card 3. Application form for up gradation of ECHS smart card for existing members 4. Revised policy on ECHS application form/Issue of Smart card (s) Temporary receipt for documents submitted for ECHS membership 5. Amendment to sample of Affidavit with Application for ECHS Membership 6. Policy on issue of duplicate Smart Card(s) 7. Policy on submission/ Acceptance of ECHS application form without PPO for Pre 1986 retirees 8. ECHS Smart Card and Revision in Cost of ECHS Smart Card 9. Closure of ECHS membership 10. ECHS Management Information System : Automation Project 11. Issue of white ECHS Smart Card to War Disabled/Battle Casualty Veterans 12. Cessation of Temporary Attachment procedure 13. PAN India validity of Smart Card without Temporary attachment Certificate (TAC) 14. Application for ECHS Cards : Clarification SECTION II: ELIGIBILITY 1. Eligibility 2. ECHS membership to reservists 3. Verification of Dependents 4. Eligibility for ECHS in respect of ESMs who joined PSUs before completing pensionable service 5. Clarification on Term ‘Family’ For Enrolment Into ECHS 6. Eligibility of dependent Son(S) 7. Implementation of Supreme Court Order Pre 01 Jan 1996 Retirees 8. ECHS Membership To Territorial Army Personnel 9. ECHS Membership To Nepal Domiciled Gorkhas (NDGS) 10. Income Criteria From All Sources For Dependent 11. Voluntary Suspension/Cancellation of ECHS Membership 12. ECHS membership to COAST GUARD pensioners 13. Extension of ECHS to retired personnel of DSC 14. Eligibility of Dependent: ECHS Membership 15. Eligibility criterion for ECHS membership: Dependent child with permanent disability 16. Clarification on term `FAMILY’ for enrolment into ECHS 17. Eligibility for joining ECHS: Recruits earning disability pension 18. Clarification on ECHS membership when Husband and Wife are Defence personnel 19. Policy on availing ECHS facilities by ESM pensioners on joining DSC 20. Verification of Dependents of Old retirees (Prior 01 April 2003) 21. Addition/Deletion of Names of members/Dependents for ECHS 22. Eligibility for joining ECHS: Officer cadets 23. Merger of Pension with Second Service 24. ECHS Advisory Note No 11 25. Extension of ECHS Facilities to Nepal Domiciled Gorkhas (NDG) Pensioner : Administrative Instruction 26. Expansion of ECHS Network : Administrative instructions for operationalisation of 199 addl Polyclinic 27. Essential treatment of serving Pers and their Dependents 28. Clarification: Effective date of Membership. 29. Eligibility for Joining ECHS : Ex-Recruits with Disability pension 30. ECHS Advisory Note No-12 31. Prevention of fraudulent membership in ECHS 32. Grant of Ex Serviceman (ESM) status to cadets SECTION III: POLYCLINICS 1. Procedure for contractual employment of staff for ECHS Polyclinics Sep 2003 2. Procedures for contractual employment of staff for ECHS policlinics 3. Amplification notes for contractual employment of staff for Policlinics 4. Availing of ECHS facilities by Re Employed Officer 5. Appt of OIC Polyclinic Sep 2004 6. Appt of OIC Polyclinic Nov 2004 7. Appt of OIC Polyclinic Dec 2004 8. Exemption of payment of ECHS Contribution by “UNMARRIED SOLDIERS” 9. Issue of Medical certificates to ECHS members and Dependents 10. Material on ECHS for Batcheet /Sainik Samachar 11. ECHS Helpline-2008 12. SOP For Disciplinary Action Against ECHS Members-2008 13. Timing of ECHS in NCR Delhi 14. Amplification on ECHS membership for Re-Employed personal 15. Treatment of Senior Citizens 16. Beefing up resources for processing of ECHS Application 17. Policy for Redressal of Grievances 18. Timings of ECHS Polyclinics 19. Change of parent policlinic : All India 20. Treatment of Senior Citizens 21. Change of parent polyclinic: All India except NCR 22. Polyclinic dependency in Delhi and NCR 23. OPD Registration at Polyclinics 24. Exemption to War disabled pensioners from payment of Contribution 25. Exemption of payment of ECHS Contribution by “WAR WIDOWS” 26. Terms and conditions for contractual staff at Polyclinics Aug 2007 27. Terms and conditions for contractual staff at Polyclinics Jun 2007 28. Cessation Of Temporary Attachment Procedure 29. Tenure of Contractual Employees at ECHS Polyclinics SECTION IV: TREATMENT 1. Treatment To Parent On Addon Card SECTION V: ADVISORY 1. Advisory note No 04:aged/invalid patients at echs polyclinics 2. Consultation By Appointment At ECHS Polyclinics 3. Contempt Petition (C) No.16 Of 2007 In Writ Petition(Civil) No. 210/1999 Filed By Retired Defence Officers Association Before The Hon'ble Supreme Court Of India 4. Advisory No-13 : Medicines for Veterans Traveling Abroad 5. ECHS Advisory Note No 12 : Emergency Treatment in ECHS Polyclinic SECTION VI: EMPLOYMENT 1. Agreement between contractually Engaged Person and Station Commander for rendering services in ECHS Polyclinics 2. Corrigendum 3. Arrangement Of Vehicles,Dvrs,Med/Non-Med Staff For Needy Echs Beneficiaries On Pay-And- Use Basis 4. AMENDMENT 5. Defence Officer Association Before The Hon'ble Supreme Court Of India SECTION VII: MISCELLANEOUS 1. ECHS Contribution by widows of service personnel 2. Status /Entitlement of Gorkha Soldiers of Nepal domicile for ECHS 3. Refund of ECHS contribution for Nepal domicile ESM 4. Vetting of ECHS Application Forms : Nepal Domiciled Gorkhas (NDG) ESM 5. Income Criteria From All Sources For Dependent 6. Material on ECHS for BatCheet /Sainik Samachar ISSUE OF ECHS SMART CARD 1. Reference to the following letters of this HQ :- (a) B/49711/AG/ECHS dt 09 Mar 2005. (b) B/49711/AG/ECHS dt 15 Apr 2008. 2. It has been observed that the ESM are facing inconvenience especially in remote areas in collection of ECHS Smart Cards under the existing procedure wherein the cards are required to be collected from the nearest Regional Centre/Station HQ. 3. Based on the feedback received from the environment, it has been decided that with immediate effect the ECHS Smart Card will be issued under respective station HQ in consultation with dependent Regional Centre through either Station HQ, Regional Centre, Polyclinic, any regular service unit or District Soldier Board as deemed appropriate ensuring proper accountability at each level. No Card (s) will be sent through mail to any member under any circumstances as the receipt for document issued is required to be withdrawn and kept at Regional Centre/Station HQ being an accountable document. 4. The letters under reference may please be amended accordingly. Col Dir (Ops & Coord) for MD ECHS Auth : B/49711/AG/ECHS dt 08 Apr 2009 EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME (ECHS) APPLICATION FORM FOR MEMBERSHIP (REV 2010) (PLEASE FILL IN CAPITALS & IN BLUE INK) n e Applicant’s AP C plaapctleeic gaotofi oSrny u bR m e gis n s( iN (cid:1)ono) . (a) Of ficer (b ) JCO & E quiv alen t ( c) OR & E qui vale nt To be filled by StHQ/Record Offic (RRPePdheCac osiBvetsoainplgc toD krCrargteop rsslohoisuz ui ennr d ) PART I - PARTICULARS OF PENSIONER APPLICATION FOR ( (cid:1) ) Pensioner Family Pensioner Future Retiree SERVICE ( (cid:1) ) Army Navy Air Force CG DSC SFF Signature of Applicant (black ink) 1. Service No 2. Rank (With prefix and suffix) (Abbreviated as per General Instructions) 3. (a) Name of Ex-Serviceman (Maximum 32 characters including spaces) (cid:1) (i) Regt/Corps/Ship/Base/Unit : _________________ (ii) Gender ( ) Male Female (iii) Citizenship ( (cid:1) ) In dian ND G (iv) Marital Status : ( (cid:1) ) Married/Unmarried/Divorce/Widow/Widower (v) Employed ( (cid:1) ) Y es No (vi) Monthly Income : __________________________ ( b) N(if aamppelic oabf lfea) mily Pensioner mily er only an (i) Gender ( (cid:1) ) Male Fema l e (ii) Category ( (cid:1) ) Officer/JCO & Equivalent/OR & Equivalent For fnsio Pe (iii) Employed ((cid:1) ) Yes No (iv) Citizenship ( (cid:1) ) Indian N D G (v) Monthly income ____________ (c) Relationship with ESM ( (cid:1) ) Spouse/ Son/ Daughter/ Fa ther/ Mother (d) Date of Demise of Pensioner (DD-MM-YYYY) (e) UID No __________________________________ (f) PAN No : __________________________________ 4. Date of Birth of Applicant (DD-MM-YYYY) Primary Member 5. Date of Commission/ Enrollment (DD-MM-YYYY) 6. Date of Retirement/ Discharge (DD-MM-YYYY) 7. Parent Polyclinic 8. Residential`` Address Tehsil Dist State Pin 9 . C(ao) ntacT te dleeptahiolsn e No e/lLeft on ( (bc)) ME(W-oMibtha N ilS oITD D : -c ode) n signaturp Impressi em mu 10. Type of Pension ( (cid:1) ) Normal Disability Family ciTh e Sp 11. Pension Payment Order No (PPO No) (attach photo copy) 12. Name & Address of Banker/Treasury from where pension drawn 13. Pension Bank Account Number 14. Record Office 15. Drug Allergy (if any) 16. Blood Group Physical Disability ( (cid:1) ) Ye s No (Optional) (Tick one as applicable) War Disability/Battle Casualty Disability ( (cid:1) ) Yes No Signature and stamp of authorising Officer of Station Headquarters/ Record Office. 2 Application Regn No PART-II PARTICULARS OF DEPENDANTS Name of SPOUSE (Maximum 20 Characters including space) Gender ( (cid:1) ) M ale Femal e Citizenship ( (cid:1) ) I n dian NDG Affix Recent Colour Passport size Photo of Date of Birth (DD-MM-YYYY) SPOUSE of Pensioner (Red Bac kground) Date of Marriage (DD-MM-YYYY) Parent Polyclinic (If not same as pensioner/ Family pension) Physical Disability ( (cid:1) ) Y e s No Employed ( (cid:1) ) Ye s No Monthly Income ____________ UID No __________________________ PAN No : _____________________________ DNarumge AMlleenrtgioyn (eifd ainn yS)e rvi ce/ D isch arge Bo ok ( (cid:1) ) Ye s No B lood Gro up onal Opti Residential Address (If not same as pensioner/ Family pension) Tehsil Dist State Pin Contact details (a) Tele No Mob (With STD code) (b) E Mail ID :- Name of FATHER (Maximum 20 Characters including Space) Citizenship ( (cid:1) ) I n dian NDG Affix Recent Colour Date of Birth (DD-MM-YYYY) Passport size Photo of FATHER of Pensioner Employed ((cid:1) ) Yes No Pensioner ( (cid:1) ) Yes No (Red Bac kground) Whether depende nt on appli cant ( (cid:1) ) Yes No Monthl y income ___________ Parent Polyclinic (If not same as pensioner/ Family pension) Name Mentioned in Service/Discharge Book ( (cid:1) ) Yes N o Physical Disability ((cid:1) ) Y e s No UID No _______________________ PAN No : _ __________ ____________ Blood Group al n Drug Allergy (if any) ptio O Residential Address (If not same as pensioner/ Tehsil Dist Family pension) State Pin Contact details (a) Tele No Mob (With STD code) (b) E Mail ID :- Name of MOTHER (Maximum 20 Characters including Space) Citizenship ( (cid:1) ) I ndian NDG Affix Recent Colour Date of Birth (DD-MM-YYYY) Passport size Photo of MOTHER of Pensioner Employed ((cid:1) ) Yes No Pensioner ( (cid:1) ) Yes No (Red Bac kground) W hether depende nt on appli cant ( (cid:1) ) Yes No Month ly income _________ Parent Polyclinic (If not same as pensioner/ FNaammiley pMeennsitoionn) ed in servic e/Discharge Book ( (cid:1) ) Yes N o Physical Disability ( (cid:1) ) Yes No UID No _______________________ PAN No : _________________________ Blood Group Drug Allergy (if any) al n ptio Residential O Address (If not same as pensioner/ Family pension) Tehsil Dist State Pin Contact details (a) Tele No (With STD code) Mob (b) E Mail ID :- Note :- Please attach relevant medical documents of Drug Allergy (if any) and Blood Group. 3 Application Regn No PART-II PARTICULARS OF DEPENDANTS Name of CHILD (Maximum 20 Characters including space) Citizenship ( (cid:1) ) Indian NDG Affix Recent Colour Passport size Photo Date of Birth (DD-MM-YYYY) of CHILD of Relation ship (with Ex-Serviceman) Employed ( (cid:1) ) Yes No (RedP Benascikognreoru nd) Marital Status ( (cid:1) ) Married Unmarried Widow Divorcee (Fo r daughter only- if applicable) Parent Polyclinic (If not same as pensioner/ Family pension) Perma nent Disability ((cid:1) ) Yes No Blood Group Name Mentioned in Service/Disc harge Book( (cid:1) ) Yes No Part II Order Published and Yes No (cid:1) Copy/ Proof attached ( ) d. UID No _______________________ PAN No : _________________________ Monthly Income _________________ e al ch D Rreusgid Aelnletiragl y (if a ny) Option be atta Address o (FIfa mnoilty s paemnes iaosn )p ensioner/ Tehs il Dist cate t Contact details State Pin ertifi (a) Tele No Mob y c (With STD code) ar (b) E-Mail ID :- ss e ec Name of d, n CHILD (Maximum 20 Characters including space) ge n Citizenship ( (cid:1) ) Indian NDG Affix Recent Colour halle Passport size Photo y c Date of Birth (DD-MM-YYYY) of CHILD of all Relation ship (with Ex-Serviceman) Employed ( (cid:1) ) Yes No (RedP Benascikognreoru nd) ysic ph M arita l Statu s ( (cid:1) ) Marr ied Unmarr ied (Fo Wr didaouwg hter only- if D aipvpolricceaeb l e) entally/ Parent Polyclinic m d (If not same as pensioner/ hil Family pension) c Perma nent Disability ((cid:1) ) Yes No Blood Group of e N ame m ention ed i n Service / Disc har ge Book ((cid:1) ) Yes N o CPaorpty I/I POrro doefr aPttuabclhisehde (d(cid:1) a )n d Yes No 2. In cas Group. U DIrDu gN Ao l_le_r_g_y_ _(i_f _a_n_y_)_ __ ____ ___ __ PAN No : __ ____ ___ ____ ___ ____ ___ __ Mo nthly Inc ome ___ ____ ___ ____ ___ onal page. Blood RA(FIfade mndsoiriltyd es epsaenmsnt esi a iaols n ) p ens ioner/ TSe tahtse il Di st Pi n Opti hotocopy this gy (if any) and Contact details pr (( ab )) ET(We-lMieth Na SoilT IDD c :o- de) Mob ESM to rug Alle e D Name of en thnt of C C DiHatiztIeeLn Doshf ipB i(r t(cid:1) h ) I nd ian N( D MGa x im um 2 0 Cha racte rs in c(DludDin-Mg Msp-aYcYe)Y Y) PAaffsixso pRf oCerctH esILnizDte C oPofh looutor n three childrdical docume ae R M ealraittaio l nS sthaitpu s(w (i (cid:1)t h )E x-S Meravrirc ieedm a n ) U nm arr ie d (Fo Wr didaou wg h teEr m onplylo- yif D eaidpvpo (lri (cid:1)cc e a)eb l e Y) e s No (WhitPee Bnasc iokngeror und) se of more thch relevant M aa Parent Polyclinic n cAtt (F P NIfaae mnmromiltey s a pma nemeneensn itaotio snD n)p eiesdnas ibinoi nlSieteyr/ r (v(cid:1) i c e) / DiYsecsh ar g e BookN o( (cid:1) ) Yes B lood N Go r o u p P a r t II O rder Published and Yes No Note : 1. I 3. Copy/ Proof attached ( (cid:1) ) UID No _______________________ PAN No : _________________________ Monthly Income _________________ al Drug Allergy (if any) on pti Residential O Address (If not same as pensioner/ Family pension) Tehsil Dist State Pin Contact details (a) Tele No Mob (With STD code) (b) E-Mail ID :- 4 Application Regn No PART-III DETAILS OF MRO PAYMENT (Serial 1 to 4 to be filled by only those whose contribution NOT deducted in PPO) 1. Payment in full or in Installments (Tick as applicable) Full One Two Three Exempted 2. Bank RBI S Bl Branch 3. MRO No Date of Payment 4. Amount (Rupees) PART-IV DETAILS OF PAYMENT FOR SMART CARDS 1. Total Cards Demanded 2. Amount (Rupees) 3. Mode of payment DD No Date of Draft Bank Name Date (DD-MM-YYYY) Note :- Faulty entries requiring subsequent correction will entail fresh cards being Made on additional payment (Signature of Applicant) (Black ink) PART-V TO BE FILLED BY STATION HEADQUARTERS/ RECORD OFFICE 1. Basic Pension (Rupees) 2. Documents Checked and Receipt issued ( (cid:1) ) Yes 3. Payment Received for Smart Cards Rs. 4. Category for Hospitalisation Private Semi-Private General 5. Date of Receipt of Application from/ Date of Retirement of Future Retiree 6. Date application forwarded (Signature and Stamp of Station To Regional Centre Headquarters/ Record Office) PART-VI TO BE FILLED BY REGIONAL CENTRE ECHS 1. Date of Receipt of Application Form 2. Date application forwarded to Vendor Checked by Verified by (Initials & No) (Initials & No) Signature and Stamp of Authorised Offr SMART CARD DETAILS (to be filled on receipt from vendor) 1. Date of Receipt of Smart Card(s) 2. ECHS No. (Mentioned in Smart Card) 3. No of Smart Card(s) issued ( (cid:1) ) One Two Three Four Five Six (a) Dispatched to (Station HQ/ Record Office/Individual) (b) Date of Dispatch Initials