Understanding reimbursement rules helps beneficiaries avoid rejection and delays. This article explains ECHS reimbursement rules applicable in 2026.
Treatments Covered Under ECHS
- Polyclinic OPD services
- Empanelled hospital treatment
- Emergency hospitalization
- Approved diagnostic tests
Expenses That Are Usually Approved
- Medicines prescribed by ECHS doctors
- CGHS-approved procedures
- Package surgeries
- Approved implants within ceiling rates
Commonly Rejected Expenses
- Non-empanelled hospital (non-emergency)
- Over-billing beyond CGHS limits
- Missing referral forms
- Unapproved diagnostics
Important Reimbursement Conditions
- Valid referral is mandatory
- Emergency certificate required for non-empanelled hospitals
- Original bills must be submitted
- Claim submission timelines must be followed
How to Avoid Claim Rejection
- Always collect referral forms
- Use empanelled hospitals
- Maintain bill copies
- Follow package rules
Final Advice
ECHS reimbursement works smoothly when rules are followed. Knowing limits beforehand avoids disappointment later.