The Ex-Servicemen Contributory Health Scheme (ECHS) provides comprehensive medical care to ex-servicemen, pensioners, and their eligible dependents. To ensure transparency and faster settlements, ECHS has introduced a structured Online Bill Processing System governed by an official Standard Operating Procedure (SOP).
This article explains the ECHS Online Bill Processing SOP in simple terms, covering eligibility, referrals, reimbursement rules, emergency cases, package rates, implants, and the complete online workflow.
Official SOP PDF:
https://www.echs.gov.in/assets/General%20SOP/SOP%20Online%20Bill%20Processing.pdf
What Is ECHS Online Bill Processing?
ECHS Online Bill Processing is a digital system used to:
- Process bills of empanelled hospitals
- Reimburse eligible expenses for non-empanelled emergency treatments
- Reduce delays, paperwork, and manual errors
- Ensure payments as per CGHS / ECHS approved rates
The system applies to hospitalization, diagnostics, procedures, implants, and follow-up care.
Who Is Eligible Under ECHS?
ECHS benefits apply to:
- Ex-servicemen drawing Service or Disability Pension
- Widows receiving Family / Liberalized Family Pension
- Spouse of pensioner
- Unemployed sons below 25 years
- Unemployed or unmarried daughters
- Dependent parents (income below prescribed limit)
- Mentally or physically challenged children (lifelong)
- Newborn baby (up to 3 months, with birth certificate)
How Medical Treatment Works Under ECHS
1. Treatment Through ECHS Polyclinics
- ECHS Polyclinics provide OPD services
- If advanced care is required, referral is issued
2. Referral to Hospitals
Referrals can be made to:
- Armed Forces Medical Services Hospitals
- Empanelled Private Hospitals
- Diagnostic & Dental Centres
Important: Referrals are issued only by authorized ECHS medical staff.
Ward Entitlement Based on Rank
| Rank at Retirement | Ward Entitlement |
|---|---|
| NCOs & Below | General Ward |
| JCOs | Semi-Private Ward |
| Officers | Private Ward |
If a higher ward is used due to non-availability, billing is restricted to entitlement only.
ECHS Package Rates – How Billing Works
ECHS follows CGHS Package Rates, which include:
- Room charges & diet
- Doctor visits
- Surgery & OT charges
- ICU/ICCU charges
- Medicines & consumables
- Investigations
- Nursing & physiotherapy
Standard Package Duration
- Super-speciality: 12 days
- Major surgery: 7 days
- Laparoscopic/Delivery: 3 days
- Day care/minor surgery: 1 day
Extra stay is allowed only with medical justification and approval.
Emergency Treatment Rules
- Emergency treatment is allowed in any hospital
- Inform nearest ECHS Polyclinic within 48 hours
- Emergency Information Report (EIR) is generated
- Reimbursement is limited to CGHS/ECHS rates
Examples of emergencies:
- Heart attack, stroke
- Severe injuries & accidents
- Acute respiratory failure
- Snake bite, poisoning
- Dialysis as life-saving emergency
Online Bill Processing Flow (Simplified)
Step-by-Step Process
- Referral issued by ECHS Polyclinic
- Hospital accepts referral
- Patient treated & discharged
- Hospital uploads:
- Scanned bills (PDF)
- Discharge summary
- Investigation reports
- Hard copy submitted to Regional Centre
- Medical & financial scrutiny
- Approval by CFA (Competent Financial Authority)
- Payment released via ECS directly to hospital
Bills up to ₹5 lakh are processed online.
Bills above ₹5 lakh require Central Organization approval.
ECHS Mediclaim Reimbursement Process: ECHS SOP for Online Bill Processing – Complete Guide (Updated)
Documents Required for Bill Submission
Mandatory documents include:
- ECHS Card copy
- Referral letter
- Emergency certificate (if applicable)
- Discharge summary
- Itemized & final bills
- Investigation reports
- Implant invoices with stickers
- Prior approval (for unlisted procedures)
All pages must be serially numbered.
Implants & Special Procedures
ECHS reimburses implants like:
- Cardiac stents
- Pacemakers
- Orthopedic implants
- Neuro implants
- Cochlear implants
- IOL (eye lenses)
Reimbursement is limited to CGHS ceiling rates.
Original invoices and implant stickers are mandatory.
Oncology, Dialysis & Long-Term Care
- Oncology referrals are issued once for full treatment cycle
- Chemotherapy & radiotherapy billed at CGHS super-speciality rates
- Dialysis allowed as emergency even in non-empanelled hospitals
- Rehabilitation & terminal care allowed up to 6 months
Follow-Up & Repeat Treatment
- Referrals valid for 1 month
- Renewed referrals required for ongoing treatment
- Oncology referrals exempt from monthly limit
Key Do’s and Don’ts
Do’s
✔ Always take treatment via ECHS referral
✔ Submit bills within one month of discharge
✔ Keep original bills & reports
✔ Inform polyclinic immediately in emergencies
Don’ts
✖ Do not exceed ward entitlement
✖ Do not purchase medicines externally during hospitalization
✖ Do not delay bill submission without approval
Final Words
The ECHS Online Bill Processing SOP ensures:
- Transparency
- Faster reimbursements
- Uniform medical billing
- Financial protection for veterans and families
Understanding this SOP helps beneficiaries avoid claim rejections, delays, and unnecessary expenses.