ECHS INDIVIDUAL REIMBURSEMENT – MONTHLY CEILING (FOR INFORMATION OF BENEFICIARIES)

[SANTOSH KUMAR MISHRA]

ECHS INDIVIDUAL REIMBURSEMENT – MONTHLY CEILING (FOR INFORMATION OF BENEFICIARIES)

As per instructions issued by the Central Organisation of the ECHS (Annexed) on processing of individual OPD reimbursement claims:

1. Normal Monthly Limit

Individual reimbursement claims for OPD medicines, investigations, and authorised outside treatment are normally processed up to ₹25,000 per beneficiary per month.

2. Special / Exceptional Cases

In cases involving serious illness, long-term therapy, costly life-saving medicines, or other justified medical necessity, reimbursement up to ₹75,000 per month may be considered, subject to:

* Specialist medical recommendation

* Non-availability certificate from ECHS Polyclinic / authorised source (where applicable)

* Approval of the competent ECHS authority in accordance with Central Organisation guidelines.

3. Mandatory Documents

Claims must invariably be supported by:

* Valid prescription from authorised medical officer / specialist

* Original cash memos and bills

* Investigation reports (where relevant)

* Required certificates / approvals

Processing of claims will be governed strictly by prevailing policy letters and administrative instructions issued by Central Organisation ECHS from time to time.

With utmost respect and warm regards,
-sd-
संतोष कुमार मिश्र/ Santosh Kumar Mishra
जेडब्ल्यूओ (एमएसीपी)/ JWO (MACP)
ईसीएचएस प्राथमिक लाभार्थी / ECHS Primary Beneficiary

📞 9582140406

📧 echsben...@gmail.com

Enclosures: As stated

Wishing you good health and continued success in your service to veterans                                

[SANTOSH KUMAR MISHRA]

*Information for ECHS Beneficiaries – Reimbursement of NA (Non-Available) Medicines and Procedure in Case of Claim Rejection*

It is observed that reimbursement claims for *Non-Available (NA) medicines* exceeding ₹25,000 are sometimes denied when they are processed under the *General Conditions* financial ceiling. Beneficiaries may note that higher reimbursement limits are admissible under specific categories as per guidelines of the *ECHS*

1. Verify the Claim Category

Before pursuing the matter, confirm that the claim has been submitted under the correct admissible category (per instance for approximately 30-day supply):

* *General Conditions:* Up to ₹25,000

* *Special Conditions (chronic / severe diseases as per policy):* Up to ₹75,000

* *Cancer Medicines:* Up to ₹5,00,000

If medicines relate to a notified Special Condition but were processed as General, a review may be requested.

*2. Approach the Regional Centre (First Respondent)*

The concerned *Regional Centre (ECHS) is the primary authority for settlement of claim issues. Beneficiaries should:

* Visit or write to the Regional Centre to obtain the exact reason for rejection.

* Submit a written request for reconsideration if categorisation appears incorrect.

* Attach prescription, NA certificate, sanction sheet, and bills.

*3. Use the Complaint & Litigation Reduction Scheme (CLRS)*

ECHS provides a mechanism for early dispute resolution through CLRS.

* *Medical claim assistance:* 9004722106 / 9910244611

* *Email for unresolved issues:*

  * [dircompl...@nic.in](mailto:dircompl...@nic.in)

  * [mdech...@nic.in](mailto:mdech...@nic.in)

Provide full details including Card No., Polyclinic, Claim No., and supporting documents.

*4. Lodge a Formal Grievance (If Required)*

If the matter remains unresolved:

* Submit a grievance on *Centralized Public Grievance Redress and Monitoring System (CPGRAMS)*

* Call the ECHS Toll-Free Helpline: *1800-114-115*

* WhatsApp support: *7703818578 / 7701976194*

*5. Check Documentation Carefully*

Many claims are rejected due to procedural deficiencies. Ensure:

* Valid *NA Certificate* issued by the OIC Polyclinic

* Prescription properly endorsed as *“Genuine”*

* Original bills uploaded correctly on the BPA portal

* Treatment period and quantity consistent with sanction norms

*Beneficiaries are advised to first seek correction at the Regional Centre level and escalate only if the issue is not resolved within a reasonable time. Proper categorisation and complete documentation generally ensure timely reimbursement.*

From,

_Santosh Kumar Mishra_ 

_Air Veteran_