Saturday, October 3, 2009

ECHS: Purchase of Medicines not Permitted as Policy

In case of an emergency, an ECHS beneficiary can directly report to an Empanelled Hospital with his ECHS Card. The hospital is responsible for issuing an emergency certificate and informing the ECHS Polyclinic regarding the emergency admission within 48 hours. Based on this, the ECHS Polyclinic then issues a formal emergency referral. The onus of this entire procedure is with the Empanelled Hospital.

Similarly in case of OPD treatment also in an Empanelled Hospital, the hospital is supposed to do the paperwork and not the ECHS member.

The ECHS beneficiary is not supposed to purchase any medicines since the same is not reimbursable as per existing policy on the subject. He is supposed to collect them from the ECHS Polyclinic based on the advise of the Empanelled Hospital.

Reimbursement of cost of medicines is permitted only in certain special conditions if the patient is referred by the Polyclinic and medicines prescribed are required to be taken with immediate effect on discharge from the Empanelled Hospital as enumerated below:
  • Post operative cases of major Cardiac Surgery / Interventional Cardiology.
  • Oncology.
  • Post operative organ transplant cases.
  • Post operative major Neurosurgical / Neurology cases.
    Prescription for demand of the medicines are required to be provided to the OIC Polyclinic immediately after discharge. Cost of medicines purchased is reimbursable for a period of maximum 30 days only.

    Col Sanjay Sah
    Regional Centre ECHS
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