ECHS — how the health scheme actually works
The Ex-Servicemen Contributory Health Scheme (ECHS) gives pensioners and their dependents cashless medical care — through its own polyclinics, service hospitals and empanelled private hospitals. It is one of the most valuable benefits an ex-serviceman holds, and also the one where families most often get stuck, because the referral system is never explained to them in plain words.
Who gets it
- Ex-servicemen drawing a pension — including disability and family pensioners. Membership comes with a one-time contribution paid at retirement (slab-wise by pension; the current slab amounts are with your Record Office and the ECHS website — we do not quote figures we have not verified).
- Dependents — spouse, dependent children, and dependent parents within the income rules. Each gets their own card.
- War widows and family pensioners — entitled in their own right.
How treatment flows — the part nobody explains
- 1 Smart card + polyclinic Every treatment starts at your parent polyclinic
- 2 Medical Officer sees you Treats there, or refers you onward
- 3 Referral in hand Note its validity date — it expires
- 4 Empanelled hospital Cashless treatment — because the referral exists
Emergency is the one exception: nearest hospital first, and inform the parent polyclinic within the laid-down time. Straight to a private hospital without a referral, without an emergency — that is where the money goes from your pocket.
- Everything starts at your polyclinic. Walk in with the smart card. The Medical Officer treats what can be treated there and issues medicines.
- Referral — if the polyclinic cannot treat it, the Medical Officer refers you to a service hospital or an empanelled private hospital. Treatment at an empanelled hospital is cashless with a valid referral — that referral has a validity period, so note the date.
- Going straight to a private hospital without referral is where families lose money — without a referral, ECHS pays only in a genuine emergency, and the paperwork burden is on you.
- Emergency — go to the nearest hospital (empanelled if possible), and inform the parent polyclinic within the laid-down time so the emergency intimation is on record. Keep every paper.
The smart card
- Applications run online through the official ECHS portal — the 64-KB card is issued per member, including each dependent. Step-by-step guide: how to apply for the ECHS card.
- Application stuck, mistake to correct, or card lost? See status, corrections and duplicate card.
- Keep the card's number noted at home, and report a lost card to the polyclinic immediately — a temporary slip keeps treatment going while the duplicate comes.
- Change of city? Get your parent polyclinic changed — treatment runs on the polyclinic where you are registered.
⚠ The date on the referral A referral has a life. Since the revised rules of 2 September 2024 an ordinary referral is valid for three months (it used to be one month), covering up to three specialists and six consultations. For cancer, diabetes, hypertension and cardiac cases it runs 180 days — and follow-up after listed critical treatments (cardiac surgery, transplant, dialysis, cancer) does not need re-validation at all. If someone at the counter tells a chronic patient to come back monthly, this is the rule to ask about.
Frequently asked questions
Is ECHS free?
There is a one-time contribution paid at retirement (slab-wise by pension — current slabs are on the ECHS website). After that, treatment within the rules is cashless. There is no monthly premium.
Can I go straight to a private hospital?
Only in a genuine emergency — and then your parent or nearest polyclinic must be informed within 48 hours of the admission. (At an empanelled hospital the hospital itself raises the emergency report, also within 48 hours.) Bills for reimbursement go to the parent polyclinic within 90 days of discharge, and are paid at CGHS rates. Otherwise treatment at an empanelled hospital is cashless only with a referral; walking in without one is how families end up paying from their pocket.
My parents live with me — are they covered?
Dependent parents can be covered, each with their own card, if they normally live with you and their combined income from all sources is not more than ₹9,000 a month (excluding dearness allowance). The polyclinic and the ECHS website carry the full dependency conditions.
I am moving to another city — what about treatment?
Get your parent polyclinic changed to the new station — it can be done online through the ECHS card portal, and the rules allow a change once in three months. Treatment runs on the polyclinic where you are registered, so do this before you need a referral, not after.
Sources
- echs.gov.in — the official ECHS portal: eligibility, contribution slabs, empanelled hospitals and card application
- Referral rules — Central Organisation ECHS letter No. B/49769/AG/ECHS dated 2 September 2024, "Revised Guidelines for Referral Process in ECHS" (referral valid three months; 180 days for cancer, diabetes, hypertension and cardiac cases), with the clarification of 4 October 2024 — policy PDF on echs.gov.in, read in full on 3 August 2026.
- Emergency intimation within 48 hours, claims within 90 days at CGHS rates, and the dependency conditions (parents' combined income not above ₹9,000 a month excluding DA) — ECHS FAQs, Central Organisation ECHS, 10 April 2023.
- Treatment procedure — SOP on Treatment Management in ECHS, 28 September 2018 (echs.gov.in).
- The scheme itself — MoD letter No. 22(1)/01/US(WE)/D(Res) dated 30 December 2002; contribution rates and ward entitlement — MoD/DESW letter No. 22D(04)/2010/WE/D(Res-I) dated 29 December 2017 (desw.gov.in).
This is general information, not medical or legal advice. Entitlement and procedure in your case are governed by ECHS orders and your membership record. Sainik Desk is a private website with no government affiliation, and no affiliation with ECHS.