FOR FILLING UP ECHS APPLICATION FORM
BY PENSIONERS INCLUDING WIDOWS/ FAMILY PENSIONERS/ NOK
1. Eligibility Conditions
(a) Ex-Servicemen drawing pension/ disability pension or widows/next of kin who are in receipt of family pension are eligible to apply for ECHS membership.
(b) Ex-servicemen who are not drawing any pension are NOT entitled for ECHS membership.
(c) Ex-servicemen who are members of any other Government Medical Scheme are NOT entitled to become ECHS members. Simultaneous membership of two Govt Medical Schemes is not permitted.
(d) Dependents. Ex-servicemen eligible to apply for ECHS membership are permitted to include names of their dependents as under: -
(i) Wife/Husband (Name should be recorded in service records of the pensioner).
(ii) Unemployed Sons below 25 years of age. Married sons, even though below 25 years of age, are NOT permitted to be included as 'dependents' (Names should be recorded in service records of the pensioner).
(iii) Unemployed/Unmarried /Divorced/widow dependant daughters, irrespective of age. (Names should be recorded in service records of the pensioner).
(iv) Physically/Mentally handicapped children for life. (Certificate for physical/mental handicap duly signed by a Service specialist is required as a supporting document). In addition proof of dependency to be attached. Onset of disability after the age of 25 years is not eligible for membership.
(v) 'Wholly dependent' parents. Parents whose monthly income from all sources exceeds Rs 1500/-pm are NOT eligible to be included as 'dependent'. (Names should be recorded in service records of the pensioner). Father/Mother who are retired employees of Central Govt./State Govt./ PSU would necessarily be drawing a pension of over Rs. 1500/- per month. Such personnel cannot be termed dependent.
(vi) In case of a widow pensioner, the parents of the deceased soldier are permitted to be included as dependents, provided their monthly income from all sources does not exceed Rs 1500/- (Names should be recorded in service records of the pensioner).
(vii) In case a widow remarries and is in receipt of pension she and her children are entitled to become ECHS members. However, present husband and children from present husband are NOT permitted to be included as dependents.
(viii) Grandparents/Grandchildren are NOT permitted to be included as 'dependents'.
(ix) In case of marriage after retirement or birth of children after retirement, Ex-Servicemen pensioners are requested to contact their Record Office for Publication of Part II Orders for Marriage/ Birth.
2. Payment of ECHS Contribution Amount.
(a) For Pre 01 Apr 2003 Pensioners. Ex-Servicemen eligible to become ECHS members are required to deposit ECHS Contribution amount in Govt Treasury/Nationalised Banks through MRO. Four copies of the MRO to be prepared as per sample attached. The rates of contribution will be based on the Revised Pension slabs (Uncommuted Basic Pension + Dearness Pension) of a pensioner as given below: -
(Un commuted Basic Pension + Dearness Pension)
RATE OF ONE TIME SUBSCRIPTION
|Upto Rs. 3000/-||Rs. 1800/-|
|Between Rs. 3001 to 6000/-||Rs. 4800/-|
|Between Rs. 6001 to 10000/-||Rs. 8400/-|
|Between Rs. 10001 to 15000/-||Rs. 12000/-|
|Above Rs. 15001/-||Rs. 18000/-|
(i) War Widows (Veer Naris) have have been exempted from paying ECHS contribution amount.
(ii) Ex-servicemen/widows/parents eligible to become ECHS members have the option to become ECHS members only upto 31 Mar 2008. Thereafter, entry to the Scheme for pre 01 Apr 2003 retirees will be closed.
(iii) Medical Allowance of Rs 100/-pm being drawn by Ex- servicemen will be stopped with effect from the date of joining the ECHS.
(iv) Amount paid by Ex-servicemen towards membership of AGIF(MBS)/AFGIS, will be refunded in full by AGIF/AFGI on joining ECHS. Members to apply for refund to AGI/ AFGI Directorate alongwith copy of ECHS Membership Card, AGIF Card, AGIF(MBS) AFGIS Card and their banker details.
(b) Post 01 Apr 2003 Retirees. Post 01 Apr 2003 pensioners are compulsory members of ECHS. Their ECHS contribution amount is deducted at source by CDA(Pension) Allahabad and reflected in the PPO. In cases where ECHS contribution amount has not been deducted at source by CDA(P), pensioners are required to deposit their contribution amount through an MRO, as per Para 2 (a) above.
3. Payment of ECHS Membership Cards
(a) Ex-servicemen eligible to become ECHS members will be issued ECHS Smart Card on payment of Rs 90/-. This Card will be called 'Master Smart Card' and will include the details of all authorized dependents. However, a pensioner is permitted to opt for a maximum of two add on cards on payment of Rs 90/- per card. The cost of Smart Cards will be paid through Demand Draft in favour of, as under: -
(i) For Pre 01 Apr 2003 Pensioners. In favour of concerned Regional Centre ECHS Non Public fund Accounts in whose jurisdication the application is being submitted.
(ii) For Post 01 Apr 2003 Pensioners. Demand Draft in favour of ECHS Regional Centre with which the Record Office of the pensioner is affiliated. The demand draft should be payable at the city of location of ECHS Regional Centre. For list of affiliation of Record Offices see Page 7.
4. Collection, Filling & Submission of ECHS Application Forms
(a) Pre-01 Apr 2003 Retirees. Ex- servicemen eligible to become ECHS members may approach nearest Station HQs or Service Hospitals or CSD Canteens to collect the ECHS Application Form, and will take following actions : -
(i) Fill up the Self Explanatory Application Form. Rank of the pensioner to be written in Abbreviated form as per details given at Page 8.
(ii) Prepare Affidavit on rs 10/- Non judicial Stamp Paper as per Specimen Format given at Page 10.
(iii) Deposit prescribed amount of ECHS Contribution in Bank/Govt Treasury through MRO.
(iv) Prepare demand draft towards cost of Smart Card (s).
(v) Make photocopy of PPO and get it attested by the pension paying bank/treasury.
(vi) Paste photographs of all eligible members on the Application Form and on Receipt of documents.
(vii) Deposit the completed Application Form alongwith connected documents to the nearest Stn HQs/ ECHS Regional Centre and obtain documents including Service/ Discharge Book for verification by the Station HQs/ ECHS Regional Centre.
(i) ECHS Application Form to be made available to the retiring person by parent unit/Record office of the individual.
(ii) ECHS application Form will be filled up (rank of the pensioner to be mentioned in abbreviated form) and submitted to concerned Record Office alongwith demand draft for cost of Smart Cards, Affidavit, Proof of allergies (if any) and certificate for Blood Group and Pension Documents as follows :
|Army Headquarters/ AG's Branch MP 6||for non- AMC Officers.|
|Army Headquarters/ AG's Branch MPRS (O)||for AMC, ADC & MNS Officers|
|Concerned Records Office (refer Page 7)||for all JCOs & OR of the Army.|
|Naval Headquarters/ Director of Personnel (DOP)||for Naval Officers.|
|Commodore Bureau of Sailors (CABS), Mumbai||for Naval PBOR.|
|Air Headquarters/DPP & R, through last posted unit||for Air Force Officers.|
|Air Force Records Office (AFRO), Delhi Cantt||for Air Force PBOR|
Notes: - 1. On Receipt of ECHS Application Form, Record Office will check the details reflected in the Application Form with that recorded in the Service documents. Record Office will issue the Receipt of Application Form and will submit the form to dependent ECHS Regional Centre.
2. On receipt of ECHS Application form from Record Office, concerned ECHS Regional Centre will re-verify the documents and would arrange manufacturing of Smart Card (s) and dispatch to Station HQ/ Record Office/ Individual.
ECHS MEMBERS: POINTS TO REMEMBER
1. Please note that whenever you or your authorized dependents require medical assistance, you need to FIRST contact your nearest ECHS Polyclinic for treatment. After working hours you may go to a Service Hospital directly.
2. In case of 'EMERGENCY' (Life Saving situation etc.), you may seek medical assistance from any Service/ empanelled/ non-empanelled civil hospital. You must inform your nearest ECHS Polyclinic within 48 hours about your illness and treatment being undertaken. This is very 'IMPORTANT'.
3. In case you have availed treatment in a 'Non-empanelled' hospital during 'EMERGENCY", you need to pay your bills to the treating hospital and claim reimbursement through your nearest ECHS Polyclinic. The reimbursement will be restricted to CGHS rates and subject to confirmation and verification of 'EMERGENCY'.
4. Also remember, whenever you need any guidance about availing treatment under ECHS, go to your nearest ECHS Polyclinic. Do not make presumptions on rules of the Scheme.
AFFILIATION OF SERVICE HQS & RECORDS OFFICES
WITH ECHS REGIONAL CENTRES
|Regional Centre||Affiliated Sections at Service HQs & Records Office|
|Delhi Cantt||Army HQs/ AG's Branch MP6 / MPRS (O) - for Army Officers; Naval Headquarters/ DOP - for Naval Officers; Air Headquarters / DPP & R - for Air Force Officers; Air Force Records Ofice (AFRO) - for all air Force PBOR; and RAJPUTANA RIFLES.|
|Pune||Armoured Corps; Regiment of Artillery; Air Defence Artillery; Mechanised Infantry; Bombay Engineer Group (BEG); BRIGADE of GUARDS; Intelligence Corps; Army Physical Training Corps (APTC); Army Postal Service (APS).|
|Patna||PUNJAB Regiment; SIKH Regiment; BIHAR Regiment; 3 & 9 GORKHA RIFLES; Army Service Corps (AT).|
|Lucknow||Bengal Engineer Group (BEG); RAJPUT Regiment; JAT Regiment; SIKH Light Infantry Regiment; DOGRA Regiment; GARHWAL RIFLES; KUMAON Regiment: 11 GORKHA RIFLES; Army Medical Corps (AMC); Remount & Veterinary Corps (RVC).|
|Hyderabad||MARATHA Light Infantry; Army Ordnance Corps (AOC); electronic and Mechanical Engineers (EME).|
|Jabalpur||Corps of Signals; GRENADIER Regiment; MAHAR Regiment; Jammu & Kashmir Rifles (JAK RIF); Army Education Corps (AEC).|
|Jammu||Jammu & Kashmir Light Infantry (JAK LI); LADAKH SCOUTS.|
|Guwahati||ASSAM Regiment; 5 & 8 GORKHA RIFLES.|
|Chandimandir||1 & 4 GORKHA RIFLES.|
|Chennai||Madras Engineer Group (MEG); PARACHUTE Regiment; MADRAS Regiment; Army Service Corps (South); Corps of Military Police (CMP); Pioneer Corps.|
|Kochi||CABS, Mumbai - for all Navy PBOR; Defence Security Corps (DSC).|
ABBREVIATED RANKS OF THE THREE SERVICES OFFICERS
|General||Gen||Admiral||Adm||Air Chief Marshal||AC Mshl|
|Lieutenant General||Lt Gen||Vice Admiral||V Adm||Air Marshal||A Mshl|
|Major General||Maj Gen||Rear Admiral||R Adm||Air Vice Marshal||AVM|
|Brigadier||Brig||Commodore||Cmde||Air Commodore||Air Cmde|
|Colonel||Col||Captain||Capt (IN)||Group Captain||Gp Capt|
|Lieutenant Colonel||Lt Col||Commander||Cdr||Wing Commander||Wg Cdr|
|Major||Maj||Lieutenant Commander||Lt Cdr||Squadron Leader||Sqn Ldr|
|Captain||Capt||Lieutenant||Lt (IN)||Flight Lieutenant||Flt Lt|
|Lieutenant||Lt||Sub Lieutenant||Sub Lt (IN)||Flying Officer||Flg Offr|
|Honorary Captain||Hony Capt||Honorary Lieutenant||Hony Lt (IN)||Honorary Flight Lieutenant||Hony Flt Lt|
|Honorary Lieutenant||Hony Lt||Honorary Sub Lieutenant||Hony Sub Lt (IN)||Honorary Flying officer||Hony Flg Offr|
|Subedar Major or Risaldar Major||Sub Maj Or Ris Maj||Master Chief Petty Officer 1||MCPO 1||Master Warrant Officer||MWO|
|Subedar or Risaldar||Sub or Ris||Master Chief Petty Officer 2||MCPO 2||Warrant Officer||WO|
|Naib Subedar or Naib Risaldar||Nb Sub Or Nb Ris||Chief Petty Officer||CPO||Junior Warrant Officer||JWO|
|Havildar or Dafedar||Hav Or Dfr||Petty Officer||PO||Sergeant||Sgt|
|Naik or Lance Dafedar||NK Or LD||Leading||Ldg||Corporal||Cpl|
|Lance Naik or Asst Lance Dafedar||LNK Or ALD||Seaman I||Sea I||Leading Air Craftsman||LAC|
|Sepoy (Rfn, Swr, Spr, Sigmn, Cfn)||Sep||Seaman II||Sea II||Air Craftsman||AC|
Registration No. _____________
RECEIPT FOR DOCUMENTS
EX SERVICEMEN CONTRIBUTORY HEALTH SCHEME (ECHS)
(USE BLUE INK ONLY)
1. Received following documents from No_________Rank________Name_____________ towards application for membership of Ex-Servicemen Contributory Health Scheme (ECHS): -
(a) Application form (duly completed).
(b) Photographs pasted at appropriate places.
(c) Affidavit in original (duly attested).
(d) Copy of MRO (where applicable).
(e) Photocopy of PPO duly attested by bankers/treasury (where applicable).
(f) Photocopy of Service/Discharge Book/proof of dependants.
(g) Demand draft (for Smart Cards).
2. Category for Hospitalisation (√) Private □ Semi Private □ General □
(Signature and Stamp of Officer)
(Adm Comdt/SSO/Officer Stn HQ/Record Officer)
All photographs to be stamped by issuing Officer.
Note : - 1. This original receipt is required to be returned at the time of collection of Smart Card(s).
2. No Smart Card will be issued if this receipt in original is not produced.
3. Record Office will send this receipt to the individual in his unit after checking the Application Form. Receipt will be collected at the time of handing over the ECHS Smart Card, before individual proceeds on pension.
Receivd Smart Card(s) (√) One □ Two □ Three □
Signature of Pensioner
Date : _____________
SAMPLE OF AFFIDAVIT
AFFIDAVIT ON Rs. 10/- NON JUDICIAL STAMP PAPER and TO BE ATTESTED BY MAGISTRATE / NOTARY PUBLIC DECLARATION
I, Service No_______________ Rank_____________ Name_______________________ of (Unit) ___________________________________, solemnly affirm and declare as follows : -
1. That I am/will be drawing pension vide PCDA Pension Payment Order No______________ dated ______________.
2. That I have the following legal dependant(s) whose photograph(s) is/are affixed below on this Affidavit:-
Name Relationship Age Date of Birth Part II Order No / CRD/SD / POR No
Signed photo of Dependant giving name,
Relationship and Identification mark.
Signed photo of Dependant giving name,
Relationship and Identification mark.
(Photograph(s) to be pasted and signed across by each dependant. In case of challenged child/minor, to be signed by Applicant)
3. (a) That the combined monthly income of my dependant father and/or dependant mother (from all sources ) is less than Rs 1500/-.
(b) My mother/father are not presently/ex employees of Central/state Government/Public Sector Undertakings. They are not in receipt of any kind of pension.
4. That my son(s) is/are under 25 years age and is/are NOT employed, & that my daughter(s) is/are NOT employed or married.
5. That I am aware that my son(s) is/are NOT eligible for the Ex-servicemen Contributory Health Scheme (ECHS) after he/they attain 25 years of age, or get employed at any time before that age. I shall inform the ECHS immediately of his/their employment.
6. That I am aware of the fact that my daughter(s) is/are NOT eligible for the Ex servicemen Contributory Health Scheme after she/they marry or get employed. I shall immediately inform ECHS authorities of her/their marriage or employment.
7. That in case of any change in the status of my dependants (due to death, marriage, employment), I will inform my Regional Headquarters ECHS at the earliest and will refund, in full, the cost of any treatment that my dependent may have received after he/she became ineligible. I shall be liable for civil/criminal action should I fail to do so.
8. That I am NOT a member of any other medical scheme funded by Central govt, PSU or any other Govt Undertaking.
9. I understand that in case I have submitted any incorrect information, or if my ECHS Membership card is misused or used by any unauthorized person, my membership will be cancelled without any notice or further hearing. In addition, I will forfeit my contribution and I will pay the entire cost of expenditure incurred on such unauthorized person(s). I will also be liable for legal action by the ECHS Organisation. I will also immediately report the loss my ECHS membership card to Station Headquarters and lodge and FIR with the local civil police.
10. I am not in possession of my Service / Discharge Book. (if applicable).
Signature of Deponent
I, the deponent above named, do hereby solemnly declare and verify that the contents of the above affidavit are true to the best of my knowledge and belief, and nothing material has been concealed or suppressed there from.
Verified at (Place) on this (Date) ....... day of (Month) .(Year)
Signature of Deponent
Certified that the above statement is declared before me at (Place) on this day os (Month) (Year) by DEPONENT Service No .. Rank Name who is identified by Name . S/O (Father's name if Identifier) ..and witnessed by Name .... S/O (Father's name of first witness) & Name . S/O (Father's name of second witness)
of Witness No. 1
1. (Name in Block Capitals)
(Full Postal Address)
of Witness No. 2
1.(Name in Block Capitals)
(Full Postal Address)
Original/Duplicate/Triplicate/Quadruplicate In lieu of IAFF (A) 507
MILITARY RECEIVABLE ORDER
MRO No :
Dated : _______________________
|The Officer-in-Charge of||
The State/Reserve Bank of India
Please receive from No. _________________ Rank _______________ Name ____________________ or order, the sum of Rupees _______________________________________________________________ on account of "EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME (ECHS)" and credit the amount as Defence Department receipt pertaining to the PCDA/CDA__________________________________________________________________________
(Fill relevant station - see reverse)
MAJOR HEAD : 0076, MINOR HEAD : 110, Sub Minor Head : 11D
Forwarded to PCDA/CDA ______________________________________________________________
(Fill relevant station - see reverse)
Signature of Issuing Officer
PART - II
_______________Treasury : State Bank of India Receipt No
Received the sum of Rs. __________(Rupees _____________________________________only)
Signature and designation of Officer-in-Charge Treasury
INSTRUCTIONS FOR MRO
Controller General Defence Accounts (CGDA) has nominated the following Army Principal Controllers of Defence Accounts (PCsDA)/Controllers of Defence Accounts (CsDA) for accounting the contribution made in their areas of jurisdiction. : -
|S. No||Regional Centres||Polyclinics Under Jurisdiction of Regional Centres||Name to be Entered in MRO Army PCsDA CsDA|
|1||Jammu||Mandi, Yol (Dharamashala), Chamba, Janglot (Kathua), Jammu, Udhampur, Srinagar, Samba, doda, Poonch, Baramulla, Leh, Rajouri||PCDA (NC) Jammu|
|2||Delhi||Delhi, Delhi (Lodhi), Jind, Sirsa, Narnaul, Sonipat, Panipat, Yamunanagar, Fatehbad, Kaithal, Kurukshatra, Bhiwani, Jhajjar, Rewari, Rohtak, Gurgaon, Hissar, Faridabad, Karnal, Ambala, NOIDA, Ghaziabad (Hindon)||PCDA (WC) Chandigarh|
|3||Chandimandir||Chandimandir, Gurdaspur, Chandigarh, Hoshiarpur, Jalandhar, Ludhiana, Ropar, Muktasar, Bhatinda, amritsar, Sangrur, Fatehgarh, Faridkot, Firozpur, Kapurthala, Patiala, Moga, Mansa, Hamirpur Bilaspur, Una, Shimla, Solan, Sriganganagar, Bikaner||PCDA (WC) Chandigarh|
|4||Jaipur||Jhunujhunu, Jodhpur, Jaipur, Kota, Barmer, Bagaur, Ajmer, Alwar, Bharatpur, Udaipur, Jaisalmer, Sikar, Churu, Pali, Sawai Madhopur||PCDA (SC) Pune|
|5||Pune||Ahmedabad, Vadodra, Jamnagar, Bhind, Bhopal, Gwalior, Sagar, Morena, Jhansi, Jalaun, Panaji, Satara, Kolhapur, Pune, Bafpur, Akola, Sholapur, Nasik (Deolali), Aurangabad, Ahmendnagar, Mumbai, Mumbai (Upnagar), Sangli, Ratnagiri, Sindudurg, Thane, Amaravati, Buldana, Jalgaon, Osmanabad, Alibagh, Latur||PCDA (SC) Pune|
|6||Lucknow||Meerut, Agra, Bareilly, Lucknow, Muzaffarnagar, Etawah, Fatehgarh, Kanpur, Mathura, Saharanpur, Shahjahanpur, Bulandshar, Etah, Mainpuri, Aligarh, Badaun, Firizabad, Kanpur Dehat, Raibareilly, Dehradun, Chamoli, Lansdowne, Pauri Garhwal, Almora, Nainital (Haldwani), Pithoragarh, Raiwala (Haridwar)||PCDA (CC) Lucknow|
|7||Kolkata||Krishnanagar, Darjeeling, Kolkatta, Bardwan, Bengdubi (Jalpaiguri), 24 Parganas (Barrackpore), Howrah, Midnapur, Gangtok||CDA Patna|
|8||Ptana||Bhojpur (Ara), Muzaffarpur, Danapur (Patna), Gaya, Chhapra, Dharbvhanga, Ranchi, Singhbhum, Ganjam (Brahampur), Cuttack, Balasore||CDA Patna|
|9||Jabalpur||Indore (Mhow), Jabalpur, Ghazipur, Gorakhpur, Allahabad, Fatehpur, Pratapgarh, Rewa, Faizabad, Varanasi, Balia, Deoria, Azamagarh, Sultanpur||CDA Jabalpur|
|10||Hyderabad||Guntur, Hyderabad, Visakhapatnam, Chittor, Ongole, Rangareddy, Krishna, East Godavari, West Godavari, Dharwad, Mysore, Karwar, Bangalore (Urbon), Bangalore (Yelahanks), Mangalore, Bijapur, Belgaum, Kodagu (Madikeri)||CDA Secunderabad|
|11||Chennai||Vellore, Chennai, Tirunaveli, Coimbatore, Tirunamalai, Thiruvallur, Virudhanagar, Dindigul, Wellington, Madurai, Dharampuri, Kanchipuram, Salem, Tiruchi, Cuddalore, Kanayakumari, Nagapattinam, Tanhavur, Theni, Tuticorin, Villupuram, Port Blair||CDA Chennai|
|12||Kochi||Trivandrum, Kannur, Palakkad, Kochi, Pathannamthitta, Kozcode, Allepy, Quilon, Trissur, Kottayam, Malapuram||CDA Chennai|
|13||Guwahati||Kamrup (Guwahati), Johrat, masimpur (Silchar), Shilong, Zakhama (Kohima), Mokokchung, Aizwal, Imphal, Agartala||CDA Guwahati|
You are requested to insert the requisite data against "EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME(ECHS)" and credit the amount as Defence Department receipt pertaining to the __________________________________ and also insert in the line - Forwarded to _______________________
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