Eligibility for ECHS
ELIGIBILITY
1.Entitlement for ECHS. ECHS has been launched to provide comprehensive medicare to all ESM in receipt of pension or disability pension, as also to his/her dependents, which includes wife/husband, legitimate children and wholly dependent parents. The Scheme is also applicable to NOKs of deceased pensioners who are drawing family/special family /liberalised family pension. Following are the eligible categories to become member of ECHS:-
(a) Ex-Servicemen Pensioner. Any person who has served in any rank (whether as combatant or as non-combatant) in the regular Army, Navy and Air Force of the Indian Union, and fulfills the following conditions:-
(i) Who has retired from such service after earning his/her
(ii) Who has been released from such service on medical grounds attributable to military service, or in circumstances beyond his/her control and is in receipt of disability pension.
(iii) Who is a personnel of the Territorial Army and falls under any of the following categories:-
(aa) Pension holders for continuous embodied service.
(ab) Persons with disability attributable to military service.
(ac) Gallantry award winners.
(iv) Who falls under any of the following categories:-
(aa) Members of Military Nursing Service.
(ab) Whole time officers of National Cadet Corps who are Ex-Servicemen /NOK and are in receipt of pension /disability pension/family pension.
(ac) 588 Emergency Commissioned Officers/Short Service Commissioned Officers who were permanently absorbed in National Cadet Corps as Whole Time Officers (WT0s) after their release from the Armed Forces.
(ad) Service officers who, prior to completing their pensionable service, in organisational interest, joined PSUs like Air India, Indian Airlines, Pawan Hans, and Shipping Corporation of India, and to whom Govt had sanctioned pension on a pro-rata-basis. On secondment or transfer to PSUs these officers received their pension either as a lump sum on full commutation or on monthly basis. For those who commuted full amount, the monthly pension was to be restored at 43% after 15 years from their date of retirement on pro-rata basis. Hence, they would be deemed to comply with the condition of being in receipt of pension from defence authorities. However, following additional conditions will have to be complied with by these ESM pensioners:-
(aaa) A mandatory certificate will have to be endorsed in their affidavit stating that, “I certify that I am not a member of any other Govt/PSU Medical Health Scheme”.
(aab) The contribution amount for enrolling as member of ECHS will be based on the rank held by the individual at the time of release and NOT on the restored pension amount. The amount will be similar to the current basic pension of the rank held at the time of retirement. (For example, if the individual retired as a Lt Col/Commander/Wing Commander, he will be required to deposit contribution through MRO as per current basic pension of this rank).
(aac) Each case will be considered on its merits.
(b) Family Pensioner. It implies the legally wedded spouse of an Armed Forces personnel, whose name figures in the service records of the personnel and whose husband/ wife (as the case may be) has died either while in service or after retirement and is granted family pension. This term also includes a child or children drawing family pension on the death of his/her pension drawing father/mother, as also parents of a deceased bachelor soldier, who are in receipt of family pension.
(c) Ex-servicemen drawing disability pension.
(d) War Widows (Exempted from Payment of Contribution)–War widows are those whose spouse had died due to any of actions appended below:
(i) Enemy action in international war.
(ii) Action during deployment with a peace keeping mission abroad
(iii) Border skirmishes.
(iv) During laying or clearance of mines, including enemy mines as also mine sweeping operations.
(v) On account of accidental explosions of mines while laying operationally oriented mine-field or lifting or negotiating minefield laid by the enemy or own forces in operational areas near international borders or the Line of Control.
(vi) War like situations.
(vii) An act of violence, attack by extremists, anti-social elements, etc., while on operational duty.
(viii) Action against extremists, antisocial elements, etc., while employed in the aid of civil power in quelling agitation riots by demonstrators
(ix) Operations specially notified by the Govt from time to time
(e) The Army Postal Service personnel are permitted to enroll into the ECHS subject to fulfilling the following conditions:-
(i) The retiring APS personnel must fulfill the primary condition of being an ex-servicemen, i.e. he/she should have served in the Armed Forces of India, in any rank as a combatant or non-combatant.
(ii) Must retire finally from the Armed Forces, without reversion to the P&T Department.
(iii) Must be in receipt of pension consequent to retirement or be in receipt of disability pension, if prematurely retired/released on medical grounds which are attributable to military service.
(iv) Must NOT be a member of CGHS or any other Govt Medical Scheme.
(h)Reservists who are drawing pension including family pension are permitted to join the Scheme. However Reservists who opted for ex-gratia payment are not eligible.
(j) A Recruit who is in receipt of medical/disability pension is alone eligible to join the ECHS. The following dependents of the recruit are NOT permitted to be included for ECHS benefits :-
(i) Parents.
(ii) Wife.
(iii) Children.
The recruit who was already married prior to joining the training at the Regimental Centre would be permitted to have his wife and children, if any, included as his dependents. This fact would be checked from the Part II Order published. However, the parents of such a recruit would not be entitled to be shown as dependents.
2. Eligibility Status for Dependants. The following categories qualify to be called dependants:-
(a) Parents. Father and Mother of the Veteran pensioner shall be deemed to be dependent if they normally reside with the Veteran pensioner and their combined income from all sources does NOT exceed Rs 2550/-pm. Parent of the spouse of the Veteran are NOT permitted to become members. In case a widow, who is in receipt of Family Pension, joins the ECHS, then the parents of her late husband can be made dependants, subject to fulfilling the conditions. However, her own parents CANNOT be made dependants. In a case where both the husband and wife are ESM pensioners, then both can opt to cover their parents as dependents. In this case both pensioners will have to make ECHS contribution, as applicable. “Parents, ie, mother and father” of unmarried deceased soldier and in case of deceased parents, then `NOK’ of unmarried deceased soldier are also eligible, provided they are in receipt of liberalised family pension.
(b) Spouse. Legally wedded husband/wife including more than one wife. Name should be included in the records of service. Spouse living separately is included as dependent, as long as the Veteran pensioner is responsible for her maintenance. When the spouse is legally separated, he/she cannot be termed as a dependent and hence cannot be made member of ECHS. In the event of plural marriage, where it is permitted by the rules, the following conditions should be fulfilled for claiming ECHS membership:-
(i) Necessary casualty for entering into plural marriage should have been published through Unit Part II Orders/POR and names of both the wives should be found recorded in the Service Discharge Book/Service Particulars Retired Officers Booklet issued by respective Service Headquarters.
(ii) The names of both the wives should be found recorded in the PPO for grant of ‘Family Pension’ award.
(iii) In the case of widows, both wives should be in receipt of a share of ‘Family Pension’ and PPO produced in support of evidence.
(iv) If the spouse is employed in Govt service then he/she can only be a member of any one Govt/Public sector medical benefit scheme and not the second one.
(v) If a war widow remarries, she would still remain eligible. Her husband, however, will NOT be eligible.
(vi) In case the ESM pensioner marries after retirement, following documents will be required as proof for dependency of wife :-
(aa) Marriage certificate from authorized Registrar of Marriages/Municipal Committee.
(ab) Application form will have to be submitted for enrolling the spouse as a dependant.
(c) Daughter(s).
(i) Details must exist in the service record of the pensioner.
(ii) Unmarried and unemployed daughters are permitted to be included as dependents.
(iii) Widowed/Divorced daughters dependant on the Pensioner and residing with the latter are also permitted to be included. However, the children of such a daughter are not eligible.
(iv)Widowed daughters, who are dependant on the pensioner and whose income from all sources is less than 2550/- per month, are entitled.
(v) Daughters with permanent mental or physical disability, irrespective of age/medical condition.
(vi) Divorced daughters are entitled when solely dependant on the pensioner and whose income from all sources is less than Rs. 2550/- per month.
(vii) In case where daughter is born after the pensioner’s retirement, following documents will be required to enable the child to be declared as a dependant and to become entitled to ECHS benefits:-
(aa) Birth Certificate.
(ab) Submission of application form to enrol as a dependant.
(d) Son(s).
(i) Unemployed and unmarried son(s) upto the age of 25 years are permitted to be included as dependents.
(ii) Details must be included in the service record of the pensioner.
(iii) Sons suffering from permanent physical or mental disability, irrespective of age or medical condition.
(iv) In case where the son is born after the pensioner’s retirement, the following documents will be required as proof of dependancy:-
(aa) Birth Certificate.
(ab) Submission of additional application form to enrol as a dependant.
(e) Mentally/Handicapped Children. Mentally/Handicapped children who are unable to earn their livelihood are permitted to be dependents for life time. The following conditions are required to be met:-
(i) Onset of disability should be prior to attainment of 25 years of age.
(ii) Permanent disability should be certified by Service Classified Specialist/Civil Surgeon duly indicating percentage of disability and the child’s inability to earn his livelihood.
(iii) The condition of disability should be mentioned in the records of pensioner and the disabled dependent son should be eligible for family pension.
(iv) The minimum degree of disability should be 40% in order to be eligible for any concession/benefits under ECHS. Assessment criterion is as laid down in ‘Guide to Medical Officers — (Military Pensions) — 2002’.
3. Amplifications on addition/deletion of names of dependents for ECHSon the above are as follows:-
(a) Addition of Dependent. A newly born child or parents becoming dependant on the ECHS member subsequent to retirement, will require the member to submit a Part II order published by the respective Record Office. In the case of divorced/widowed daughter becoming dependant on the ECHS member, the divorce paper or death certificate respectively will have to be submitted. In all these cases the ESM has to submit a fresh application along with the documents and master card for issue of new cards.
(b) Deletion of dependent. In the event, wherein the ECHS member dies, his/her spouse can continue to use the Master card, however the option lies with the spouse to get a new card made by filling up a fresh application form in order to get a smart card on his/her name. However in the case of demise of dependant the deletion can be made at any polyclinic, but if an add on card has been issued to that dependent, it will have to be returned to the Stn HQ from where the card was initially issued for cancellation. Sons above 25 years of age will be automatically deleted from dependency. Married/employed daughter is to be intimated by the member to the policlinic.
3. Specific Conditions for Continuance of Eligibility. In case an ESM pensioner (male/female) has declared his/her parents as dependants, they shall continue to receive ECHS benefits for their life time, subject only to the condition that their joint income does not exceed Rs.2550/- per month from all sources. In the event of the pensioner’s death, the widow shall be covered as she will start drawing family pension, but her parents will NOT become eligible as dependents. However, parents of the deceased pensioner, if already enrolled as dependents, would continue to enjoy benefits of the ECHS in the event of death of their ESM pensioner son/daughter, provided their joint income does not exceed Rs. 2550/- per month.
4. Emergency Commissioned Officers/Short Commissioned Officers who, after their release from the Armed Forces, were permanently absorbed in the National Cadet Corps as Whole Time Officers(WTOs/WTL0s) are eligible for availing benefits of ECHS. WTOs/WTLOs not complying with above conditions are NOT eligible.
5. Recruits who sustained injury during training which is attributable to military service, he is eligible for status of ESM and granted disability pension. Since these recruits meet the twin conditions mandatory for membership, these are eligible for ECHS membership.
6. Clarification On ECHS Membership When Husband and Wife are Defence Personnel.
(a) When Both Husband and Wife are Defence Pensioners
(i) Only one has to give ECHS contribution.
(ii) Both can cover their respective parents by making two ECHS contributions.
(b) When one is a defence person and other is a Central Govt employee, the latter has the choice to withdraw from CGHS when the spouse becomes a member of the ECHS.
7. Persons Not Eligible Under ECHS. The following are NOT eligible for becoming members of ECHS:-
(a) Gorkha pensioners of Nepal domicile.
(b) Whole time NCC officers who do not meet the twin conditions, that a prospective member must be an ex-serviceman who has served in the Armed Forces of India in any rank, and in receipt of pension/family pension/disability pension paid by Government.
(c) Ex-ECOs/SSCOs who do not meet twin conditions as mentioned above.
(d) Legally divorced spouse.
(e) Married and/ or employed daughters.
(f) Parents of widow/war widow.
(g) Husband of a remarried war widow.
(h) Officer cadets, who get injured during training and are boarded out on medical grounds.