ECHS Announces New Healthcare Rates for Ex-Servicemen Effective December 2025

The Ex-Servicemen Contributory Health Scheme (ECHS) has unveiled significant updates to its healthcare pricing framework, introducing revised rates that will take effect on December 15, 2025. This change follows a notification from the Ministry of Health & Family Welfare (MoH&FW) and is documented in an Office Memorandum dated October 3, 2025. The new rates will replace all previously issued guidelines.

New Rates Affecting Healthcare Services

The revised Central Government Health Scheme (CGHS) package rates will now apply to various healthcare services accessed through ECHS-empanelled Healthcare Organisations (HCOs). This includes medical reimbursement claims submitted by service pensioners and other eligible beneficiaries. Furthermore, cashless treatment options will continue to be available for service pensioners as per existing regulations.

For treatment at non-empanelled private HCOs, the ministry maintains that reimbursement may be granted in exceptional cases, but the rates will align with the Non-NABH (National Accreditation Board for Hospital for Healthcare Providers) standards for the respective city.

Detailed Rate Structure and Adjustments

The updated rate matrix introduces a nuanced approach based on several factors, including hospital accreditation, the type of healthcare facility, city tier, and ward entitlement. Key aspects of the new structure are as follows:

– **Accreditation-linked pricing**: Non-NABH and Non-NABL HCOs will see rates that are 15% lower than those of NABH/NABL-accredited facilities. Conversely, rates for super-speciality hospitals will be 15% higher than those for NABH-accredited hospitals in the same city category.

– **City-based classification**: HCOs located in Tier II (Y) cities will charge rates that are 10% lower, while those in Tier III (Z) cities will see a 20% reduction compared to facilities in Tier I (X) cities. Notably, Y-tier rates will apply to HCOs in the North-East region and the Union Territories of Jammu & Kashmir and Ladakh.

– **Ward entitlement adjustments**: The new package rates will generally correspond to semi-private wards. Beneficiaries entitled to general wards will experience a 5% decrease in rates, while those entitled to private wards will face a 5% increase on the admissible claim amount.

Uniform rates will apply for various services such as consultations, radiotherapy, investigations, day care, and minor procedures that do not necessitate admission.

For cancer patients, existing CGHS rules regarding surgeries will remain unchanged, while the revised rates will apply solely to chemotherapy, investigations, and radiotherapy.

Understanding the ECHS Framework

The Ex-Servicemen Contributory Health Scheme is a central government-funded initiative that provides comprehensive medical coverage to Armed Forces veterans and their dependents. This program utilizes a network of polyclinics, military hospitals, and private facilities to facilitate cashless treatment for a wide range of healthcare needs, from routine care to major surgeries.

As these changes are implemented, beneficiaries are encouraged to familiarize themselves with the new rates and guidelines to ensure a smooth transition in their healthcare services. The ECHS remains committed to enhancing healthcare access for ex-servicemen and their families, ensuring that quality medical support is available in a timely and efficient manner.