Step 1: First: treat the emergency
Do not delay life- or limb-saving treatment to complete a normal planned referral. Official ECHS material recognises emergency routes through a service hospital, an empanelled hospital, or—when necessary—a non-empanelled hospital.
Step 2: If you can reach a service or empanelled hospital
Show the ECHS smart card/accepted entitlement document as soon as possible. At an empanelled hospital, ECHS terms provide for grave-emergency admission even without a normal referral slip and cashless treatment until stabilisation.
Step 3: If you must use a non-empanelled hospital
Take the required emergency treatment. The beneficiary/representative may have to pay the non-empanelled hospital initially. Reimbursement is subject to ECHS emergency rules and admissible rates; it is not a promise that every rupee charged by the hospital will be reimbursed.
Step 4: Inform ECHS within 48 hours
For emergency treatment at a non-empanelled hospital, inform the nearest or parent ECHS polyclinic within 48 hours of admission. The official FAQ says the polyclinic will generate the Emergency Information Report (EIR). Keep evidence of the intimation.
Step 5: Collect the emergency proof and records
Preserve the ECHS card copy, emergency certificate/medical evidence, admission and treatment records, investigation reports, prescriptions, discharge summary, original bills and receipts, and any EIR/communication with ECHS. The beneficiary has the responsibility to establish that the treatment was an emergency.
Step 6: Submit the reimbursement claim
The official ECHS FAQ states that for emergency treatment at a non-empanelled hospital, the member submits the bills and case summary to the concerned polyclinic within 90 days from discharge. Older/current compendium material also records the 90-day submission timeline, with waiver authorities for delayed cases.
Step 7: If the 48-hour intimation or 90-day submission was missed
Do not abandon the claim automatically. Official compendium instructions describe waiver routes depending on the delay. Submit the case promptly with reasons and supporting evidence through the polyclinic so the competent ECHS authority can decide it.
Step 8: What happens after submission
The claim is processed under the applicable ECHS individual-reimbursement rules and competent financial authority. Reimbursement for non-empanelled emergency treatment is according to admissible ECHS/CGHS rates and rules, not necessarily the hospital’s full billed amount.
Step 9: If more information is asked for
Respond with the exact documents requested and keep copies. A Need More Information (NMI) query can hold up processing; keep the claim/reference details and follow the official claim-status route where available.
Step 10: If an empanelled hospital demands cash during emergency
ECHS empanelment terms state that emergency treatment is cashless until stabilisation. Immediately contact the nearest polyclinic/OIC and Director Regional Centre if the hospital demands payment contrary to the authorised emergency route.
Step 11: Whom to contact
Nearest or parent ECHS polyclinic first; Director Regional Centre for unresolved hospital/claim issues; official ECHS helpline 1800-114-115 for clarification. For an ongoing medical emergency, prioritise clinical care and local emergency services.
Frequently asked questions
Do I need a normal referral before emergency treatment?
Not for a grave emergency where delaying care is unsafe.
What is the key deadline for a non-empanelled emergency admission?
Inform the nearest or parent polyclinic within 48 hours of admission.
When should the reimbursement claim be submitted?
The official FAQ states within 90 days from discharge for non-empanelled emergency treatment.
Will ECHS reimburse the hospital’s entire bill?
Not necessarily. Reimbursement is subject to admissible ECHS/CGHS rates and rules.
What if I missed a deadline?
Submit promptly with reasons; official instructions provide waiver routes for certain delayed cases.