Fixed Medical Allowance (FMA) to ECHS Beneficiaries

Grant of Fixed Medical Allowance (FMA) to ECHS Beneficiaries – Executive Instructions

Central Organisation, ECHS
Adjutant General’s Branch
IHQ of MoD (Army)
Thimayya Marg,
Near Gopinath Circle
Delhi Cantt — 110010

PC-II to B/49791-FMA/AG/ECHS

11 Jan 2019

SO ECHS, IHQ of MoD (Navy)
Air HQ (VB) (D Fin P) / PD DAV (SP)
HQ Southern Command (A/ECHS)
HQ Eastern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Central Command (A/ECHS)
HQ Northern Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)

EXECUTIVE INSTRUCTIONS : GRANT OF FIXED MEDICAL ALLOWANCE (FMA) TO ECHS BENEFICIARIES

1.References :-

(a) Govt of India, ‘Ministry of Defence letter No 22(01)/2011/ WE/D(Res-I) dated 01 Nov 2018 (copy enclosed).

(b) CGDA letter No AT-IV/4918/XXXVI dated 12 Dec 2018 vide which letter at Para 1 (a) has been promulgated to all PCDAs / CDAs for implementation (copy enclosed).

Eligibility

2. ECHS membership is a compulsory membership for all ESM pensioners wef 01 Apr 2003. It is optional for pensioners prior to 01 Apr 2003. Once a person becomes a member, the same is irreversible. An ESM on becoming member of ECHS has to forfeit the Fixed Medical Allowance (FMA). However, Govt of India, Min of Def vide their letter No 22(01)/2011/ WE/D(Res-I) dated 01 Nov 2018 has now sanctioned FMA to ECHS beneficiaries with the conditions as covered in succeeding paragraphs.

3. Mandatory Conditions: FMA has been made applicable to the following categories of primary ECHS beneficiaries :-

(a) There is no ECHS Polyclinic in his / her district.

(b) There is no service hospital in his / her district.

(c) There is no MI Room upgraded to provide treatment to ESM in’ his/ her district.

4. List of Applicable Districts.

(a) List of districts which make a person eligible is as per Appendix to Govt letter at Para 1 (a). There are 365 districts meeting this criteria at this stage.

(b) Since Govt keeps creating new districts besides redrawing district boundaries, these will be notified by Ops & Coord Section of Central Organisation ECHS for information to all besides being uploaded on ECHS website on 01 Jan every year.

(c) Even if a district is notified, FMA will be applicable only if conditions at Para 3 above are fulfilled.

5. Address at the Time of Superannuation / Discharge from Service with Pension.

(a) Due to domestic, job and multiple other factors, ESM keep getting re-located from one place to another. The address at the time of grant of pension / family pension will be the basis to ascertain whether an ESM belongs to an applicable district as defined at Para 4 above. The data of this address will be taken from the following :-

(i) Permanent address as recorded in PPO.

(ii) In case of PPOs not having permanent address, address as recorded in Pension Book / Discharge Book.

(iii) Any other service document which gives permanent address at the time of grant of pension / family pension.

(b) While provisions exist for change of permanent address, the same will not be applicable for grant of FMA if changed after grant of pension / family pension. There is no restriction in change of permanent address while in service but the permanent address on the first day of eligibility for pension / family pension will be the address for applicability of FMA.

(c) It is the responsibility of ESM opting for FMA to ensure that he / she applies for FMA only if his / her permanent address as recorded at the time of grant of pension / family pension is part of applicable districts. Wrong data when detected will make such an ESM ineligible for ECHS membership along with his / her dependants. Station HQs will also verify this at the time of processing the applications.

Options / Restrictions for FMA Beneficiaries

6.Option for FMA.

(a) It is optional for an individual ESM to opt for FMA even if he / she is eligible.

(b) Even if eligibility conditions are met, an ESM may not opt for FMA.

(c) Unless an ESM applies, FMA will not commence automatically even if eligibility conditions are fulfilled.

(d) Those who opt for FMA being eligible will cease to draw FMA once any of the facilities as per Para 3 get created.

(e) Once opted for FMA, individual ESM will not have any choice to apply for stoppage of FMA. Stoppage will be only based when any of the three conditions as per Para 3 are created.

7. Restrictions for those Opting for FMA: Persons opting for FMA will not be eligible for OPD care through ECHS for themselves and their dependants. These are as under :-

(a) No OPD treatment from any ECHS Polyclinic.

(b) No bpp treatment from any Service Hospital.

(c) No OPD treatment from any Service MI Room.

(d) No OPD treatment from any empanelled hospital.

(e) No reimbursement from any Hospital for OPD treatment including Govt Hospitals.

(f) No medicines from any ECHS Polyclinic.

(g) No medicines except those given during inpatient treatment or at the time of discharge from Service Hospital / Govt Hospital / Empanelled Hospital as applicable as per ECHS norms.

8. Grant of FMA.

(a) ESM / family pensioner will be eligible for grant of FMA @ Rs 1000/- per month despite being an ECHS member or an amount as amended by Govt from time to time.

(b) The date of commencement of FMA will be the first day of the subsequent second month in which the pensioner has submitted the application, eg, FMA will commence from 01st Jul for all applications submitted during 1st May to 31st May. Station HQ must issue the receipt with date and ESM must maintain copy of the same.

(c) When any of the conditions as specified in Paras 3 & 4 are fulfilled, FMA will be ceased and OPD will recommence. The date of cessation of FMA will be the first day of the following second month when such conditions are fulfilled. ESM will also need to apply.

(d) Incase of delay in processing, PCDA / CDA concerned will grant / recover arrears from ESM as per Para 8 (a) to (c) above.

9. Commencement / Restoration of FMA.

(a) As stated above, the ECHS member residing in a district where ECHS Polyclinic / Service Hospital / Upgraded MI Room is not available can seek commencement of FMA payment through his/her Pension Distribution Authority (PDA) /Authorised Pension Disbursing Bank, by submitting an application in the prescribed format at Appendix A to the nearest Military Station/Air Force Station/ Naval Station (ECHS Cell) in triplicate. Distribution of ibid applications will be as under :-

(i) Original Copy: The Original copy will be forwarded to O/O PCDA (Pension) Allahabad, O/o PCDA (O) Pune, O/o PCDA (Navy & Coast Guard) Mumbai, O/o JCDA (AF) New Delhi-10 (“as applicable” and similar office pertaining to the ECHS member’) for endorsement in PPO/issue of corrigendum PPO/updating Pension Records of Pensioners/Family Pensioners managed by Centralised Pension Processing Centres of Banks.

(ii) Duplicate Copy: The duplicate copy will be received by designated, Regional Centre ECHS from the Stn HQ for uploading the same in PDF and onward transmission to Cent Org ECHS. Thereafter forward the hardcopy to concerned Record Offices at Centre/Air Force Record Office, New Delhi 10, Naval Pay Office, Colaba, Mumbai, Army HQ /Naval HQ /Air HQ[PD DAV] Bureau of Naviks, Mumbai (“as the case may be” and “similar office pertaining to the ECHS member”) for retaining in concerned Pensioners’ Records.

(iii) Triplicate Copy: The triplicate Copy will be retained with Stn HQ (ECHS Cell) which will retain the application for a period of three years. Thereafter, these can be disposed off in the normal manner as prevailing in the respective services.

(b) Based on the ibid original application, O/o PCDA (Pension) Allahabad, O/o PCDA (Navy & Coast Guard) Mumbai, O/o JCDA(AF) New Delhi-10 (“as applicable and similar office pertaining to the ECHS member”) will sanction FMA & endorse in PPO / issue of corrigendum PPO updating Pension Recorfls of Pensioners / Family Pensioners managed by Centralised Pension Processing Centres of Banks/DPDO.

(c) Cessation of FMA: The cessation of FMA by PDA / bank would be based on a certificate (Appendix B) issued by Central Organisation ECHS through existing chain of Command & Control regarding the operationalisation of ECHS Polyclinic / Armed Forces Hospital in a district with the commencement date. The smart card of the ESM will be updated on the status of FMA and medical facility available to him. ESM and Stn HQ will be also responsible for prompt action

Provision for IPD Treatment

10. ESM along with his / her dependants will continue to be eligible for IPD treatment as applicable to all other ECHS members. Procedures for IPD treatment will be same for emergency treatment. As regards planned IPD treatment, the ECHS beneficiary will be required to initially obtain lab tests / diagnostics / prelim examination by a Medical Officer clearly endorsing the requirement of IPD based treatment. He will then obtain a referral from parent ECHS Polyclinic for treatment. The authority for the referral, however, will be the decision of Medical Officer at the ECHS Polyclinic. Subsequent treatment and bill processing will follow the existing process. ECHS Polyclinic will be utilised only for decision for IPD referral and if required, for issue of IPD referral as applicable in that Polyclinic.

11. The current card of all ESM and their dependants will be marked with permanent marker by Stn HQ once the application is submitted by ESM to concerned Stn HQ. Use of any OPD facility from the date of applicability for FMA as explained at Para 8 (b), eg in given example of the case, marking will be made — “No OPD – 01 JUL 2019″ or as the case may be. Any use of OPD facility by ESM and his / her dependants thereafter will result in cancellation of all cards permanently. Record of such persons will also be kept in parent ECHS Polyclinic.

12. As detailed at Para 9 above, all Stn HQs will maintain details of all persons granted FMA and same will ,be forwarded to Stats & Auto Section of Central Organisation ECHS through concerned Regional Centre ECHS. This data will be shared with UTI ITSL by Central Organisation and UTI ITSL shall ensure that OPD referrals for such persons for consultation and diagnostics or any other OPD treatment at ECHS Polyclinics and / or empanelled facilities is not generated.

13. Once cessation of OPD facilities consequent to grant of FMA takes place, the information will be updated as per format below :-

DETAILS FOR CESSATION OF OPD FACILITIES CONSEQUENT TO GRANT OF FMA BY STN HQ TO CENTRAL ORG ECHS (STATS & AUTOMATION)

 

14. The details of individual as forwarded by Stn HQ as per format given above will be forwarded to Bill Processing Agency and Smart Card Making Agency to carry out following :-

(a) Bill Processing Agency (BPA): To carry out under mentioned actions for both 32 & 64 Kb Card holders:-

(i) BPA will ensure that the individuals granted FMA are not provided OPD treatment from any of the empanelled facilities.

(ii) Any OPD treatment claim even if erroneously raised by hospital will not be processed.

(iii) BPA will ensure IPD referrals are provided from the system when approved by OIC for the individuals granted FMA.

(iv) The synchronization of data regarding FMA should be carried out on monthly basis and reconciled with data held with Central Organisation ECHS.

(b) Smart Card Making Agency: To carry out under mentioned actions for 32 & 64 Kb Card holders :-

(i) The Smart Cards of individual granted FMA will be endorsed in the database and it will be ensured through system that OPD treatment at ECHS Polyclinic and the referral for OPD treatment at empanelled facility is not provided.

(ii) The individuals who have already been provided 64 Kb Card if opt for FMA then their cards will be suitability endorsed in backend database and the token generated at ECHS Polyclinic should reflect this endorsement that ‘OPD Treatment Not Allowed’.

(iii) A bridge being deployed for generation of referrals at ECHS Polyclinics should incorporate provision such that individuals opting for FMA should not be provided any OPD referral.

(iv) The synchronization of data regarding FMA should be carried out on monthly basis and reconciled with data held with Central Organisation ECHS.

15. For info and necessary compliance please.

(Niranjan Kumar)
Brig
Dy MD
for MD ECHS

Source: ECHS