Diseases and Treatments Covered Under ECHS Scheme — Complete 2025 List

Understanding exactly what the ECHS scheme covers prevents unpleasant surprises at the time of treatment. ECHS provides comprehensive healthcare coverage — but coverage is defined by specific schedules of procedures, diagnostic lists, and drug formularies. This guide consolidates the key categories of covered diseases, treatments, and investigations relevant to retired Indian Army Gorkha veterans and their families using A & B International Hospital Pokhara.

What Major Disease Categories Does ECHS Cover?

ECHS covers diseases across all major medical specialties — cardiac, orthopedic, neurological, oncological, nephrology, respiratory, gastroenterology, endocrinology (including diabetes), infectious diseases, mental health, gynecology, ophthalmology, ENT, and pediatrics. Coverage is defined by the ECHS schedule of procedures and is updated periodically by the Indian Ministry of Defence.

The scope of ECHS coverage is intentionally broad, designed to cover the full range of medical conditions that retired military personnel and their families may face. Rather than listing excluded conditions, ECHS operates primarily on a schedule of charges and approved procedures basis — if a procedure or treatment is listed, it is covered; unlisted treatments may require prior approval on a case-by-case basis.

What Cardiac Conditions and Procedures Are Covered Under ECHS?

ECHS covers the diagnosis and treatment of coronary artery disease, heart failure, arrhythmias, valvular heart disease, hypertensive heart disease, and congenital heart conditions. Covered procedures include ECG, echocardiography, coronary angiography, angioplasty with stenting, coronary artery bypass grafting (CABG), pacemaker implantation, and cardiac medications.

Key cardiac coverage points:

• Investigations: ECG, Holter monitoring, echocardiogram, treadmill test, coronary angiography, cardiac CT angiography.
• Interventional cardiology: Coronary angioplasty (PTCA) with drug-eluting stents — covered up to ECHS schedule; stent cost is reimbursed at ECHS rate.
• Cardiac surgery: CABG (bypass surgery), valve repair/replacement — at approved higher referral centres.
• Pacemakers and ICD: Implantation covered up to scheduled cost; prior authorization required.
• Medicines: Antiplatelet agents, beta-blockers, ACE inhibitors, statins, antiarrhythmics — all within ECHS formulary.

For cardiac procedures requiring referral to a higher centre (outside Pokhara), the polyclinic or A & B International Hospital initiates the referral chain.

What Orthopedic Conditions and Surgeries Does ECHS Cover?

ECHS covers the management of osteoarthritis, fractures, spinal disc disease, ligament injuries, and bone infections. Covered surgical procedures include knee replacement, hip replacement, spinal surgery, ORIF for fractures, arthroscopic procedures, and joint aspirations. Implant costs are reimbursed at ECHS schedule rates.

Orthopedic coverage in detail:

• Conservative management: Physiotherapy, pain management, joint injections — all covered.
• Fracture treatment: Plaster casting, surgical fixation (ORIF/CRIF), external fixation.
• Joint replacement: Total knee replacement and total hip replacement — covered; implant cost reimbursed at ECHS rate. Prior authorization required for costly implants.
• Spinal surgery: Discectomy, laminectomy, spinal fusion — covered at approved facilities.
• Arthroscopy: Knee arthroscopy, meniscus repair, ACL reconstruction.
• Physiotherapy: Postoperative rehabilitation covered.

A & B International Hospital’s orthopedic department, equipped with American technology, provides most orthopedic procedures locally — veterans do not need to travel to India for the majority of orthopedic care.

Which Neurological Conditions Does ECHS Cover?

ECHS covers stroke, epilepsy, Parkinson’s disease, peripheral neuropathy, meningitis, brain tumors, and other neurological conditions. Covered investigations include CT scan, MRI brain/spine, EEG, nerve conduction studies, and lumbar puncture. Neurological medications are covered within the ECHS formulary.

Coverage highlights for neurology:

• Stroke: Emergency treatment, admission, investigations (CT/MRI), thrombolysis where indicated, rehabilitation.
• Epilepsy: Diagnosis, anti-epileptic medications, EEG, MRI.
• Parkinson’s disease: Diagnosis, medications (levodopa combinations, dopamine agonists).
• Neuropathy: Assessment including nerve conduction studies; medications for pain management.
• Brain tumors: Investigation, surgery, radiation, and chemotherapy — at approved higher referral centres.
• Dementia: Diagnosis and medications (donepezil, memantine) within formulary.

What Cancer (Oncological) Treatments Does ECHS Cover?

ECHS covers the diagnosis and treatment of cancer across all major types — including surgery, chemotherapy, radiation therapy, targeted therapy, and palliative care — at approved empanelled oncology centres. Investigations including biopsy, PET scan, CT staging, and tumour marker tests are covered.

Important oncology coverage notes:

• Surgery: Cancer surgery (mastectomy, colectomy, nephrectomy, etc.) is covered at empanelled hospitals with surgical oncology.
• Chemotherapy: Covered; high-cost targeted therapies may require pre-authorization and case-by-case approval.
• Radiation therapy: At approved centres with radiotherapy equipment.
• PET-CT: Covered for cancer staging and treatment monitoring where indicated.
• Palliative care: Covered within ECHS guidelines.

For cancer requiring radiation or advanced oncology, patients in Pokhara are typically referred to higher centres in Kathmandu or India through the ECHS referral chain.

What Medicines Are Covered Under ECHS?

Medicines listed in the ECHS drug formulary are dispensed free of charge at polyclinic pharmacies or empanelled hospital pharmacies. The formulary covers drugs for most common chronic and acute conditions. Non-formulary drugs require special approval from ECHS and may not always be sanctioned.

Formulary coverage includes:

• Antihypertensives (amlodipine, losartan, atenolol, hydrochlorothiazide)
• Antidiabetic drugs (metformin, glipizide, insulin, newer agents in some cases)
• Lipid-lowering drugs (statins, fibrates)
• Analgesics and anti-inflammatory drugs (paracetamol, NSAIDs, weak opioids for appropriate conditions)
• Antibiotics (amoxicillin, ciprofloxacin, cotrimoxazole, and others)
• Cardiac drugs (aspirin, clopidogrel, beta-blockers, ACE inhibitors, nitrates)
• Respiratory drugs (salbutamol, ipratropium, budesonide, theophylline)
• Neurological drugs (anti-epileptics, Parkinson’s medications, antidepressants)
• Orthopaedic (calcium, vitamin D, bisphosphonates for osteoporosis)

Newer and expensive drugs (biological agents, newer diabetes drugs such as SGLT2 inhibitors, expensive antibiotics) may not be in the standard formulary and will require special sanction.

What Is Not Covered Under ECHS?

ECHS does not cover cosmetic procedures, experimental treatments, non-medical dietary supplements, assisted reproductive technology (IVF), self-inflicted injuries, dental procedures beyond basic restorations and extractions, and procedures specifically excluded in the ECHS schedule. Treatments at non-empanelled hospitals are not covered except in emergencies.

Key exclusions to be aware of:

• Cosmetic surgery: Any procedure performed for aesthetic rather than medical reasons.
• Experimental/investigational treatments: Treatments not recognised by mainstream medicine or not approved by ECHS.
• Routine dental beyond basic: Complex prosthetics, orthodontics, implants are not covered.
• Spectacles and hearing aids: Coverage is limited under ECHS (check current schedule).
• Non-emergency treatment at non-empanelled hospitals: Only emergency care at non-empanelled facilities may be considered for reimbursement.
• Self-inflicted injuries and substance abuse treatment: Excluded from coverage.

When in doubt, verify coverage with the ECHS polyclinic or A & B Hospital’s ECHS billing desk before undergoing treatment.

How Do You Get Pre-Authorization for Expensive Procedures Under ECHS?

Pre-authorization is required for high-cost procedures — joint replacements, cardiac interventions, expensive implants, cancer treatments. The empanelled hospital submits a pre-authorization request to ECHS with clinical details, cost estimate, and justification. ECHS approves, modifies, or declines within defined timelines.

Pre-authorization process:

1. Specialist at A & B recommends the high-cost procedure with clinical justification.
2. Hospital prepares the pre-authorization package: patient ECHS details, clinical notes, proposed procedure, cost estimate based on ECHS schedule.
3. Submitted to ECHS through the hospital’s ECHS billing interface.
4. ECHS reviews and responds — approval, partial approval, or request for additional information.
5. Procedure is scheduled after approval is received.
6. Billed to ECHS post-procedure with actual treatment records.

Elective high-cost procedures should not be scheduled before pre-authorization is obtained — costs incurred without pre-authorization may not be reimbursed.

Get Expert ECHS-Covered Treatment at A & B International Hospital Pokhara

Whether it is cardiac care, orthopedic surgery, diabetic management, or specialist diagnostics, A & B International Hospital provides cashless ECHS-covered treatment across a broad range of conditions. Our billing team handles all ECHS paperwork — you focus on your recovery.

A & B International Hospital

Bindhyaabasini, Pokhara-02, Kaski, Nepal

Phone: +977 061-412512

Website: abinthospital.com

Emergency: 24 hours, 7 days

Bring your ECHS Smart Card and polyclinic referral. Every covered service is rendered cashlessly — with the professional care you deserve.