Ayushman Bharat, CGHS, ECHS, ESIC: How Claims Actually Work

For someone living with limb loss, getting a good prosthetic can be life-changing. But let’s face it—prosthetics aren’t cheap. Even the most basic models come with a price tag, and advanced bionic hands like Grippy™ cost more. That’s why so many people ask us the same question: “Can I get any government help for this?”

The answer is yes—but the process isn’t always clear.

India has some very powerful health schemes like Ayushman Bharat, CGHS, ECHS, and ESIC. Each one is meant to support different groups of people—whether you’re below the poverty line, a government employee, a defence veteran, or part of the working class.

These schemes can cover medical treatments, surgeries, hospital stays, and sometimes even prosthetic devices. But here’s the truth: many people struggle with how to actually use them. From paperwork to permissions, from empanelled hospitals to claim approvals—things can get confusing fast.

That’s where this guide comes in.

We’re going to break down how each scheme works, who qualifies, what prosthetic-related support is available, and most importantly—how to file and follow up on a claim the right way.

If you’re looking for real answers, practical advice, and a roadmap to using these schemes for your prosthetic needs, you’re in the right place.

Let’s get started.

Ayushman Bharat: India’s Largest Health Protection Scheme

Who It’s For

Ayushman Bharat, also known as PM-JAY (Pradhan Mantri Jan Arogya Yojana), is aimed at supporting poor and vulnerable families across India.

It’s designed for people who fall under the Socio-Economic Caste Census (SECC) list, making it especially useful for daily wage workers, farmers, labourers, and those without formal employment.

If your family is included in the SECC list and you have a valid ration card, there’s a good chance you’re eligible for Ayushman Bharat.

You can check your eligibility on the official PMJAY portal.

What It Covers

Under Ayushman Bharat, you get free treatment coverage up to ₹5 lakh per year, per family.

This includes surgeries, hospitalization, medicines, diagnostics, ICU, and even follow-up care in some cases.

While the primary focus is on inpatient care, there are also select packages for rehabilitation, which may include prosthetics and orthotic aids, depending on your condition and the hospital.

However, there’s no specific package titled “prosthetic limb” that is automatically covered for everyone.

How Claims Work Under Ayushman Bharat

Ayushman Bharat is cashless at empanelled hospitals. That means once your eligibility is verified, and the hospital raises a treatment request, the cost is settled directly between the hospital and the scheme.

Here’s how it usually works:

1. You visit an empanelled hospital with your Ayushman card or ration card.
2. The hospital checks your eligibility using the PMJAY software.
3. A medical assessment is done.
4. If surgery or limb loss has occurred, the doctor may recommend a prosthetic as part of rehab.
5. The hospital raises a treatment package request for approval.
6. Once approved, the procedure is done cashless.
7. The claim is settled directly by the government. You don’t pay anything.

What’s the Catch?

The main challenge is that very few prosthetic providers are directly empanelled under PM-JAY.

So while the amputation surgery or hospital rehab may be covered, the actual prosthetic limb often needs to be arranged separately.

Some hospitals do partner with prosthetic makers and include it as part of a larger package. But this depends on the hospital and state policies.

At Robobionics, we help patients coordinate with hospitals and check whether prosthetic costs can be bundled in as part of their treatment.

CGHS: The Health Scheme for Central Government Employees

Who Can Use CGHS?

The Central Government Health Scheme (CGHS) covers current and retired central government employees.

This includes:

• Civil servants
• Pensioners
• Central government undertakings
• Judiciary staff
• Members of Parliament

It’s only available in selected cities, and users must register and pay a nominal subscription.

Once enrolled, CGHS gives access to a wide list of approved hospitals, diagnostic centers, and dispensaries.

What Prosthetic Coverage Does CGHS Offer?

CGHS has a well-defined policy for prosthetics and assistive devices. It allows reimbursement for:

• Artificial limbs
• Orthopedic appliances
• Walking aids
• Wheelchairs and similar devices

Coverage is subject to:

• A doctor’s prescription
• Approval from a government medical board or CGHS specialist
• Purchase from a CGHS-approved or empanelled supplier

So yes, prosthetics are covered. But prior approval is critical.

The process may feel bureaucratic, but it’s structured.

How the Reimbursement Works

CGHS works mostly on reimbursement, not cashless.

Here’s how a prosthetic claim typically flows:

1. You consult a CGHS-approved doctor or hospital.
2. The doctor recommends a prosthetic, with justification and medical need.
3. You apply for prior approval from the CGHS office in your city.
4. Once approved, you purchase the device from a registered vendor.
5. You submit the claim along with original bills, approval letter, and medical prescription.
6. The CGHS office processes the claim and reimburses the allowed amount.

Reimbursement is based on government-approved rates, so if you choose a higher-end prosthetic, you may have to bear the extra cost yourself.

Robobionics helps clients by providing detailed invoices and breakups in CGHS-compliant formats, which improves approval speed.

ECHS: Health Support for Defence Veterans

Who Qualifies for ECHS?

The Ex-Servicemen Contributory Health Scheme (ECHS) is made for former members of the Indian Armed Forces and their dependents.

To access ECHS, veterans must register through the Kendriya Sainik Board or their local ECHS polyclinic. They are then issued a Smart Card, which is required at the time of treatment.

ECHS is run by the Ministry of Defence and has its own network of polyclinics and empanelled private hospitals across India.

What’s Covered Under ECHS?

ECHS offers comprehensive health coverage. This includes outpatient services, hospitalization, diagnostics, medicines, and post-surgical care.

For amputees or those in need of physical rehabilitation, prosthetic limbs and assistive devices are also covered, provided there is a valid medical reason.

The amount covered usually depends on:

• Type of prosthetic (basic or advanced)
• Recommendation by an ECHS doctor
• Availability of the prosthetic through an empanelled vendor

In many cases, veterans are eligible for fully cashless treatment, including prosthetics, as long as it’s done through an authorized facility.

How to File a Claim Under ECHS

If you’re using ECHS and need a prosthetic, here’s the usual process:

1. Visit your nearest ECHS polyclinic.
2. Get evaluated by an ECHS-appointed doctor.
3. If needed, they refer you to a specialist or hospital for further evaluation.
4. The hospital may then prescribe a prosthetic, including type and specs.
5. ECHS raises a proposal through its system and sends it for approval.
6. Once approved, you’re referred to a listed vendor or hospital where the prosthetic is arranged.
7. No money is paid upfront if the vendor is empanelled. It’s fully cashless.

However, if the prosthetic provider is not empanelled under ECHS, you may have to pay first and then claim reimbursement.

Common Issues and Workarounds

Many veterans prefer high-quality, tech-driven prosthetics like Grippy™ over standard models. While ECHS may not always approve these in full, partial reimbursements are possible.

In such cases, Robobionics helps by:

• Providing comparison sheets between models
• Supplying medical justifications from fitting experts
• Offering split invoices if required by the ECHS office

These steps can make the claim smoother and more likely to be accepted, even if the amount covered isn’t 100%.

ESIC: Support for the Working Class

Who Can Use ESIC?

The Employees’ State Insurance Corporation (ESIC) covers workers in organized sectors who earn up to ₹21,000 per month (₹25,000 for disabled persons).

If you or your employer contribute to the ESI fund every month, you are entitled to medical benefits under this scheme.

It applies to factory workers, shop employees, security guards, small office staff, and many others in similar professions.

What Medical Support Is Offered?

ESIC provides free or subsidized healthcare, including:

• Hospitalization
• Surgery
• Medicines
• Maternity and disability care
• Occupational injury treatment

If an employee loses a limb due to a work-related accident, prosthetic limbs are covered under ESIC’s rehabilitation policy.

Claiming a Prosthetic Under ESIC

The process under ESIC is fairly structured but depends heavily on approvals.

Here’s how it works:

1. You report your injury to your employer.
2. You’re referred to an ESIC hospital or dispensary.
3. The ESIC medical officer evaluates your case.
4. If the limb loss is confirmed and linked to an accident or medical condition, they recommend a prosthetic.
5. The hospital raises an internal claim and coordinates with a registered vendor.
6. The prosthetic is fitted either free of charge or at minimal cost to the patient.

This process is entirely cashless for eligible beneficiaries if followed through the ESIC system.

When You Need to Buy Outside

Sometimes the ESIC hospital may not have access to quality prosthetics or experienced vendors.

In such cases, the patient can apply for permission to buy from outside, along with a medical certificate and estimate.

Robobionics helps such patients with:

• Quotation formats approved by ESIC norms
• Filling reimbursement forms
• Coordinating follow-ups with local ESIC offices

This ensures the cost is either refunded or partially covered, depending on the case.

Common Challenges Across All Schemes

Lack of Awareness and Misinformation

One of the biggest problems people face is simply not knowing what their scheme covers. Whether it’s CGHS, ECHS, ESIC, or Ayushman Bharat, most beneficiaries don’t fully understand the benefits they’re entitled to.

This leads to confusion, missed opportunities, or worse—out-of-pocket expenses for something that could have been covered.

Many assume prosthetics are automatically excluded. But as you’ve seen, that’s not always the case. It just takes the right paperwork, a clear diagnosis, and following the right process.

Empanelled Vendor Restrictions

Each scheme works with its own list of empanelled hospitals, polyclinics, or suppliers. If your prosthetic provider isn’t on that list, your claim may be denied—even if the medical need is valid.

This is why vendor empanelment matters. At Robobionics, we are actively working to partner with more hospitals and centres across India that are linked with these schemes. This helps us make claims smoother and cashless wherever possible.

Too Much Paperwork, Not Enough Help

Getting approval often means running from one counter to another. Doctor notes, disability certificates, price estimates, pre-approvals, and then finally the device.

For someone recovering from an amputation, that’s a lot.

That’s why having someone experienced to guide you is crucial. At Robobionics, we’ve helped hundreds of families prepare, file, and follow up on claims the right way. We simplify the steps, handle the back and forth, and make sure your file is complete from the start.

How to Improve Your Claim Approval Odds

Always Get a Clear Doctor’s Prescription

The first thing your claim reviewer will look at is the doctor’s recommendation. This must be very specific. It should mention:

• The exact type of limb lost (left hand below elbow, right leg above knee, etc.)
• The cause of the amputation (accident, illness, surgery)
• The medical necessity of a prosthetic limb
• A reference to rehabilitation or physical recovery

The clearer and more medical your doctor’s note is, the more likely it is to be accepted.

If your doctor is unsure how to word it, we can help you draft the right kind of request.

Use Photos, Diagnostic Reports, and Supporting Evidence

Many schemes rely heavily on documentation. Photos of the amputation site, X-rays, disability certificates, and even hospital discharge summaries can support your claim.

The more evidence you include, the less chance there is of a rejection. Don’t assume one letter is enough—build a full story around your need.

Keep Original Bills and Ask for GST-Compliant Invoices

If your claim is through CGHS, ECHS, or ESIC reimbursement, you must submit original bills with the correct details.

This means:

• Your full name and ID number
• GST number of the vendor
• Model number and specs of the prosthetic
• Date of fitting and delivery
• Signature or stamp of the provider

We provide all of this by default, making your reimbursement application as smooth as possible.

Follow Up—Gently But Firmly

Government schemes often have delays. After submitting a claim, follow up politely every two weeks. Get a reference number, contact the scheme coordinator, and stay informed.

If you’re working with Robobionics, we do this for you. We keep in touch with the hospital or department until your claim moves forward.

Real-Life Scenarios That Worked

Ramesh, a Railway Worker Using ESIC

Ramesh, a 48-year-old from Nagpur, lost his hand in an industrial mishap. His factory was covered under ESIC, but no one helped him file a claim.

He found Robobionics through a camp. Our team spoke to his employer, retrieved his ESIC number, and helped him get a hospital referral.

The ESIC centre approved his Grippy Mech Hand in 3 weeks, fully covered under cashless care.

He was able to return to work with dignity, with zero out-of-pocket expense.

Meena, a Retired Government School Teacher on CGHS

Meena had diabetes-related complications and underwent a below-knee amputation. Her CGHS policy allowed for prosthetics, but only under pre-approved limits.

We worked with her CGHS officer, submitted a doctor’s letter, a fitting plan, and a detailed invoice. She chose a mid-range mechanical prosthetic leg.

Her reimbursement was approved in full within 45 days.

She told us, “I didn’t even know this was possible. You showed me how to claim what I deserved.”

What to Do If You’re Not Covered Under Any Scheme

You Still Have Options

Not everyone has access to government schemes. Maybe your job wasn’t eligible for ESIC. Or you’re not a government employee, so CGHS and ECHS don’t apply. And perhaps your family doesn’t appear on the Ayushman Bharat list either.

If this is your situation, don’t lose hope.

At Robobionics, we’ve seen this many times. We’ve helped individuals without coverage find real solutions using:

• EMI plans with low or zero interest
• State disability welfare schemes
• Corporate CSR grants
• Crowdfunding platforms like Ketto or Milaap

There are people, programs, and communities that want to help. All you need is a little direction. And that’s what we’re here for.

What Makes a Prosthetic Claim Strong?

Clear Medical Justification

All four schemes—Ayushman Bharat, CGHS, ECHS, and ESIC—require that the prosthetic device be medically necessary, not cosmetic. So, your application must include this clearly.

If your doctor can explain how the prosthetic will improve your mobility, allow you to work again, or prevent further health problems (like spinal issues from poor posture), your case becomes stronger.

We help doctors and patients frame this language properly.

Documentation That Tells a Full Story

You’re not just submitting papers. You’re telling the story of your injury, your recovery, and your need.

Every report, photo, certificate, and receipt helps paint that picture.

If you make your file complete, clear, and organized, you reduce the chances of rejection or delay. Most importantly, you show the scheme officers that your case is real and urgent.

How Robobionics Can Help You Navigate the System

Step-by-Step Support

When you come to Robobionics, we don’t just fit you with a hand or leg and send you off. We stay with you through every step of the financial process.

That includes:

• Reviewing your eligibility for government schemes
• Helping you collect and organize documents
• Writing supporting letters or justifications
• Communicating with scheme officers
• Following up on claim status
• Reapplying if a claim is rejected

We know how these systems work. And more importantly, we know how to work around them when needed—always ethically and within rules, but with creativity and heart.

Custom Invoices, Split Billing, and Pre-Approvals

We customize our paperwork to match what different schemes ask for.

That means:

• Separate bills for fitting and product cost
• Product descriptions matched to scheme codes
• Breakdowns of mechanical vs electronic components
• Pre-approval formats for CGHS and ECHS
• GST-compliant invoices for smooth reimbursement

These small things make a big difference when it comes to approval.

Frequently Asked Questions

Can I claim a bionic hand like Grippy™ under CGHS or ESIC?

In some cases, yes. If your doctor justifies the need, and if it fits within the allowed cost limit or can be partially paid out, approval is possible. Full reimbursement for advanced bionics is rare, but partial is realistic with the right documentation.

Can I use Ayushman Bharat at a private prosthetic clinic?

Usually not directly. You must go through an empanelled hospital. If your prosthetic is included in a larger surgical or rehab package, it may be covered. We can help coordinate this with partner hospitals.

What if my claim is rejected?

You can appeal. Almost every scheme has a second-level review process. Most rejections happen because of missing or unclear paperwork—not because your case isn’t valid.

With our help, many clients have gone from rejection to partial or full approval just by fixing the documents and resubmitting properly.

Will I have to pay upfront?

It depends on the scheme. CGHS and ECHS usually ask for you to pay first, then claim. Ayushman Bharat and ESIC can be cashless if you go through the official route.

If you need the prosthetic immediately and can’t wait, we can also help set up an EMI plan and help you claim later.

Your Next Step: Book a Free Demo and Consultation

If you’re considering a prosthetic and want to understand your options—financial, technical, and medical—we invite you to book a free demo with our expert team.

We’ll show you:

• How the prosthetic works
• What documentation you’ll need
• Whether your scheme is likely to cover it
• EMI options if you don’t have coverage
• Real stories of people like you who got approved

There’s no pressure. Just clear, honest advice and a team who understands what you’re going through.

Visit https://www.robobionics.in/bookdemo/ and take the first step.

Final Thoughts: Help Is Out There—Let’s Reach It Together

Government schemes are not perfect. They involve forms, rules, and sometimes frustrating delays. But they exist to help. And with the right guidance, they do work.

Whether you’re a retired soldier, a factory worker, a government employee, or a low-income family member—there’s a path forward.

Robobionics is here to walk that path with you. Not just to fit a prosthetic, but to make sure it reaches your hand, your leg, your life—fully supported and affordably.

You don’t have to figure it out alone.

Let us help you take that next step—firmly, proudly, and with full support.

Additional Resources You Can Explore

If you want to dig deeper into the specifics of each scheme, we’ve listed some official and helpful resources below. These links can help you check eligibility, download forms, or contact the right departments.

Official Scheme Portals

• Ayushman Bharat (PM-JAY):
  https://pmjay.gov.in – For checking eligibility, hospital locator, and claim packages.
• CGHS (Central Government Health Scheme):
  https://cghs.gov.in – For reimbursement forms, empanelled hospitals, and guidelines.
• ECHS (Ex-Servicemen Contributory Health Scheme):
  https://echs.gov.in – To download Smart Card application forms, view polyclinic details, or track claims.
• ESIC (Employees’ State Insurance Corporation):
  https://www.esic.gov.in – For employee registration, benefits guide, and branch contacts.

Disability Support & Welfare

• National Institute for Locomotor Disabilities:
  http://niohkol.nic.in – For rehabilitation services and prosthetic guidance.
• ADIP Scheme – Ministry of Social Justice & Empowerment:
  http://disabilityaffairs.gov.in – For free aids and appliances to persons with disabilities.

These resources are especially useful if you are applying independently or want to confirm the latest guidelines from the source.

Don’t Just Hope—Act

You’ve made it through a long, detailed article. That means you’re serious about finding the right way to afford your prosthetic—and we admire that.

But the next step is just as important.

Don’t let the system delay your recovery. Don’t let paperwork discourage you. And definitely don’t think you have to do this all alone.

Let Robobionics stand by your side.

We’re here with world-class prosthetics, real financial guidance, and a support system built on care, not confusion.

Start today. Book your free demo and consultation at https://www.robobionics.in/bookdemo/.

Your journey back to confidence, movement, and independence begins now.