Dear Seniors,
Greetings for the day.
I have a query regarding ESIC. In my company, one worker took treatment for dengue fever from a private hospital without utilizing ESIC benefits in October due to his ignorance towards ESI benefits, even though he is listed in ESIC. His medical expenses exceed his paying capacity.
Now, we want to claim his medical expenses from the ESI department since we have been paying his contributions. Is it possible to claim his expenses from ESIC in this case? If so, what is the complete procedure for this?
Thank you.
Warm Regards,
Deepak Agarwal
From India
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9Greetings for the day.
I have a query regarding ESIC. In my company, one worker took treatment for dengue fever from a private hospital without utilizing ESIC benefits in October due to his ignorance towards ESI benefits, even though he is listed in ESIC. His medical expenses exceed his paying capacity.
Now, we want to claim his medical expenses from the ESI department since we have been paying his contributions. Is it possible to claim his expenses from ESIC in this case? If so, what is the complete procedure for this?
Thank you.
Warm Regards,
Deepak Agarwal
From India
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Dear Deepak ji,
Please see the attached format of Medical Reimbursement from ESI for outpatient treatment. Also, please read the article on "Dengue Fever" for simple medical treatments.
Regards, PBS KUMAR
From India, Kakinada
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Please see the attached format of Medical Reimbursement from ESI for outpatient treatment. Also, please read the article on "Dengue Fever" for simple medical treatments.
Regards, PBS KUMAR
From India, Kakinada
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Dear Friends,
We are in the fast food services industry with restaurants located all over India. One of my employees at the Ranchi restaurant was a victim of a robbery while returning home after a night shift, resulting in serious injuries from knife wounds on his head and neck. He is currently hospitalized at Raj Hospital and Research Centre in the ICU due to the severity of his condition.
The company has incurred costs amounting to Rs. 12,000 during his treatment. Following the incident, we submitted an accident report and informed the ESI Branch office, along with sending a letter of intimation to the Administrative Medical Officers at ESIC, Ranchi main office.
However, despite these actions, we have not received any support from ESIC. Can you please guide me on how to seek reimbursement from ESIC? I have the Reimbursement Form from ESI.
Thank you,
Sunetra Mukherjee
From India, Delhi
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We are in the fast food services industry with restaurants located all over India. One of my employees at the Ranchi restaurant was a victim of a robbery while returning home after a night shift, resulting in serious injuries from knife wounds on his head and neck. He is currently hospitalized at Raj Hospital and Research Centre in the ICU due to the severity of his condition.
The company has incurred costs amounting to Rs. 12,000 during his treatment. Following the incident, we submitted an accident report and informed the ESI Branch office, along with sending a letter of intimation to the Administrative Medical Officers at ESIC, Ranchi main office.
However, despite these actions, we have not received any support from ESIC. Can you please guide me on how to seek reimbursement from ESIC? I have the Reimbursement Form from ESI.
Thank you,
Sunetra Mukherjee
From India, Delhi
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On the continuation of the previous case of the Ranchi incident, the private hospital was under ESIC Medical Super Speciality Hospital of Ranchi. We had approached them and tried to convince, but all efforts were in vain.
From India, Delhi
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From India, Delhi
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Dear Friends,
When sending the ESI-covered employee on official work to out-of-station locations, it is advisable to have the PEHACHAN CARD and carry ESI FORM - 105. This will enable the employee to utilize ESI benefits in case of illness or accidents, etc. A copy of Form - 105 is attached.
Regards,
PBS KUMAR
From India, Kakinada
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When sending the ESI-covered employee on official work to out-of-station locations, it is advisable to have the PEHACHAN CARD and carry ESI FORM - 105. This will enable the employee to utilize ESI benefits in case of illness or accidents, etc. A copy of Form - 105 is attached.
Regards,
PBS KUMAR
From India, Kakinada
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Subject: Medical Reimbursement Process from ESIC
Dear [Recipient's Name],
In reference to your query, please note the following steps to proceed further for Medical Reimbursement from ESIC.
1. Obtain the Discharge Summary or Discharge card from the Private Hospital where the IP received treatment.
2. Collect all bills, including the cost of operation, doctor's charges, anesthetist charges, nursing charges, room service charges, ICU charges, cost of medicines, test examination charges, along with supporting bills from the hospital.
3. Obtain the Emergency Certificate from the treating hospital.
4. Obtain the Essentiality Certificate from the treating hospital.
5. Obtain the No Stock Certificate from ESIC to allow the purchase of treatment materials from outside.
6. Obtain the Eligibility Certificate from ESIC.
7. Provide an Advanced Stamped Receipt for payment.
8. Include Bank Account Details.
9. Submit the required documents as per the checklist issued by ESIC for Reimbursement.
10. Attach a copy of the ESIC Pehchan Card/Permanent ID Card.
11. Provide the Scrutiny Certificate.
12. Ensure all bills are certified by the treating doctor and the Medical Officer of the ESI Hospital where the IP is attached, along with payment proof by the IP.
13. Include a Letter from the IP for the submission of Bills for Medical Reimbursement.
14. Ensure forwarding of a Letter from the Employer by the IP.
15. Provide a Post Card for intimation from ESIC.
Please submit the above documents to the DIMS office for Medical Reimbursement by the IP.
Thank you for your attention to this matter.
Best Regards,
V R RAO PULIPAKA
From India, Chennai
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Dear [Recipient's Name],
In reference to your query, please note the following steps to proceed further for Medical Reimbursement from ESIC.
1. Obtain the Discharge Summary or Discharge card from the Private Hospital where the IP received treatment.
2. Collect all bills, including the cost of operation, doctor's charges, anesthetist charges, nursing charges, room service charges, ICU charges, cost of medicines, test examination charges, along with supporting bills from the hospital.
3. Obtain the Emergency Certificate from the treating hospital.
4. Obtain the Essentiality Certificate from the treating hospital.
5. Obtain the No Stock Certificate from ESIC to allow the purchase of treatment materials from outside.
6. Obtain the Eligibility Certificate from ESIC.
7. Provide an Advanced Stamped Receipt for payment.
8. Include Bank Account Details.
9. Submit the required documents as per the checklist issued by ESIC for Reimbursement.
10. Attach a copy of the ESIC Pehchan Card/Permanent ID Card.
11. Provide the Scrutiny Certificate.
12. Ensure all bills are certified by the treating doctor and the Medical Officer of the ESI Hospital where the IP is attached, along with payment proof by the IP.
13. Include a Letter from the IP for the submission of Bills for Medical Reimbursement.
14. Ensure forwarding of a Letter from the Employer by the IP.
15. Provide a Post Card for intimation from ESIC.
Please submit the above documents to the DIMS office for Medical Reimbursement by the IP.
Thank you for your attention to this matter.
Best Regards,
V R RAO PULIPAKA
From India, Chennai
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Yes, this is possible to claim all medical bills from ESIC. Please make sure that you have fulfilled all the formalities, such as:
1. OPD slip from ESIC medical Hospital
2. ESIC Card of Employee
3. Reimbursement form duly signed by the medical officer of ESIC with a stamp
4. All the bills must be signed by the healthcare provider who treated the patient.
NOBAL KISHOR
From India, Shimla
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1. OPD slip from ESIC medical Hospital
2. ESIC Card of Employee
3. Reimbursement form duly signed by the medical officer of ESIC with a stamp
4. All the bills must be signed by the healthcare provider who treated the patient.
NOBAL KISHOR
From India, Shimla
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Dear All,
Thank you for your suggestions. They will help me a lot. When I visited the ESI dispensary, they said reimbursement is not possible because the IP is not referred by the ESI medical officer from his attached dispensary to the private doctor. Is there any clause like this in bill reimbursements? Should the IP first take a reference from the medical officer?
Thank you.
Warm Regards,
Deepak Agarwal
From India
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Thank you for your suggestions. They will help me a lot. When I visited the ESI dispensary, they said reimbursement is not possible because the IP is not referred by the ESI medical officer from his attached dispensary to the private doctor. Is there any clause like this in bill reimbursements? Should the IP first take a reference from the medical officer?
Thank you.
Warm Regards,
Deepak Agarwal
From India
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Hi,
I cannot exactly quote the clause, but I understand from the ESI officials that prior intimation is required. This is to avoid misuse of super specialty treatment, especially when treatment facilities are available in ESI hospitals. The concept is that if advanced treatment is not available at ESI hospitals, we can seek treatment in private hospitals with their reference. However, this is not strictly required in the case of accidents and critical illnesses.
Regards
From India, Coimbatore
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I cannot exactly quote the clause, but I understand from the ESI officials that prior intimation is required. This is to avoid misuse of super specialty treatment, especially when treatment facilities are available in ESI hospitals. The concept is that if advanced treatment is not available at ESI hospitals, we can seek treatment in private hospitals with their reference. However, this is not strictly required in the case of accidents and critical illnesses.
Regards
From India, Coimbatore
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Hi, one of our employees working in Bangalore has a mother who resides in Assam state and is covered under the ESI Act. She requires treatment that is outstation. Can you please guide me on the procedure to follow? If there are any specific formats needed, could you kindly send them to me?
Thank you for your assistance.
From India, undefined
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Thank you for your assistance.
From India, undefined
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ESIC Form-Medical Expense Reimbursement.p df
Medical Reimbursement Format.doc