Hi all,
I am working as an HR executive. One of our employees, who is covered under the ESI Scheme, was admitted to a hospital due to typhoid. However, the hospital was not an ESI hospital. Is this person eligible for a refund of the expenses incurred? If yes, what are the procedures to follow?
From India, Kottayam
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1I am working as an HR executive. One of our employees, who is covered under the ESI Scheme, was admitted to a hospital due to typhoid. However, the hospital was not an ESI hospital. Is this person eligible for a refund of the expenses incurred? If yes, what are the procedures to follow?
From India, Kottayam
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Sir,
It is difficult to get any reimbursement at this stage due to the reasons that the treatment has not been obtained from ESIC or an ESIC authorized dispensary/hospital.
However, the insured person or his relatives attending to him may contact the authorized ESI dispensary/IMO concerned to which he is attached and discuss with him:
(i) the possibility of reimbursement of past expenses,
(ii) obtaining treatment for the sickness if required, for the next spell of illness if not fully cured.
From India, Noida
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It is difficult to get any reimbursement at this stage due to the reasons that the treatment has not been obtained from ESIC or an ESIC authorized dispensary/hospital.
However, the insured person or his relatives attending to him may contact the authorized ESI dispensary/IMO concerned to which he is attached and discuss with him:
(i) the possibility of reimbursement of past expenses,
(ii) obtaining treatment for the sickness if required, for the next spell of illness if not fully cured.
From India, Noida
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As per the process, the insured person should report to the concerned dispensary or the ESI hospital. Basing on the requirements, the RMO will refer the case to any other hospital. In emergencies, the employee can directly get admitted. On the same day, the information should be passed on. Normally, the ESI will issue a credit note to the hospital. However, you can meet the RMO concerned and explain the issue. The bills need to be cleared by the Medical board; hence, it may be a bit difficult. Instead of wasting more money, let the IP go and get admitted to the ESI hospital so that the expenditure can be reduced, and he will also get leave.
From India, Hyderabad
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From India, Hyderabad
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The patient should have gone to ESI hospital only. If one did not go there, one should give proper justification like an emergency and ESI hospital was unreachable, etc. As soon as the emergency is over and the patient is stable, one should be shifted to the ESI hospital. If not, once the patient is discharged, one should make an application addressed to the Director of the ESI Scheme and attach all the bills, prescriptions, discharge card, and other docs. Wait for the reply.
Normally, they should pay the expenses for medicines according to their cost structure. If not, approach ESI Corporation and wait. If you do not get a satisfactory reply, one can either file a claim before the ESI Court or Consumer Court. ESI Corporation has a huge amount of funds available, but since they are not pro-people, they keep on accumulating funds collected from workers and employers in the name of workers' welfare but do not use it for workers' welfare.
From India, Coimbatore
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Normally, they should pay the expenses for medicines according to their cost structure. If not, approach ESI Corporation and wait. If you do not get a satisfactory reply, one can either file a claim before the ESI Court or Consumer Court. ESI Corporation has a huge amount of funds available, but since they are not pro-people, they keep on accumulating funds collected from workers and employers in the name of workers' welfare but do not use it for workers' welfare.
From India, Coimbatore
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Sirs,
1. I feel that it is not proper to say that the ESI Corporation has a huge amount of funds available, but since they are not pro-people, they keep accumulating funds collected from workers and employers in the name of workers' welfare without utilizing it for the welfare of workers, as mentioned by one of the participants above.
2. Currently, a major portion of expenses in the ESI Scheme is allocated to "medical benefits."
3. ESI dispensaries, hospitals, or tied-up hospitals are available in every implemented area. If an insured person or their dependent incurs medical expenses at their own discretion, ESIC is not to be held responsible. In my opinion, if medical facilities or expenses are obtained in a hospital or dispensary not recognized by ESIC, there is no basis for filing a case in the EI Court or consumer court.
Thank you.
From India, Noida
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1. I feel that it is not proper to say that the ESI Corporation has a huge amount of funds available, but since they are not pro-people, they keep accumulating funds collected from workers and employers in the name of workers' welfare without utilizing it for the welfare of workers, as mentioned by one of the participants above.
2. Currently, a major portion of expenses in the ESI Scheme is allocated to "medical benefits."
3. ESI dispensaries, hospitals, or tied-up hospitals are available in every implemented area. If an insured person or their dependent incurs medical expenses at their own discretion, ESIC is not to be held responsible. In my opinion, if medical facilities or expenses are obtained in a hospital or dispensary not recognized by ESIC, there is no basis for filing a case in the EI Court or consumer court.
Thank you.
From India, Noida
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Dear Mehta ji,
Of course, the major part of funds collected, being ESIC contributions, goes into the development of infrastructure and administration. However, employees are also required to follow the procedures laid down.
In case someone seeks treatment outside of an ESIC Hospital/Dispensary and directly visits any Government Hospital, they can still receive the due benefits after obtaining approval from the Regional Office, ESIC. Nevertheless, treatment received from a private doctor or hospital is not recognized.
P K Sharma
From India, Delhi
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Of course, the major part of funds collected, being ESIC contributions, goes into the development of infrastructure and administration. However, employees are also required to follow the procedures laid down.
In case someone seeks treatment outside of an ESIC Hospital/Dispensary and directly visits any Government Hospital, they can still receive the due benefits after obtaining approval from the Regional Office, ESIC. Nevertheless, treatment received from a private doctor or hospital is not recognized.
P K Sharma
From India, Delhi
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The discussion has been very positive.
I just want to add that the reimbursement depends on circumstances. If the IP was admitted in an emergency or the ESI medical care arrangements were not available to the IP, he should get the reimbursement as per approved rates. Accordingly, he should make a case and file his claim with necessary bills in his dispensary/SMC office.
From India, Gurgaon
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I just want to add that the reimbursement depends on circumstances. If the IP was admitted in an emergency or the ESI medical care arrangements were not available to the IP, he should get the reimbursement as per approved rates. Accordingly, he should make a case and file his claim with necessary bills in his dispensary/SMC office.
From India, Gurgaon
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The employee will get the reimbursement of all medicine, 100% of expenses, and the rent of the room will be at the discretion of the signing authority, who will be the regional director.
The condition is that he should have informed the local ESI dispensary about his illness within 48 hours. If not, then he can ask his company to provide him a letter stating his illness and the period for which he was absent. On behalf of that, the ESI dispensary will forward all his expenses to the area ESI inspector's office. However, this process takes a lot of time, sometimes up to 12 months.
From India, Muzaffarnagar
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The condition is that he should have informed the local ESI dispensary about his illness within 48 hours. If not, then he can ask his company to provide him a letter stating his illness and the period for which he was absent. On behalf of that, the ESI dispensary will forward all his expenses to the area ESI inspector's office. However, this process takes a lot of time, sometimes up to 12 months.
From India, Muzaffarnagar
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Dear friends,
ESI has been created for a noble cause of serving the employees in various establishments. Unfortunately, the purpose has not been fully served. I'm sorry to say this, but I have seen instances in ESIC, like any other Indian authorities, corrupt systems, misuse of power, wasting of the nation's wealth and infrastructure omnipresent here as well. People, in cases like this, by bribing, get their bills passed for reimbursement, get their leave approved or reimbursed. I'm not declaring everybody like this nor encouraging anyone to adopt such methods, but such things do happen in the system.
From India, Bangalore
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ESI has been created for a noble cause of serving the employees in various establishments. Unfortunately, the purpose has not been fully served. I'm sorry to say this, but I have seen instances in ESIC, like any other Indian authorities, corrupt systems, misuse of power, wasting of the nation's wealth and infrastructure omnipresent here as well. People, in cases like this, by bribing, get their bills passed for reimbursement, get their leave approved or reimbursed. I'm not declaring everybody like this nor encouraging anyone to adopt such methods, but such things do happen in the system.
From India, Bangalore
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