Dear Sir(s),
I believe that treatment at ESI Hospitals/ESIC Model Hospitals is a result of the entitlement of the insured persons covered under the scheme, and the insured persons are not required to incur any expenses. There should be no "percentage calculation for medicines and bed charges," as mentioned by one of the contributors above. Furthermore, due to their entitlement, medicines are also provided by these hospitals. It would be even better if you could contact the medical superintendent of the ESI hospital or the Regional Director of ESIC in the area if you encounter any difficulties in receiving medical treatment, including medicines and admission at these hospitals.
Kind regards,
[Your Name]
From India, Noida
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965I believe that treatment at ESI Hospitals/ESIC Model Hospitals is a result of the entitlement of the insured persons covered under the scheme, and the insured persons are not required to incur any expenses. There should be no "percentage calculation for medicines and bed charges," as mentioned by one of the contributors above. Furthermore, due to their entitlement, medicines are also provided by these hospitals. It would be even better if you could contact the medical superintendent of the ESI hospital or the Regional Director of ESIC in the area if you encounter any difficulties in receiving medical treatment, including medicines and admission at these hospitals.
Kind regards,
[Your Name]
From India, Noida
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Dear Ankitha,
ESI Corporation has tied up with Apollo Hospitals. First, you have to check with the Branch office of the ESI for any reimbursement if you undergo any treatment at the hospital.
Soundrarajan
From India, Chennai
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ESI Corporation has tied up with Apollo Hospitals. First, you have to check with the Branch office of the ESI for any reimbursement if you undergo any treatment at the hospital.
Soundrarajan
From India, Chennai
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Dear Ankitha ji,
I am very sorry to hear that your father is no longer with us, and I pray to God to give you the courage and strength to bear this immense loss.
I have gone through your thread with responses from everyone. Firstly, the title of the thread "ESI for member death" is misleading.
You are not entitled to any amount from ESIC due to the passing of your father. However, you can approach the ESI Branch office for reimbursement of medical expenses that you incurred for your father's treatment in a private hospital or non-tie-up hospital. To do so, you need to convince the corporation of the following:
1. Hospitalization was necessary at private hospitals due to extreme emergency or life-threatening situations.
2. Explain the reason for not informing the ESI Corporation of the hospitalization at a private hospital.
3. Justify the delay in submitting the claim for medical reimbursement.
For hospitalization at private hospitals in extreme emergencies or life-threatening situations, ESIC provides reimbursement of medical expenses at actuals without any limit. This reimbursement is completely separate from your contributions.
Each Branch office or RO may have its own procedure for claiming medical expense reimbursement. I am attaching a claim form devised by the MO at Pune, Maharashtra. The claim form at the Branch office you are associated with may be different.
I suggest you give it a try. Best of luck.
From India, Mumbai
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I am very sorry to hear that your father is no longer with us, and I pray to God to give you the courage and strength to bear this immense loss.
I have gone through your thread with responses from everyone. Firstly, the title of the thread "ESI for member death" is misleading.
You are not entitled to any amount from ESIC due to the passing of your father. However, you can approach the ESI Branch office for reimbursement of medical expenses that you incurred for your father's treatment in a private hospital or non-tie-up hospital. To do so, you need to convince the corporation of the following:
1. Hospitalization was necessary at private hospitals due to extreme emergency or life-threatening situations.
2. Explain the reason for not informing the ESI Corporation of the hospitalization at a private hospital.
3. Justify the delay in submitting the claim for medical reimbursement.
For hospitalization at private hospitals in extreme emergencies or life-threatening situations, ESIC provides reimbursement of medical expenses at actuals without any limit. This reimbursement is completely separate from your contributions.
Each Branch office or RO may have its own procedure for claiming medical expense reimbursement. I am attaching a claim form devised by the MO at Pune, Maharashtra. The claim form at the Branch office you are associated with may be different.
I suggest you give it a try. Best of luck.
From India, Mumbai
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Dear Ankitha ji,
In an ESI hospital or ESI tie-up hospital, you do not need to spend a single paisa. All treatments, including medicines, are free of cost. I am surprised how you spent 30K in an ESI tie-up hospital. According to me, the tie-up arrangements are meant to provide cashless treatment. ESI treatment is not related to your salary or ESI contribution, as I mentioned earlier. There is no upper limit, but it is based on the actual expenses.
From India, Mumbai
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In an ESI hospital or ESI tie-up hospital, you do not need to spend a single paisa. All treatments, including medicines, are free of cost. I am surprised how you spent 30K in an ESI tie-up hospital. According to me, the tie-up arrangements are meant to provide cashless treatment. ESI treatment is not related to your salary or ESI contribution, as I mentioned earlier. There is no upper limit, but it is based on the actual expenses.
From India, Mumbai
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Dear Ankitha ji,
I was doing research on the forum and found your year-old thread at the link below: https://www.citehr.com/479339-esi-cl...lculation.html. Your thread or query was appropriately replied to at that time. You should have taken precautions this time to follow accordingly. By the way, what has happened to your earlier claim? Please share with this forum.
From India, Mumbai
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I was doing research on the forum and found your year-old thread at the link below: https://www.citehr.com/479339-esi-cl...lculation.html. Your thread or query was appropriately replied to at that time. You should have taken precautions this time to follow accordingly. By the way, what has happened to your earlier claim? Please share with this forum.
From India, Mumbai
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Dear Keshav Korgaonkar Sir,
Thank you so much for your elaborate reply. I went to ESI hospital for my father's treatment claim. They said to attend a meeting in Chennai. Every month, on the second Tuesday, they conduct this meeting for cases like this. I forgot the meeting name; I think it's "sikkayath" or "sikkath," but I'm not sure. I went to Chennai on the 9th; they said the meeting is canceled. On the 8th, I confirmed with the local ESI about the meeting, but in Chennai, they said the meeting is canceled. They asked me to come to the next meeting. What can I do for this, sir? What documents do they need? Kindly clarify for me, sir.
Thank you so much for your valuable words.
Ankitha
From India, Mumbai
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Thank you so much for your elaborate reply. I went to ESI hospital for my father's treatment claim. They said to attend a meeting in Chennai. Every month, on the second Tuesday, they conduct this meeting for cases like this. I forgot the meeting name; I think it's "sikkayath" or "sikkath," but I'm not sure. I went to Chennai on the 9th; they said the meeting is canceled. On the 8th, I confirmed with the local ESI about the meeting, but in Chennai, they said the meeting is canceled. They asked me to come to the next meeting. What can I do for this, sir? What documents do they need? Kindly clarify for me, sir.
Thank you so much for your valuable words.
Ankitha
From India, Mumbai
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You can claim the amount from ESI no need of any intimation. Intimation in 24 hours is needed in case of employment injury or accident.
From India, Muzaffarnagar
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From India, Muzaffarnagar
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Dear Senior,
I am the IP member in ESI. If I spend Rs 30,000 for my appendix treatment at a private hospital, how do I claim the medical reimbursement? Please tell me the procedure and send me the PDP form.
Thank you.
From India, Bengaluru
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I am the IP member in ESI. If I spend Rs 30,000 for my appendix treatment at a private hospital, how do I claim the medical reimbursement? Please tell me the procedure and send me the PDP form.
Thank you.
From India, Bengaluru
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1. Sir, ESIC has its own referral system and instructions for referring its patients outside ESIC hospitals on its panels. A set of instructions was uploaded by me in the past in some threads. You can search the same and examine the instructions and take action accordingly.
2. So far as I understand, if you have not received the case referred as per instructions before such an operation, it will be difficult to claim any reimbursement later on.
3. It will be even better if you contact the ESIS dispensary Incharge and discuss the issue with him. Whether to refer the case outside ESIS is to be decided by the said in-charge of ESIS dispensary.
From India, Noida
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2. So far as I understand, if you have not received the case referred as per instructions before such an operation, it will be difficult to claim any reimbursement later on.
3. It will be even better if you contact the ESIS dispensary Incharge and discuss the issue with him. Whether to refer the case outside ESIS is to be decided by the said in-charge of ESIS dispensary.
From India, Noida
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