Respected Seniors,
I have a doubt ESI claim. One of our colleague's father has been hospitalized. Doctors told them that heart operation should be done & nearly Rs. 3,00,000 exp may occur..My colleague she is insured person under ESI & her father is a retired government servant (pensioner). Now my question is can he be treated in ESI hospital? or whether the medical exp can be reimbursed or not ?
Some staff in ESI hospital are telling that medical exp will be reimbursed but his pension will be stopped.
Please clear my doubt with your valuable suggestions I can ask my colleague to take proper step for the same.
From India, Dharwad
1I have a doubt ESI claim. One of our colleague's father has been hospitalized. Doctors told them that heart operation should be done & nearly Rs. 3,00,000 exp may occur..My colleague she is insured person under ESI & her father is a retired government servant (pensioner). Now my question is can he be treated in ESI hospital? or whether the medical exp can be reimbursed or not ?
Some staff in ESI hospital are telling that medical exp will be reimbursed but his pension will be stopped.
Please clear my doubt with your valuable suggestions I can ask my colleague to take proper step for the same.
From India, Dharwad
Sir,
With reference to issue raised by you as above, I may request you to kindly go through Section 2(11)(v) of ESI Act, 1948 which defines "family". Kindly also see Rule 61A of the ESI (Central) Rules, 1950, which lays down as follows:-
"61A. Income limit of dependent parents for eligibility to medical benefit - The income of dependent parents for eligibility to medical benefit under sub-clause (v) of clause (11) of Section 2 of the Act from all sources should not exceed five thousand rupees in a month."
To my knowledge, there appears to be no provision of stoppage of 'Pension" except as laid down in Conduct Rules governing the services or retirement of dependant parent.
Hope you will refer to the above quoted provisions of the said Act and rules framed thereunder.
With regards;
From India, Noida
With reference to issue raised by you as above, I may request you to kindly go through Section 2(11)(v) of ESI Act, 1948 which defines "family". Kindly also see Rule 61A of the ESI (Central) Rules, 1950, which lays down as follows:-
"61A. Income limit of dependent parents for eligibility to medical benefit - The income of dependent parents for eligibility to medical benefit under sub-clause (v) of clause (11) of Section 2 of the Act from all sources should not exceed five thousand rupees in a month."
To my knowledge, there appears to be no provision of stoppage of 'Pension" except as laid down in Conduct Rules governing the services or retirement of dependant parent.
Hope you will refer to the above quoted provisions of the said Act and rules framed thereunder.
With regards;
From India, Noida
Hello
SsDarwad
Your colleague's father can not get treatment from ESI HOSPITAL because at the time of filling DECLARATION FORM,you are declaring that your father's income is not higher than Rs.5000/-.So your father can not be entitled for availing the benefits
V.Subbarao
From India, Madras
SsDarwad
Your colleague's father can not get treatment from ESI HOSPITAL because at the time of filling DECLARATION FORM,you are declaring that your father's income is not higher than Rs.5000/-.So your father can not be entitled for availing the benefits
V.Subbarao
From India, Madras
Hi,
Please note that the income limit of Rs 5,000/=, mentioned earlier in this thread, has been increased. It currently stands at Rs 15,000/=. This increase was done vide Ministry of Labour and Employment's Gazette Notification dated 20th April 2010 and the enhanced limit became effective from 1st May 2010. Additionally, there have been some recent press reports in October, 2013, that the Ministry intends to raise the income limit further to Rs 25,000/=. I am not aware of any formal notification having been issued in this regard so far.
You could check it out, but in absence of the most recent enhancement of limit, the current income limit stands at Rs 15,000/= per month.
While you could re-check if your colleague's father would be eligible under the current income limit for his treatment to be undertaken under the ESI scheme (assuming of course that he has been declared as a dependent), you also mention that your colleague's father is a Government Pensioner.
You could check out the eligibility under the CGHS scheme of the Central Government. It should be possible to get the treatment done under this scheme since, he would be covered under it. It is likely that there would be some monetary limits for treatment viz., type of room, etc, but it could be an additional avenue that can be explored by your colleague.
Regards
Raju Bhatnagar
From India, Bangalore
Please note that the income limit of Rs 5,000/=, mentioned earlier in this thread, has been increased. It currently stands at Rs 15,000/=. This increase was done vide Ministry of Labour and Employment's Gazette Notification dated 20th April 2010 and the enhanced limit became effective from 1st May 2010. Additionally, there have been some recent press reports in October, 2013, that the Ministry intends to raise the income limit further to Rs 25,000/=. I am not aware of any formal notification having been issued in this regard so far.
You could check it out, but in absence of the most recent enhancement of limit, the current income limit stands at Rs 15,000/= per month.
While you could re-check if your colleague's father would be eligible under the current income limit for his treatment to be undertaken under the ESI scheme (assuming of course that he has been declared as a dependent), you also mention that your colleague's father is a Government Pensioner.
You could check out the eligibility under the CGHS scheme of the Central Government. It should be possible to get the treatment done under this scheme since, he would be covered under it. It is likely that there would be some monetary limits for treatment viz., type of room, etc, but it could be an additional avenue that can be explored by your colleague.
Regards
Raju Bhatnagar
From India, Bangalore
Dear Mr.Raju Bhatnagar,
!.The income limit of dependant parent mentioned by my friend Harsh Mehtaji,is different from the wage ceiling for coverage of an employee under the ESI mentioned by you.
2. The income limit of dependant parent for purpose of getting a benefit as a dependant parent of an esi covered employee is still Rs.5000.This has nothing to do with the proposed increase in wage ceiling for coverage,which is still under publication of an intention notification stage.
3.So this particular case if the pension is >Rs 5000 p.m. he will not be elegible for esi coverage.
4.As rightly pointed out by you, he can avail treatment under cghs.
Thanks & Regards,
S.SANKARALINGAM
RETD.SR.DY.DIRECTOR, ESIC
ADVOCATE & LABOUR LAW ADVISOR
e.mail:
From India, Chennai
!.The income limit of dependant parent mentioned by my friend Harsh Mehtaji,is different from the wage ceiling for coverage of an employee under the ESI mentioned by you.
2. The income limit of dependant parent for purpose of getting a benefit as a dependant parent of an esi covered employee is still Rs.5000.This has nothing to do with the proposed increase in wage ceiling for coverage,which is still under publication of an intention notification stage.
3.So this particular case if the pension is >Rs 5000 p.m. he will not be elegible for esi coverage.
4.As rightly pointed out by you, he can avail treatment under cghs.
Thanks & Regards,
S.SANKARALINGAM
RETD.SR.DY.DIRECTOR, ESIC
ADVOCATE & LABOUR LAW ADVISOR
e.mail:
From India, Chennai
Dear Mr Sankaralingam,
Thank you for the clarification.
Dear ssdharwad2005,
Please note that the limit mentioned by Shri Sankaralingamji, is the correct limit for coverage of dependent parents. The limit of Rs 15,000/= is the wage limit for coverage of employees under ESI.
I had erroneously mixed the two.
Regards
Raju Bhatnagar
From India, Bangalore
Thank you for the clarification.
Dear ssdharwad2005,
Please note that the limit mentioned by Shri Sankaralingamji, is the correct limit for coverage of dependent parents. The limit of Rs 15,000/= is the wage limit for coverage of employees under ESI.
I had erroneously mixed the two.
Regards
Raju Bhatnagar
From India, Bangalore
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ESI Medical Facilities Scheme 2010.pdf