As far am concerned there is no reimbursement of medical bills from ESIC deptt....
Those who draw wages less than Rs 6500/ m are eligible for free treatment from ESIC recognised hospitals..
As this is the part of the insurance coverage which employers contributes 4.75% & employee - 1.75% towards the same.
agree with Rajatji's reply to you but the only amendment made here is that the limit of Rs.6500/- has been increased to Rs.7500/- recently. please cross check. The mode of claiming is the submission of original bills + discharge summary of the doctor. Make sure that you maintain a photocopy of whatever you are submitting to the ESI authorities just as a precaution.
Reimbursement of medical expenses is permissible. For claiming the same you are required to follow the under mentioned process
1. Treatment should be under the supervision of ESI doctor.
In case of an emergency you can approach private hospital if ESI hospital / dispensary is not available in the area or the same is not functioning during your emergency requirements. In such you have to inform the ESI dispensary / hospital doctor regarding the treatment being taken from other hospital. Generally doctors allow treatment if the same is from Govt.Hospital and or Super speciality hospital. In such case all the treatment papers , medicine purchase bills along with prescription slips are required to be signed by the hospital doctor from where an individual has taken the treatment.
2. Bills of treatment are required to be submitted with your concerned ESI dispensary / hospital. This is on the prescribed proforma.
3. Eligibility certificate is to be submitted to dispensary / hospital duly signed by Branch Manager of Local ESI office.
4. Request for treatment from outside in emergency is to be made in writing to concerned ESI dispensary / hospital to which an individual is attached.
5. ESI dispensary / hospital doctor will recommend your case for reimbursement to State health Authorities.
If you complete these formalities , ESI dispensary / Hospital will forward these bills to State Health authorities for sacntion and reimbursement.
After sanction you will receive information from ESI dispensary / hospital for claiming the reimbursement. It takes time ( 2 to 3 months minimum) depending upon availability of funds with the government.
So there is no need to feel otherwise, if you are contributing towards ESI fund and is eligible for the same, definetly you will get the reimbursement.
You cont claim Medical Reimbursement from ESIC only u can avail Medical benefits ( Medical Treatment, Medicines,etc) what ever the cost maybe Free of cost, if your salary is lessthan 7500 pm & you have contributed to ESI for 6 months ie 1 contribution period april- september.
only thing you can claim from ESI is for LeavePayment ie, you can claim for the salary for the number of days on Medical leave which has to be certified by ESI medical officer.
if you want get Medical leave,You have to get ESI leave form the ESI medical officer submit it to your ESI local office where you will be get reimbursement for up to 75% of your leavedays Salary.
There is a possibility ro remibursement of Medical expenses through ESIC, provided that such medical facility may not be available in the ESIC Hosiptal and Chief doctor shoud recommend the insured person to go for external treatment.
Once you made the expenses you can approach relevant ESIC Hospital and fill the required forms and submit the original bills. Also you should give some undertaking that the expenses made by the company and it is not by the employee and not recovered from his salary.
I already got like this from Hosur ESI Hospital during the year 2004.
All the best
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