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I think treatment in ESI Hospitals/ESIC Model Hospitals are as a result of entitlement of the insured persons covered under the scheme and the insured persons are not required to incur any expenditure. There should not be any "some percentage calculation there medicines and Bed charge" as mentioned by one of contributors as above. Further by virtue of entitlement, the medicines are also supplied by the said hospitals. It will be more better if you may contact medical superintendent of said ESI hospital or the Regional Director, ESIC of the area, if you feel any difficulty in getting medical treatment including medicines and admission in the said hospitals.

From India, Noida
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 take any treatment in the hospital.

From India, Chennai
Dear Ankitha ji,

I am very sorry to hear that your father is no longer now and pray GOD to give you courage and strength to bear this immense loss.

I have gone through your thread with responses by all. In the first place, the title of the thread "ESI for member death' is misleading.

You are not entitled to any amount from ESIC on account of the death of your father. However, you can approach the ESI Branch office for reimbursement of medical expense which you incurred for the treatment of your father in private hospital / non-tie up hospital. You need to convince the the corporation following:

1. Hospitalization was done with private hospitals under extreme emergency / life threatening situation;

2. Justify the reason for not informing the ESI Corporation of the hospitalization with private hospital; and

3. Justify the delay in submission of claim of medical reimbursement.

Hospitalization with private hospitals under extreme emergency / life threatening situation, reimbursement of medical expenses are made by ESIC at actuals with no limit. This reimbursement / expense is not at all linked with your contribution.

Every Branch office or RO may have its' own procedure for claiming the reimbursement of medical expenses. I am attaching herewith a claim form as devised by MO at Pune, Maharashtra. Claim form in Branch office to which you are attached may be different one.

Just try it. All the best.

From India, Mumbai

Attached Files
File Type: pdf ESIC Form-Medical Expense Reimbursement.pdf (1.47 MB, 966 views)

Dear Ankitha ji,
In ESI hospital or ESI tie up hospital, you need not to spent single naya paisa. All the treatment with medicine is free of cost. How you spend 30K in ESI tie up hospital, I wonder. According to me the tie-up arrangements have been entered into to provide cashless treatment.
ESI treatment is nothing to do with your salary or ESI contribution, as I said earlier also. There is no upper limit but at actual.

From India, Mumbai
Dear Ankitha ji,
I was doing research on the forum and found your year old thread as given below link.
Your thread or query was appropriately replied that time. You would have taken precautions this time to follow accordingly. By the way, what has happened to your that (earlier) claim? Please share with this forum.

From India, Mumbai
Dear Keshav Korgaonkar Sir ,
Thank u so much for your elaborate reply . i went to esi hospital for my father treatment claim .they said to attend meeting in chennai .every month second tuesday they conduct this meeting for this type cases. i forgot the meeting name i think "sikkayath" or "sikkath" iam not sure . i went to chennai last 9th .they said meeting is cancelled . on 8 th i confirm with local esi about meeting .but in chennai they said meeting is cancelled .they said to come on next meeting . what can do for this sir . what are the document they need .kindly clear me sir ....
.Thank u so much for your valuable words .

From India, Mumbai
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
Dear Senior ,
Iam the IP member in ESI . If i Spend Rs 30000 for my Apendix Treatment with privet hospital means ,how to claim the medical reimbursement please tell me the procudure ..send me pdp form ..also

From India, Bengaluru
1. Sir, ESIC has its own referral system and instructions for referring its patients outside ESIC hospitals on its panels. A set of instructions were uploaded by me in the past in some of threads. You can search the same and examine the instructions and take action accordingly.
2. So far as I understand, if you have not get the case referred as per instructions before such operation, it will be difficult to claim any reimbursement later on.
3. It will be more better if you may contact the ESIS dispensary Incharge and discuss the issue with him. Whether to refer the case outside ESIS is to be done by said incharge of ESIS dispensary.

From India, Noida
Needed esi format to submit bills for reimbursement

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