Dear seniors,
My father passed away on 4th November 2014 due to heart failure. Both my brother and I are members of ESI. Is there any scheme available to receive any amount from ESI? The ESI deduction from my salary is only Rs. 104, whereas for my brother, it is Rs. 187. I would like to know who is eligible to receive the maximum amount and what the procedure is. Our family does not have any financial support. Your assistance is greatly appreciated.
Thank you in advance.
From India, Mumbai
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2My father passed away on 4th November 2014 due to heart failure. Both my brother and I are members of ESI. Is there any scheme available to receive any amount from ESI? The ESI deduction from my salary is only Rs. 104, whereas for my brother, it is Rs. 187. I would like to know who is eligible to receive the maximum amount and what the procedure is. Our family does not have any financial support. Your assistance is greatly appreciated.
Thank you in advance.
From India, Mumbai
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Dear Ankithagupta,
I'm sorry about the thing that happened. If your father was under the ESI scheme and he died while working, then you can claim an amount from ESI. I don't understand your second question. Just because you and your brother are under the ESI scheme does not necessarily mean that you will receive money from ESI. The scheme is designed to cover your medical expenses in case of illness or sickness.
Thank you.
From India, Chennai
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I'm sorry about the thing that happened. If your father was under the ESI scheme and he died while working, then you can claim an amount from ESI. I don't understand your second question. Just because you and your brother are under the ESI scheme does not necessarily mean that you will receive money from ESI. The scheme is designed to cover your medical expenses in case of illness or sickness.
Thank you.
From India, Chennai
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Thank you for your reply. My father is not a member with ESI. My second question is regarding the ESI deducting amounts from our monthly salaries. The amount deducted from my salary is 104, and from my brother's salary is 187. Only my brother and I are ESI members. My question is, does ESI provide any amount in case of our father's death? If so, who should apply for this, sir?
From India, Mumbai
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From India, Mumbai
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Ankita Gupta,
I don't think ESI will provide any compensation for your case. Your father may receive benefits because you are covered by ESI, which includes your family. However, in the event of your father's or guardian's death, ESI will not provide any compensation.
From India, Chennai
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I don't think ESI will provide any compensation for your case. Your father may receive benefits because you are covered by ESI, which includes your family. However, in the event of your father's or guardian's death, ESI will not provide any compensation.
From India, Chennai
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Sir,
One more thing. I spent Rs 40,000 on hospital treatment for my dad. I admitted my father to Apollo Hospital. Yesterday, I went to the local ESI for claim reimbursement. They said we are not eligible to get a claim because Apollo Hospital is not tied up with ESI. ESI only gives reimbursement for treatment at tied-up hospitals. Sir, what can I do now for this issue?
From India, Mumbai
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One more thing. I spent Rs 40,000 on hospital treatment for my dad. I admitted my father to Apollo Hospital. Yesterday, I went to the local ESI for claim reimbursement. They said we are not eligible to get a claim because Apollo Hospital is not tied up with ESI. ESI only gives reimbursement for treatment at tied-up hospitals. Sir, what can I do now for this issue?
From India, Mumbai
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Hi Ankitagupta, Check whether Apollo is tie up with the ESIC. If not we can’t do anything.
From India, Chennai
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From India, Chennai
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Hi,
I agree. In the case of an emergency such as a heart condition, you can be admitted to the nearest hospital for treatment. However, you must inform ESIC within 24 or 48 hours that you have been admitted to the nearest private hospital for emergency treatment. Only then can you claim reimbursement.
Nilesh Dhameliya HR-Head Surat
From India, Surat
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I agree. In the case of an emergency such as a heart condition, you can be admitted to the nearest hospital for treatment. However, you must inform ESIC within 24 or 48 hours that you have been admitted to the nearest private hospital for emergency treatment. Only then can you claim reimbursement.
Nilesh Dhameliya HR-Head Surat
From India, Surat
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Thanks To Both Of You . no one guide us about the procedure of ESI .now I understand its to late for applying Reimbursement .thanks for your valuable words
From India, Mumbai
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From India, Mumbai
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Dear Senior,
I am the IP member in ESI. If I spend Rs. 30,000 for my kidney stone treatment with an ESI tie-up hospital, can I apply for claim reimbursement? What amount will they give me? Is there any percentage for ESI, or is the percentage based on the company salary?
My salary ESI deduction amount is Rs. 118 for every month. Kindly clarify this for me.
Ankitha
From India, Mumbai
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I am the IP member in ESI. If I spend Rs. 30,000 for my kidney stone treatment with an ESI tie-up hospital, can I apply for claim reimbursement? What amount will they give me? Is there any percentage for ESI, or is the percentage based on the company salary?
My salary ESI deduction amount is Rs. 118 for every month. Kindly clarify this for me.
Ankitha
From India, Mumbai
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Hi Ankit,
Yes, if you have been admitted to the hospital for treatment, there is a percentage calculation for medicines and bed charges. It would be better for you to visit a local dispensary. I think this treatment may also be available in ESIC. Please check with them.
From Kenya, Nairobi
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Yes, if you have been admitted to the hospital for treatment, there is a percentage calculation for medicines and bed charges. It would be better for you to visit a local dispensary. I think this treatment may also be available in ESIC. Please check with them.
From Kenya, Nairobi
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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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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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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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Medical Reimbursement Format.doc
PF ONLINE CLAIM PROCESS.jpg
Medical reimbursement.p df