An employee is covered under esi scheme, now he is affected with some disease and admited in a private hospital, the reason is there is no the required equipment for his treatment in esi hospital. the bill value cost about 6.5 lakhs, whether the employee could claim atleast partially through the ESI scheme? if yes kindly revert me the procedures. Thanking you.
From India, Tirupur

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1. Sir, it is not mentioned by you whether the treatment being obtained from private hospital is being done after the case has been referred by ESI Hospital or not ? If the case has not been referred by ESIC, I think, it will not be possible to claim any refund from ESIC.
2. I think, you may discuss the issue locally with concerned ESI dispensary to which the said employee is attached, from where you can also obtain prescribed form for such reimbursement, if allowed.

From India, Noida

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