Hi All, There is a friend of mine who is covered under ESIC, recently tried to add his wife name in his dependent list. Whereas the online facility did not allow him to add saying that the option is locked for some reason. Now his wife's delivery is done and he had to spend huge amount as hospital bill.
Can anybody advice if he can claim this hospital amount or avail ESIC benefit in this case.
Best Regards,

From India, Pune
1. Sir, even if any facility is not available online from ESIC at any time, the insured person should have immediately personally contacted his appropriate Branch Office of ESIC and get the name of his wife entered into the Identity Card as well as other records of ESIC. When the desired procedure was not followed, it is doubtful whether the said insured person will be reimbursed any expenses incurred for the treatment of his wife in private hospital.

2. ESIC has its own referral policy and before any insured person or his family member is allowed to avail treatment in any tie-up hospital, he/she is required to appear before appropriate Insurance Medical Officer of the ESI Dispensary to which he is attached and get his case referred to the said private hospital. Since in this case no proper compliance has been made, hence the chances to get reimbursement of medical expenses are very less.

3. However, the insured person after making compliance as mentioned in para 1 above may contact the concerned Insurance Medical Officer of ESIS Dispensary and discuss the issue.

From India, Noida
Dear Sir
If the IP has obtained all of the medical bills from the Hospital regarding delivery of his wife, he can claim for rembrushment from ESI Corporation even in case of the lapses mentioned by Mr Mehta. The only thing is required to mention all of the facts in application for rembrushment.

From India, Mumbai

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