1. Sir, I may submit that, so far as the payment of cash benefits, namely Maternity Benefit (MB), for the entitled period of such leaves is concerned, ESIC generally allows the payment of such cash benefit (MB) as an ALTERNATIVE EVIDENCE (AE) case depending upon the facts of each case and also depending on the entitlement of the insured woman during the relevant benefit period. Such powers, as far as I know, are vested with the Manager/Branch Officer and concerned senior officer at the Divisional/Regional Office of ESIC. Therefore, even if delivery takes place in a private hospital, the period of maternity leave is generally sanctioned as an alternative case and paid subject to confirmation by the employer regarding absence from work for the period of such claims. In my opinion, the Insured Woman/claimant can contact the concerned office as mentioned above along with the original certification of delivery, birth of child/fitness certificate, etc., issued by such a private hospital. If medical leave is still continuing, she can visit her ESIS dispensary and get the relevant certificate if allowed by the Doctor In charge.
2. However, so far as the reimbursement of medical expenses incurred in a private hospital is concerned, such expenses, if the referral policy is not followed, are not reimbursed. However, there is a provision for reimbursement of Rs. 5000/- in confinement cases incurred at places where there are no ESIS facilities (viz. non-implemented areas) (please see Rule 56-A of ESI (Central) Rules, 1950).