Can ESI Cover Medical Bills from Private Hospitals When No ESI Facility Exists?

Dear All,

Can anybody help me? One of our employees worked in Hyderabad. His mother had an operation at a private hospital as there are no ESI hospitals there. Can medical bills be claimed through ESI or not?

Raju

ESI Corporation will reimburse any medical expenses incurred by the insured and dependents in hospitals run by private agencies only when such facilities are not available in the ESI Hospital as certified by the Insurance Medical Officer. To claim the amount spent, a request shall be made to the Local Office of the ESIC in the prescribed form (I presume it is form 18 A).

Regards, Madhu.T.K