How Do I Get My Medical Expenses Reimbursed by the ESIC Department?

Please tell me the way to get the Medical Expenses Reimbursement from the ESIC Department.

Hi Amit,

As far as I am concerned, there is no reimbursement of medical bills from the ESIC department. Those who earn wages less than Rs 6500/month are eligible for free treatment from ESIC-recognized hospitals. This is part of the insurance coverage to which employers contribute 4.75% and employees contribute 1.75%.

Regards,
Rajat

Hi there,

I agree with Rajatji's reply to you, but the only amendment made here is that the limit of Rs. 6500/- has been increased to Rs. 7500/- recently. Please cross-check. The mode of claiming is the submission of original bills and the discharge summary of the doctor. Make sure that you maintain a photocopy of whatever you are submitting to the ESI authorities just as a precaution.

Regards,
Sadashiv Rao

The insured person/employee can avail the benefits in the ESIC hospitals and would not be charged for the treatment. He/she needs to produce the ESI card. I have attached the ESI document for all those HR professionals in India.

Cheers,
Anuradha

Dear Amit,

Reimbursement of medical expenses is permissible. For claiming the same, you are required to follow the undermentioned process:

1. Treatment should be under the supervision of an ESI doctor. In case of an emergency, you can approach a private hospital if an ESI hospital/dispensary is not available in the area or if the same is not functioning during your emergency requirements. In such cases, you have to inform the ESI dispensary/hospital doctor regarding the treatment being taken from another hospital. Generally, doctors allow treatment if it is from a Government hospital and/or a super specialty hospital. In such cases, all treatment papers, medicine purchase bills, along with prescription slips, are required to be signed by the hospital doctor from where an individual has taken the treatment.

2. Bills of treatment are required to be submitted to your concerned ESI dispensary/hospital on the prescribed proforma.

3. An eligibility certificate is to be submitted to the dispensary/hospital, duly signed by the Branch Manager of the Local ESI office.

4. A request for treatment from outside in an emergency is to be made in writing to the concerned ESI dispensary/hospital to which an individual is attached.

5. The ESI dispensary/hospital doctor will recommend your case for reimbursement to State health authorities.

If you complete these formalities, the ESI dispensary/hospital will forward these bills to State Health authorities for sanction and reimbursement.

After sanction, you will receive information from the ESI dispensary/hospital for claiming the reimbursement. It takes time (2 to 3 months minimum) depending upon the availability of funds with the government.

So, there is no need to feel otherwise. If you are contributing towards the ESI fund and are eligible for the same, you will definitely get the reimbursement.

Regards,

Anil Anand

Hi,

You can't claim Medical Reimbursement from ESIC. You can only avail Medical benefits (Medical Treatment, Medicines, etc.) free of cost, if your salary is less than 7500 per month and you have contributed to ESI for 6 months, i.e., 1 contribution period from April to September. The only thing you can claim from ESI is for Leave Payment, i.e., you can claim for the salary for the number of days on Medical leave, which has to be certified by an ESI medical officer.

If you want to get Medical leave, you have to obtain an ESI leave form from the ESI medical officer and submit it to your ESI local office, where you will get reimbursement for up to 75% of your leave days' salary.

Manu

Hi Amit,

Mr. Rao is right, the wages limit is ₹7500/- and the contribution is 4.45% (employer) and 1.75% (employee).

Pardeep Sangwan

Dear Pardeep,

Correct contribution rates towards ESI are:
Employee: 1.75% of salary/wages
Employer: 4.75% of salary/wages

Regards,
Anil Anand

Hi,

There is a possibility of reimbursement of medical expenses through ESIC, provided that such medical facility may not be available in the ESIC Hospital and the Chief doctor should recommend the insured person to go for external treatment. Once you have made the expenses, you can approach the relevant ESIC Hospital, fill out the required forms, and submit the original bills. You should also provide an undertaking that the expenses were incurred by the company and not by the employee, and will not be recovered from their salary.

I have already received such reimbursement from Hosur ESI Hospital in the year 2004.

All the best,

M. Suriyanarayanan

Chennai

Hi Amit & Sadashiv,

The limit of ESIC applicable has been increased to Rs. 10,000 recently. Please check it, isn't it?

Regards,
Sweta

Hi,

The limit of ESIC is Rs. 10,000. Can you please clarify who is covered under ESIC? I would like to understand the basic criteria, such as the minimum number of employees, etc.

Regards,
Devesh V. Gavand

Hi, I'm Sarah Jafri, working as an Assistant Manager - Operations. My ESIC has been deducted since October 2009. Recently, my mother was hospitalized, incurring Rs. 25,000 in expenses because I haven't received my ESIC card or number. Please guide me on what can be done in this case. Can I get reimbursement from ESIC? Also, please send me the list of hospitals registered with ESIC.

Regards,
Sarah