How Is My ESI Claim Amount Calculated for Hospital Expenses? Seeking Guidance

Hi, senior, I am working in a private company for over two years. My ESI deduction amount is either 100, 99, or 95 routinely. Six months ago, my father was admitted to the hospital for a heart problem. I claimed the hospital expense amount in ESI, which was Rs. 29,755. Could you please let me know how they calculate the claim amount and how much they will give me?

Thanks in advance.

"Wishing you all an advance Happy New Year."

I wish you a Happy New Year in advance and also wish your father a healthy life.

ESI Scheme Hospitalization Benefits

Under the ESI Scheme, hospitalization at ESI hospitals or ESI wards attached to government or public hospitals, or at tie-up hospitals, does not require any out-of-pocket expenses. Treatment is provided free of cost (cashless) with no limit. In cases of hospitalization at private hospitals due to extreme emergency or life-threatening situations, ESIC reimburses medical expenses at actuals with no limit. This reimbursement is not linked to your contributions.

Thank you.

Reimbursement of Medical Expenses under ESIC

The question is whether the treatment for a dependent was obtained from an ESIC Hospital or dispensary. If yes, then there is no question of any reimbursement since the expenses are to be incurred by the ESIC institutions. However, if the treatment is obtained from any private or even government hospital without recommendations and reference through an ESIC dispensary or hospital, then in such a situation, the reimbursement of any amount is doubtful.

For reimbursement, the Insured Person can visit the concerned ESI Dispensary and submit the claim on the prescribed form, completing the formalities as per the procedure laid down.

Regards

Sir, my father has been diagnosed with diabetes and he also requires insulin for treatment. Could you please confirm if it is possible to receive treatment for this condition through ESIC since our entire family is covered by it? Additionally, please advise on the procedure for obtaining insulin injections from ESIC if it is necessary to administer them on a weekly basis.