Can ESI Cover Private Hospital Bills When Treatment Isn't Available in ESI Hospitals?

An employee is covered under the ESI scheme. Now, he is affected by some disease and admitted to a private hospital because the required equipment for his treatment is not available in the ESI hospital. The bill value amounts to about 6.5 lakhs. Can the employee claim at least partially through the ESI scheme? If yes, kindly provide me with the procedures. Thank you.

Regards.

Clarification on ESI Reimbursement for Private Hospital Treatment

1. Sir, it is not mentioned whether the treatment being obtained from a private hospital is being done after the case has been referred by the ESI Hospital or not. If the case has not been referred by ESIC, I think it will not be possible to claim any refund from ESIC.

2. I think you may discuss the issue locally with the concerned ESI dispensary to which the said employee is attached. From there, you can also obtain the prescribed form for such reimbursement if allowed.