Is This Employee Eligible for ESI Benefits for Urgent Medical Treatment at AIIMS?

An employee appointed on 01.12.2014 and registered on 18.01.2015 on the ESIC Portal suddenly experienced a severe headache and went to a private hospital since he did not have a TIC. From there, he has been referred to AIIMS.

Eligibility for ESI Benefits

Is he eligible to receive ESI benefits for treatment expenses that will be incurred at AIIMS, either by way of advance for medical expenses directly in the name of AIIMS or through reimbursement? Kindly suggest, as he is a poor employee and cannot afford such treatment.

ESIC Referral Policy and Eligibility for Reimbursement

1. ESIC has its own referral policy, and for this purpose, the insured person should have appeared before the Insurance Medical Officer (Doctor) of the concerned ESI Dispensary to which he was attached. As mentioned in the above remarks, the employee did not have an ESI Identity Card/TIC. Therefore, it is doubtful whether ESI will make any reimbursement.

2. Further, in cases requiring super-specialty treatment, ESIC has laid down some eligibility conditions. In my opinion, the said employee or his employer may contact the ESI Dispensary and discuss the issue.