Struggling to Add Wife as ESIC Dependent: Can Hospital Bills Be Claimed Now?

Hi All,

There is a friend of mine who is covered under ESIC and recently tried to add his wife's name to his dependent list. However, the online facility did not allow him to add her, stating that the option is locked for some reason. Now, his wife's delivery is done, and he had to spend a huge amount on hospital bills.

Can anybody advise if he can claim this hospital amount or avail ESIC benefits in this case?

Best Regards,
Sukanya

Steps to Ensure ESIC Benefits for Family Members

1. Even if any facility is not available online from ESIC at any time, the insured person should immediately contact the appropriate Branch Office of ESIC in person. They should ensure that their wife's name is entered into the Identity Card and other ESIC records. If the desired procedure was not followed, it is doubtful whether the insured person will be reimbursed for any expenses incurred for the treatment of his wife in a private hospital.

2. ESIC has its own referral policy. Before any insured person or their family member is allowed to avail treatment in any tie-up hospital, they are required to appear before the appropriate Insurance Medical Officer of the ESI Dispensary to which they are attached and get their case referred to the said private hospital. Since in this case no proper compliance has been made, the chances of getting reimbursement of medical expenses are very low.

3. However, after making the compliance mentioned in paragraph 1 above, the insured person may contact the concerned Insurance Medical Officer of the ESIC Dispensary and discuss the issue.

Dear Sir,

If the IP has obtained all of the medical bills from the hospital regarding the delivery of his wife, he can claim for reimbursement from ESI Corporation even in case of the lapses mentioned by Mr. Mehta. The only thing required is to mention all the facts in the application for reimbursement.

Thank you