Understanding ESI Reimbursement: Does It Align with CGHS Rules or Follow Its Own?

Hi all,

I would like to know how the ESI department works on the reimbursement process. Which types of rules do they follow? Does ESI follow CGHS (Central Government Health Scheme) rules or any others?

Thank you.

ESIC allows its members to seek treatment from outside facilities when ESIC is unable to provide the specific treatment itself. This is subject to the recommendation of the panel doctor and the AMO. In such cases, members can settle the bills directly with the hospital/dispensary or seek reimbursement after payment through the AMO office. However, all actions require prior approval from the panel doctor/AMO.

ESI follows ESI Rules for Reimbursement. If you want to know more about them, visit this Employees State Insurance or ESI Act, Rules, Forms, Returns: Simplified: Procedure of Making an ESI Claim.