Navigating ESIC Reimbursement: How Can I Claim for My Father's Emergency Hospitalization?

My name is Ruchika. My father is admitted to a private hospital in case of an emergency. He is admitted due to a paralytic attack. My father's name is linked with my ESIC card. What is the full procedure to claim reimbursement from ESIC? I humbly request you to please guide me as soon as possible.

ESIC Referral and Reimbursement Process

ESIC has its own referral and reimbursement system. Copies of a few instructions issued by ESIC in the past (which are within my knowledge) are uploaded below. I believe you should review them to understand the procedures you need to follow and how to comply with the instructions, making it easier for you to receive reimbursement.

In summary, the ESIS dispensary to which you are attached is the appropriate office from which you should obtain a referral for your father to any private hospital in case of an emergency. I recommend that you contact the ESIS dispensary with your ESIC Identity Card/Family Identity Card and treatment papers from the private hospital. Additionally, you can verify your eligibility by discussing the matter with the Branch Office of ESIC to which you are attached.

Best wishes.

Meet with your AMO ESIC immediately with admission details on record. If the patient is still in the hospital, the AMO can settle the bill directly with the hospital if the hospital is on the panel of ESIC.

If your father is still in the hospital, you can submit the ESIC documents. Before that, you need to bring the authorized documents from your ESIC office to the hospital authority, usually the person in charge of the TPA. They can assist you. Most hospitals directly charge the bill to ESIC. A little bit of personal involvement is required from your side to ensure everything is clear before your father gets discharged. I suggest you finalize the details before the discharge procedure starts.

How to process for reimbursement if treatment is taken in a non-network ESI hospital?

Please explain the form and the complete process.

Thanks