Medical Reimbursement for Dependents: What Steps Do I Need to Follow?

Subject: Medical Reimbursement Claim for Dependent

Dear Sir,

I hope this message finds you well. I am writing to inquire about the process for claiming medical reimbursement for a dependent. Could you please provide guidance on the necessary steps and documentation required for this procedure?

I appreciate your assistance in this matter and look forward to your prompt response.

Thank you and regards,

Prema

Dear Sir,

Kindly let me know how I can claim medical reimbursement for a dependent through ESIC.

Regards,
Prema

Medical Reimbursement Process for Dependents

If the treatment is done as per the panel doctor/dispensary of ESIC, then they will provide the requisite form and send the member to AMO with the form for filling out the form. There is no alternate way to claim the expenditure done on dependents. Direct reimbursement for "accident only" cases is allowed for the employee only, provided the establishment has submitted an accident report within the prescribed time and the family members of the employee have reported to the panel doctor/dispensary immediately after the incident.

If you are in Chennai, please visit the Regional Director ESIC Office with copies of bills, treatment details, doctor fees, room rent, diagnostic expenses, and medicine expenses.

Include all necessary details such as Pechan Card photos taken by ESIC for patient identification, and Form 6 submitted online. This form should contain your number, name, number of days worked, your contribution, and that of the company.

Plan to visit on the 2nd Wednesday, when they organize the Adaalat meet.

Carry a letter justifying the need for external treatment when an ESI Dispensary or Hospital is available. Genuine cases are settled quickly. However, medicines purchased as an outpatient will not be reimbursed under this scheme to prevent misuse. I hope this clarifies any confusion.