Confused About ESIC Entitlement? How Do I Claim Medical Expenses for My Wife?

Dear Sir, my wife is seriously suffering from joint disease, and she is also pregnant. In a case of emergency, I admitted my wife to a non-ESIC hospital where I spent a lot of money on her treatment. Now, my wife and our little angel are doing well. I went to ESIC to claim the amount spent, and they informed me that I can claim it, but I need to first collect entitlement from my company. However, my company is unaware of what entitlement is. Today, the ESIC office is closed due to a holiday. Could you please explain to me what entitlement is and how I can collect it?

Thank you.

Understanding ESIC Entitlement and Claim Process

🏥 What is ESIC Entitlement?
ESIC (Employees' State Insurance Corporation) provides medical benefits to employees covered under the ESIC Act, including treatment at ESIC hospitals. Entitlement refers to the process where an employee seeks reimbursement for medical expenses incurred outside ESIC facilities.

📝 Steps to Collect Entitlement from Your Company
1. Consult HR Department: Approach your company's HR department to understand the process for claiming ESIC entitlement.
2. Submit Requisite Documents: Provide necessary documents such as medical bills, treatment records, and ESIC card details to your HR for verification.
3. Request Company Endorsement: Your company needs to endorse your claim for ESIC entitlement, confirming the treatment was necessary and not covered by ESIC directly.
4. Follow Up with ESIC: Once your company endorses the claim, submit it to ESIC for further processing and reimbursement.

🔍 Additional Information
- ESIC entitlement typically requires company verification to ensure the treatment was essential and not covered under ESIC directly.
- It's essential to follow the prescribed process to avoid delays in reimbursement.
- Seek clarification from ESIC or your company's HR department for specific details on entitlement procedures.

By following these steps and understanding the process, you can collect the entitlement from your company and proceed with claiming reimbursement from ESIC for the medical expenses incurred.