Can I Access ESI Benefits Independently for Minor Illnesses Without Company Approval?

Hi, I am Soumyakanti from Kolkata, employed in the private sector where my company provides me with medical benefits, but not ESI. This benefit can only be availed after admission to the hospital. However, many times, my family and I suffer from minor illnesses where hospital admission is not necessary. In those cases, I do not utilize my medical benefits, and all the costs are covered by my own savings.

For this reason, I would like to know if I can avail myself of ESI benefits without my company's approval. I am willing to bear the costs even if they are chargeable. Please, can somebody help me by providing useful information, if possible?

With Regards, Soumyakanti Panda

Dear Soumyakanti,

An employee cannot enroll in ESIC without the employer's code. If your salary is more than 21k gross, your employer has likely excluded you from ESIC and instead covered you under a Mediclaim policy, which provides claims for 24-hour hospitalization or surgery, etc. Please note that Mediclaim is designed to protect you from significant medical expenses. However, consultations without admission and pharmacy bills are not covered.

Additionally, if you frequently incur small amounts that add up significantly, I have a solution for you. In every Mediclaim policy, there is a clause for pre and post-admittance expenses, i.e., one month before and two months after the date of admission. You can ask your doctor to admit you for observation for a day, which will enable coverage for all pharmacy bills and doctor consultation charges for three months. I must mention that while this workaround may not be considered ethical, it is the most practical answer to your question.

Kind regards