Navigating ESI Maternity Benefits: Can I Get Referred to My Private Hospital?

Jayati 347
Hello, is it possible that I should get referred from ESI Hospital to my private hospital where I am currently receiving treatment? If yes, what is the procedure?
nathrao
Various hospitals have tie-ups with ESIC

You need to check with your local ESIC office about which hospitals they have tie-ups with.

Additional info

Medical Benefit

Super speciality treatment

Procedure to be followed by the ESI beneficiaries to avail Super speciality medical treatment

The insured person shall approach the ESI Dispensary to which he/she is attached, and the Medical Officer shall issue a referral letter to the IP to approach the concerned empanelled medical institution. If the IP/beneficiary needs medical attention during the non-working hours of the concerned ESI Dispensary, they may directly approach the nearest ESI Hospital for getting a referral letter. If there is no ESI Hospital situated near the IP’s place of living, the IP shall approach the nearest government hospital for getting a referral letter.

In the case of an emergency, the IP/beneficiary can get medical attention just by producing his/her ESI identity card at the designated private medical institution. They shall produce the necessary referral letter and other relevant documents within 48 hours. (In any case, a referral letter is a must to avail of treatment under the package deal.)

The IP/beneficiary shall produce the referral letter along with the ESI Identity Card at the designated private medical institution and avail of the treatment without paying any amount out of his/her pocket. However, any facility other than the items included in the package deal shall be borne by the IP/beneficiary.

While referring the IP/beneficiary to the concerned empanelled medical institution, the Medical Officer in charge has to verify whether the IP/beneficiary is eligible for treatment. The IP shall produce all the relevant documents demanded by the designated hospital and extend his/her cooperation to the hospital authorities. The designated hospital, after imparting treatment to the IP/beneficiary, shall raise the claim bill directly to the Directorate where it will be settled.
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